Ethnicity and nativity status as determinants of perceived social support: Testing the concept of familism

Research has demonstrated a protective effect of social support on health. Social support is most often treated as an independent variable. However, as with disease risk factors, which are not randomly distributed, health-promoting resources such as social support are also systematically patterned. For example, in the USA, family support is thought to be high among Latinos, Mexican Americans in particular. Using data from the Project on Human Development in Chicago Neighborhoods, we explored the relationships between ethnicity/nativity status, socioeconomic status (SES) and perceived social support from family and friends. We also assessed the role of retention of culture—measured as primary language spoken at home—on social support. Finally, we tested whether SES moderated the relationship between ethnicity/nativity status and social support. Foreign and US-born Latinos, most notably, foreign-born Mexicans, reported higher family support compared to non-Latino whites. Primary language spoken at home seems to account for the relationship between ethnicity/nativity and familial social support. Mexican-born and US-born Latino immigrants reported lower social support from family at higher levels of SES. Each ethnic minority group reported lower perception of friend support compared to non-Latino whites. There was a strong SES gradient in subjective support from friends with higher support reported among those with higher SES. This study provides evidence for the notion that Latinos in the USA, specifically foreign-born Mexicans, may rely on family ties for support more than do non-Latino whites. Findings also help identify ethnicity/nativity status, primary language spoken and SES as determinants of social support. Specifically, the higher familial social support found among Latino immigrants may be due to retention of culture. Effect modification by SES suggests that Latinos of lower and higher SES may differ with regard to the traditionally-held value of familism.     

Pathways and Correlates Connecting Latinos' Mental Health With Exposure to the United States

Objectives. We examined potential pathways by which time in the United States may relate to differences in the predicted probability of past-year psychiatric disorder among Latino immigrants as compared with US-born Latinos.Methods. We estimated predicted probabilities of psychiatric disorder for US-born and immigrant groups with varying time in the United States, adjusting for different combinations of covariates. We examined 6 pathways by which time in the United States could be associated with psychiatric disorders.Results. Increased time in the United States is associated with higher risk of psychiatric disorders among Latino immigrants. After adjustment for covariates, differences in psychiatric disorder rates between US-born and immigrant Latinos disappear. Discrimination and family cultural conflict appear to play a significant role in the association between time in the United States and the likelihood of developing psychiatric disorders.Conclusions. Increased perceived discrimination and family cultural conflict are pathways by which acculturation might relate to deterioration of mental health for immigrants. Future studies assessing how these implicit pathways evolve as contact with US culture increases may help to identify strategies for ensuring maintenance of mental health for Latino immigrants.It has been shown that Latino immigrants have better mental health than their US-born counterparts and non-Latino Whites, despite having disadvantaged socioeconomic status^1–3 (the “immigrant paradox”). It has also been shown that the mental health of immigrants declines over time in the host country³ (the “acculturation hypothesis”). Our findings from the National Latino and Asian American Study (NLAAS) on the prevalence of psychiatric disorders among Latinos in the United States indicate that foreign nativity is protective for some Latino groups (e.g., Mexicans) but not others (e.g., Puerto Ricans),⁴ implying that other factors besides nativity play a part in US Latinos'' risk of psychiatric disorders. Also, there is evidence that risk of psychopathology is the result of differences in immigrants'' length of residence in the United States and age at arrival. For example, Mexican immigrants in the United States for 13 years or more had higher rates of any mental health disorder, any mood disorder, alcohol abuse, and drug abuse than Mexican immigrants in the United States for fewer than 13 years.³ Findings from the NLAAS indicate that the longer that Latino immigrants remain in their country of origin, the less cumulative risk of onset of psychiatric disorders they experience, resulting in lower lifetime rates of disorders.⁵There is a lack of consensus about which aspects of US exposure are relevant for mental health.⁵ A number of hypotheses have linked years in the United States and mental illness among Latinos.³ US-born Latinos may have a weaker affiliation with traditional Latino values that buffer against mental illness than do Latino immigrants. When individuals come into contact with US culture, there may be negative outcomes such as increased intergenerational conflict,⁶ augmenting their risk for psychopathology. Although family factors have been hypothesized to be a protective factor for immigrant Latinos,^7,8 few empirical studies have actually tested this hypothesis with regard to psychiatric disorders. Another hypothesis is that US-born Latinos may have higher expectations for their quality of life than immigrant Latinos because of their citizenship status and their acquisition of skills similar to those possessed by non-Latino Whites.⁹ However, over time, these expectations may remain unfulfilled because of discrimination, resulting in social stress and declining levels of mental health.¹ Also, as time passes, immigrants may have perceptions of low social status¹⁰ that may be associated with higher risk of psychopathology.Other immigration-related factors could also affect adaptation experiences when integrating into the United States. Specifically, those arriving in the United States at early formative ages (0–10 years) may have weaker identification with Latino cultural values¹¹ and may confront significant pressure to acquire English as their dominant language.¹² English language dominance represents a strong cultural anchor for socially constructed meaning¹³ that may enable immigrants to join certain peer networks and not others. The neighborhoods where Latinos typically live are less safe than those inhabited by non-Latino Whites,¹⁴ which may increase Latinos'' likelihood of psychiatric disorders¹⁵ by increasing ambient hazards. In addition, exposure to racial/ethnic based discrimination^16,17 has been associated with negative mental health outcomes. The NLAAS study provides a unique opportunity to explore these pathways because these domains have been assessed for both Latino immigrants and US-born Latino respondents.We assessed the association of time in the United States with past-year risk for psychiatric disorder, with and without adjustment for potentially influential covariates. Then we tested different pathways explaining the link between time in the United States and psychiatric disorders.     

Trends in the Mexican infant mortality paradox over the past two decades

PurposeMexicans in the United States have lower rates of several important population health metrics than non-Hispanic whites, including infant mortality. This mortality advantage is particularly pronounced among infants born to foreign-born Mexican mothers. However, the literature to date has been relegated to point-in-time studies that preclude a dynamic understanding of ethnic and nativity differences in infant mortality among Mexicans and non-Hispanic whites.MethodsWe assessed secular trends in the relation between Mexican ethnicity, maternal nativity, and infant mortality between 1989 and 2006 using a linked birth–death data set from one US state.ResultsCongruent to previous research, we found a significant mortality advantage among infants of Mexican relative to non-Hispanic white mothers between 1989 and 1991 after adjustment for baseline demographic differences (relative risk = 0.78, 95% confidence interval, 0.62–0.98). However, because of an upward trend in infant mortality among infants of Mexican mothers, the risk of infant mortality was not significantly different from non-Hispanic white mothers in later periods.ConclusionsOur findings suggest that the “Mexican paradox” with respect to infant mortality is resolving. Changing sociocultural norms among Mexican mothers and changes in immigrant selection and immigration processes may explain these observations, suggesting directions for future research.     

The influence of perceived risk to health and immigration-related characteristics on substance use among Latino and other immigrants

Objectives. We examined whether immigration-related characteristics and perceptions of risk surrounding substance use were independently associated with lifetime use of cigarettes and various illicit substances among immigrant and native-born Latino and non-Latino White adults in the United States.Methods. Data were from the 2002 National Survey on Drug Use and Health. Analyses were limited to Latinos and non-Latino Whites 18 years and older. We used cross-tabulations and multivariate logistic regression to test relations between risk perceptions, immigration characteristics, and substance use.Results. More than two thirds of all respondents perceived moderate or great risk to health and well-being associated with all substances analyzed. The odds of lifetime substance use by Latino and non-Latino White immigrants were lower than for US-born non-Latino Whites. Immigrant Latinos’ odds of lifetime substance use were lower than for US-born Latinos. Moderate or great perceived risk was associated with lower likelihood of lifetime use of all substances except cigarettes.Conclusions. Foreign birth appeared to protect against substance use among both Latino and non-Latino White immigrants. Future studies should examine potential protective factors, including cultural beliefs and practices, acculturation, familial ties, and social network influences.The significant health, social, and economic burdens of substance use and abuse1 demand greater understanding of the interplay between risk and protective factors, including race/ethnicity and nativity. Latinos appear to engage in health-promoting substance use behaviors over their lifecourse.2^–5 Data from the National Survey on Drug Use and Health (NSDUH) indicate that past-month and past-year rates of illicit substance use are similar for Latinos and non-Latino White adults, yet estimates of lifetime illicit substance use differ (37.2% vs 48.1%, respectively).4 The mechanisms underlying differences in substance use have not been fully elucidated. Psychosocial factors such as social norms, peer and family attitudes toward and behaviors regarding substance use, family bonding, individual academic accomplishments, and substance use at a young age (i.e., preadolescence or adolescence) may influence lifetime attitudes and behaviors regarding substance use.6^–8 Using nationally representative data, we examined the roles of perceived risk to health (of substance use) and immigration characteristics as correlates of substance use among immigrant and US-born Latinos and non-Latino Whites.Demographic shifts and variations in substance use may create a need for detailed investigations of Latinos’ and immigrants’ substance use behaviors. Latinos are the largest racial/ethnic subgroup in the United States. By 2005, more than 41.9 million Latinos resided throughout the country, and of these, 40% were foreign-born.9 If current trends continue, by 2045, 23% of all US residents (approximately 90.3 million people) will be of Latino ancestry.10 Attending to the health and health care needs of Latinos and immigrants is a vital investment in the nation’s future health.Heterogeneity among Latinos and non-Latino Whites underscores the need for disaggregating data by birthplace.3^,11^,12 The National Epidemiological Survey on Alcohol and Related Conditions showed that US-born Whites were more likely to meet criteria for a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV),13 substance use disorder than were native and immigrant Mexican American adults; yet, even US-born Mexicans were more likely than were Mexican immigrants to be diagnosed with any substance use disorder.3 Cross-cultural studies found that substance use varies among immigrants between and within birth countries.12^,14^,15 In Mexico, which historically has sent large numbers of immigrants to the United States,11 the prevalence of lifetime substance use is less than that of industrialized countries (the United States, Canada, the Netherlands, Brazil, and Germany)12; yet, substance use varies geographically within the country. Rates of illicit substance use are highest in Tijuana (14.7%) and Ciudad Juarez (9.2%), cities on the US–Mexico border where injection of heroin, methamphetamine, and cocaine is particularly prevalent.16 Substance use prevalence also varies by birthplace (i.e., mainland vs island) and immigration experiences among Puerto Ricans.17Non-Latino White immigrants are heterogeneous, including both Western (e.g., United Kingdom) and Eastern Europeans (e.g., Poland, Russia).11 One US study reported higher lifetime odds of any substance use disorder among US-born non-Latino Whites compared with White immigrants3; data were not disaggregated by country of origin. Yearly and lifetime rates of use of certain substances (cocaine, marijuana) may be lower in some European countries14^,15 compared with rates in the United States.Frameworks explaining differences in illicit substance use by country of nativity have considered psychosocial factors such as acculturation18 and social environment (e.g., family health behaviors and family cohesion, age at initiation).6 Gil and Vega’s framework of immigrant adolescent substance use18 proposes the migration context as one of several factors shaping substance use behaviors, reflecting a family’s premigration socioeconomic and cultural circumstances as well as age at immigration. This framework also includes immigration and postmigration experiences (e.g., authorized vs unauthorized migration, family vs individual migration or family reunification, labor migration, arrival conditions, acculturation and assimilation stresses.) Potentially protective psychosocial factors include a risk-reducing familial context, including negative attitudes toward substance use, abstention from substance use by siblings and parents, and family involvement and cohesion. Delayed initiation into substance use (i.e., after adolescence) is itself associated with reduced risk of engaging in substance use over the lifecourse.6 Thus, the mere presence or absence of 1 or more risk factors does not imply future substance use. For this reason, interactions between risk and protective factors must be examined systematically.We examined the substance use attitudes and behaviors of immigrant and native-born populations to assess the relation between race/ethnicity and nativity and substance use. We analyzed various psychosocial factors relevant to immigrant communities’ experiences with illicit substance use to answer the following research questions: (1) Do perceptions regarding the health and social impacts of illicit substance use vary according to race/ethnicity and nativity? (2) Are race/ethnicity, nativity, and level of perceived risk to health posed by substance use independently associated with illicit substance use? (3) Are other immigration-related measures (e.g., age at immigration, language preferences) independently associated with immigrants’ level of illicit substance use? We hypothesized that persons who migrated to the US as adolescents would be more likely to engage in substance use than would postadolescent immigrants and that individuals indicating a Spanish-language preference (vs English) for survey participation would be less likely to engage in substance use.     

Alcohol Use Among Latinos: A Comparison of Pre-Immigration,Post-Immigration,and US Born Latinos

US born Latinos have higher rates of alcohol use than Latino immigrants. Yet, little is known about drinking patterns of Latinos before their immigration to the US This exploratory study compares the past month regular, binge, and heavy alcohol use patterns of Latino immigrants prior to immigration with that of post-immigration and US born Latinos. Data on past month alcohol use prior to immigration was collected from 516 recent adult Latino immigrants. Results were compared with US born and post-immigration Latinos using national aggregate data. Alcohol use patterns among Latino immigrants prior to immigration were similar to that of US born Latinos. Alcohol use patterns were lower among Latinos after immigration when compared to pre-immigration and US born Latinos. This study provides a foundation for further exploration of the drinking patterns of Latinos in the US before they immigrated to this country. Findings suggest more research is needed to uncover the underlying factors associated with the higher rates of alcohol use among Latinos prior to their immigration when compared to alcohol use patterns of post-immigration Latinos.     

Adverse pregnancy outcomes: differences between US- and foreign-born women in major US racial and ethnic groups.

OBJECTIVES: This study examined whether there were significant differentials between US-born and foreign-born women in risks of infant mortality, low birthweight, and preterm birth and whether these differentials, if they existed, varied across major US racial/ethnic groups. METHODS: Multivariate logistic regression was applied to national linked birth/infant death records for 1985 through 1987 to estimate overall and ethnic-specific maternal nativity effects on pregnancy outcomes. RESULTS: Substantial maternal nativity differences in risks of infant mortality and low birthweight were found, with the magnitude of the nativity effect varying significantly across racial/ethnic groups. Overall, foreign-born status was associated with 7% and 20% lower risks of low birthweight and infant mortality, respectively. However, the reduced risk of adverse pregnancy outcome associated with immigrant status tended to be substantially larger for Blacks, Cubans, Mexicans, and Chinese than for other ethnic groups. CONCLUSIONS: Maternal nativity status, along with ethnicity, may serve as an important axis of differentiation in birth outcome studies. Further research needs to be conducted to assess the effects of behavioral, cultural, and psychosocial factors in explaining the nativity differentials observed here.     

Substance Use and Cumulative Exposure to American Society: Findings From Both Sides of the US–Mexico Border Region

Objectives. We investigated whether Mexican immigration to the United States exerts transnational effects on substance use in Mexico and the United States.Methods. We performed a cross-sectional survey of 2336 Mexican Americans and 2460 Mexicans in 3 Texas border metropolitan areas and their sister cities in Mexico (the US–Mexico Study on Alcohol and Related Conditions, 2011–2013). We collected prevalence and risk factors for alcohol and drug use; Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, alcohol-use disorders; and 2 symptoms (hazardous use and quit or control) of drug use disorder across a continuum of migration experiences in the Mexican and Mexican American populations.Results. Compared with Mexicans with no migrant experience, the adjusted odds ratios for this continuum of migration experiences ranged from 1.10 to 8.85 for 12-month drug use, 1.09 to 5.07 for 12-month alcohol use disorder, and 1.13 to 9.95 for 12-month drug-use disorder. Odds ratios increased with longer exposure to US society. These findings are consistent with those of 3 previous studies.Conclusions. People of Mexican origin have increased prevalence of substance use and disorders with cumulative exposure to US society.During the past 25 years, epidemiological research in the United States has consistently found that alcohol and drug use and disorders of use among Mexican immigrants and Mexican Americans tend to be associated with increasing immersion into US society.1–8 More recently, transnational effects of migration on substance use in both the United States and Mexico have become apparent. First, in a comparable Mexican population without any migration experience as a reference group, it was found that Mexican immigrants in the United States and US-born persons of Mexican origin exhibited increased risk of alcohol and drug use.9,10 Second, it was also shown that, in Mexico, substance use of return migrants and families of migrants was also affected by this immigration flow.11,12 These findings suggest a transnational pattern whereby Mexican immigrants increase their use of substances while in the United States by means of early age at immigration and years living in the United States,13–15 and transmit, directly and indirectly, substance use behaviors back into Mexico. This conceptualization is intriguing, but the data provided so far are limited to studies either in the United States or in Mexico. The only previous binational study9 collected data from a wide range of communities in Mexico and the United States and evidence with greater geographic detail is needed to corroborate and extend our understanding.The border regions of Mexico and the United States are particularly important as settings in which the cultures of the 2 countries come into contact and as transit points for migrants moving in both directions. The border region is also filled with contrasts. The US counties are much richer than the Mexican municipalities, but some of the US counties in the border area are among the poorest in the United States. At the same time, some of the Mexican border municipalities are among the richest when compared with national Mexican averages. Research in this region has documented the impact that US nativity, age at immigration, and years living in the United States have in increasing alcohol and drug use and disorders among those of Mexican ancestry living in the US borderland.8,16–18 On the Mexican side of the border, research generally documented higher prevalence rates for substance use and disorders of use when compared with cities off the border or against national averages.19Previous research nevertheless lacks a binational approach—with a common framework and risk factors. Our project, the first simultaneous study that includes the dynamic experiences of contemporary Mexican immigration on both sides of the border, has started to shed new insights on the alleged differences of alcohol and drug use and disorders of use in the US–Mexico border area.20,21 Our main hypothesis is that with early age of immigration, and increasing time and contact with the US culture, alcohol use, drug use, alcohol use disorders (AUDs) and symptoms of drug use disorder (DUD) will increase along a continuum of immigration experiences in this transnational population. Our main goal is to report the prevalence of, and risk factors for, the occurrence of alcohol use, drug use, AUD, and symptoms of DUD for this population of Mexican ancestry. A second goal is to put these new results in the context of previous findings and to examine the consistency of risk estimates for substance use across the full spectrum of the Mexican immigrant groups.     

Extended Family Ties Among Mexicans,Puerto Ricans,and Whites: Superintegration or Disintegration?*

Abstract: Addressing recent theoretical debates, this study examined the differences in extended family integration among Mexicans, Puerto Ricans, and Whites, as well as the importance of culture and structure in explaining these differences. Our findings showed Whites and Latinos/as have distinctive patterns of extended family integration: Mexicans and Puerto Ricans exhibited higher rates of coresidence and proximate living than Whites; Whites had greater involvement in financial support than Mexicans or Puerto Ricans, but Mexicans were more involved in instrumental help. Structural factors such as income, education, and nuclear family composition explained much of these ethnic differences. The study’s findings suggest that policy should emphasize the unmet needs in Latino/a communities and the role of extended families.     

US Cultural Involvement and Its Association With Suicidal Behavior Among Youths in the Dominican Republic

Objectives. We examined how US cultural involvement related to suicide attempts among youths in the Dominican Republic.Methods. We analyzed data from a nationally representative sample of youths attending high school in the Dominican Republic (n = 8446). The outcome of interest was a suicide attempt during the past year. The US cultural involvement indicators included time spent living in the United States, number of friends who had lived in the United States, English proficiency, and use of US electronic media and language.Results. Time lived in the United States, US electronic media and language, and number of friends who had lived in the United States had robust positive relationships with suicide attempts among youths residing in the Dominican Republic.Conclusions. Our results are consistent with previous research that found increased risk for suicide or suicide attempts among Latino youths with greater US cultural involvement. Our study adds to this research by finding similar results in a nonimmigrant Latin American sample. Our results also indicate that suicide attempts are a major public health problem among youths in the Dominican Republic.There is growing evidence that US nativity increases risk for suicide ideation, suicide attempts, and death by suicide for Latino youths and adults. Foreign-born Latinos have lower rates of completed suicide compared with US-born Latinos across several national and regional cohorts.^1–3 Moreover, rates for suicide ideation or attempts among foreign-born or less acculturated Latinos have been lower than those of their US-born counterparts.^4–7The phenomenon of immigrant Latinos having better health outcomes than US-born Latinos has been referred to by various names, including the healthy immigrant effect, the Latino paradox, and the epidemiological paradox. Moreover, this trend has been found for numerous outcomes.⁸ A number of models have been proposed to explain this finding including cultural protective factors associated with Latino culture,^9,10 discrepancies in intergenerational values between immigrant parents and their US-born children,¹¹ and selection bias related to immigration of healthier or more resilient individuals.^12,13 Methodological constraints have unfortunately limited the ability to test determinants that could explain these differences. One constraint that has limited the ability to test the selection bias hypothesis has been the scarcity of comparable data from “feeder” nations that provide US Latino immigrant populations.In one of the few studies that used cross-national data, Mexican youths in high schools near the US–Mexico border reported lower rates of suicide ideation than Mexican American youths in high schools on the US side of the border.¹⁴ In another study using a binational (United States and Mexico) sample of Mexicans, US-born Mexicans and Mexican-born immigrants who arrived in the United States when aged 12 years or younger had higher rates of suicide ideation than Mexicans without a history of migration to the United States or a family member living there. Mexicans with family members living in the United States and US-born Mexicans were also at higher risk for suicide attempts.¹⁵ These findings do not support the selection bias explanation for nativity differences in suicide behaviors among adults or youths of Mexican ancestry living in the United States. Although the literature suggests that Latinos share certain core panethnic cultural values such as familism and respect,^16–18 the peoples of Latin America have distinct historical, social, immigration, and cultural contexts. It is therefore prudent to test, validate, or disprove explanatory mechanisms such as immigration selection bias across different Hispanic subgroups.One variation on the approach of using data from feeder countries is to examine how US cultural involvement may relate to risk for suicidal behavior within a non–US setting via mechanisms related to “cultural globalization.” Cultural globalization parallels the process known as economic globalization and refers to the penetration of cultural influences (e.g., US cultural influence) on the lifestyles, values, norms, and retention of cultural heritage in youths around the world.^19,20 The strength of this approach is that it examines the relationship between US cultural influence and suicidal behavior in a nonimmigrant Latino population.The Dominican Republic (DR)—because of its large US-based population,²¹ relatively close proximity to the United States, and historical connections to the United States^22,23—offers an excellent natural experiment to test whether US cultural influence relates to outcomes such as suicide risk behaviors among youths. For example, there are approximately 1.3 million Dominicans living in the United States,²¹ compared with a relatively modest population of approximately 10 million Dominicans living in the Dominican Republic.²⁴ This ratio of US Dominicans to DR Dominicans makes possible several mechanisms for how cultural globalization in the Dominican Republic may occur, especially as it relates to US cultural influence. The first, circular migration, has been conceptualized and operationalized in multiple ways. We use a literal definition: leaving and then returning to a country of origin, once or repeatedly. Circular migration is often driven by immigrants’ economic circumstances, legal status, and US labor market demands.²⁵ Another mechanism for US cultural influence in the Dominican Republic occurs through ties that Dominicans have with relatives, friends, or acquaintances who live in the United States or who have lived in the United States. The US cultural influence in the Dominican Republic also occurs indirectly via the influences of electronic media such as US-based movies, television, and music.We examined how US cultural involvement indicators relate to suicide attempts among a nationally representative sample of public high school students in the Dominican Republic. We focused on suicide behavior because it has been identified as a growing worldwide public health concern for youths and young adults.^26,27 Moreover, suicide attempts are associated with hospitalization, future attempts,²⁸ and future death by suicide.^29,30 Despite prevalent concern about adolescent suicide attempts, little is known about the epidemiology of suicide behaviors in the Dominican Republic.To our knowledge, this is the first study to publish data on suicide attempts among DR youths that used a nationally representative sample. However, in one unpublished report that used data from a national sample of DR youths attending public school in 1997, as many as 7.9% of the youths reported a suicide attempt during the past year.³¹ This rate is on par with the 7.7% of youths who reported a suicide attempt during that same year in the United States, but lower than the 10.7% of US Hispanics who reported a suicide attempt in 1997.³² These rates for suicide behavior represent a public health problem among youths in the Dominican Republic. This study will add to the literature by publishing results related to suicide attempts among DR youths in a nationally representative sample and by increasing knowledge regarding the healthy immigrant effect pertaining to suicide attempts. On the basis of the robust associations found between suicide behaviors and US involvement among US Latino and Mexican populations, we hypothesized that greater US cultural involvement would increase risks for suicide attempts among DR youths.     

Heterogeneity in management of diabetes mellitus among Latino ethnic subgroups in the United States.

BACKGROUND: Recent debate suggests that general racial/ethnic categories may obscure potentially important subgroup differences within minority groups. The purpose of this study was to examine the quality of diabetes care among ethnic subgroups of the Latino population in the United States while accounting for aspects of acculturation and access to care. METHODS: We evaluated adults (> or =18 years old) with previously diagnosed diabetes in the 2003 National Health Interview Survey (n = 2136; United States population estimate = 13,471,587). The Latino subgroups (n = 373; United States population estimate = 1,556,259) were Mexicans, Puerto Ricans, and Other Latinos. Through a series of logistic regressions we examined ethnic group and quality of care for diabetes while controlling for demographics, access to care, and acculturation. RESULTS: Among Latinos, 43% conducted their interview in Spanish and 59% were immigrants to the United States. Ethnic group differences were apparent in the analyses. In a logistic regression analysis including all Latinos, with Puerto Ricans as the reference group, Mexicans (odds ratio, 0.24; 95% CI, 0.07-0.85) and Other Latinos (odds ratio, 0.15; 95% CI, 0.04-0.58) were significantly less likely to have only one doctor for their diabetes care. Mexicans were less likely than Puerto Ricans (odds ratio 0.39; 95% CI, 0.18- 0.84) to know about glycosylated hemoglobin. Similarly, among Latino immigrants, Mexicans (odds ratio, 0.13; 95% CI, 0.02-0.81) and Other Latinos (odds ratio, 0.09; 95% CI, 0.01-0.63) were significantly less likely than Puerto Ricans to have only one doctor for their diabetes care and management. Measures of acculturation and immigration were not independent predictors of diabetes quality of care. CONCLUSIONS: Differences in diabetes management exist between Latino ethnic subgroups; treating Latinos in the United States as one homogenous category may be a barrier to the appropriate provision of care.     

Discrimination and Substance Use Disorders Among Latinos: The Role of Gender,Nativity, and Ethnicity

Objectives. We examined the relationship between discrimination and substance use disorders among a diverse sample of Latinos. We also investigated whether the relationship between discrimination and substance use disorders varied by gender, nativity, and ethnicity.Methods. Our analyses focused on 6294 Latinos who participated in the National Epidemiologic Survey on Alcohol and Related Conditions from 2004 to 2005. We used multinomial logistic regression to examine the association between discrimination and substance use disorders.Results. Discrimination was significantly associated with increased odds of alcohol and drug use disorders among Latinos. However, the relationship between discrimination and substance use disorders varied by gender, nativity, and ethnicity. Discrimination was associated with increased odds of alcohol and drug use disorders for certain groups, such as women, US-born Latinos, and Mexicans, but this relationship did not follow the same pattern for other subgroups.Conclusions. It is important to determine which subgroups among Latinos may be particularly vulnerable to the negative effects of discrimination to address their needs.Latinos are the largest ethnic or racial minority group in the United States1 and the fastest growing group entering substance abuse treatment programs.2 Although Latinos are disproportionately affected by substance abuse,3 they have been understudied.4 Previous research shows that high levels of poverty, minority status, and residential concentration in areas with widespread drug and alcohol distribution have been considered to be factors that may put Latinos at risk for substance use disorders.5 More recently, discrimination has also been considered to be a risk factor.6,7 As studies aim toward filling the gap in the literature, the heterogeneity of Latinos must also be considered.Discrimination has been associated with alcohol and drug use8–13 and substance use disorders among Latinos.6,7 Stress-coping frameworks and the minority stress model have been applied to hypothesize that individuals belonging to various marginalized groups respond to experiences of discrimination with unhealthy coping behaviors, such as substance use.14,15 Moreover, discrimination may lead to underemployment, lower wages, and limited access to health services and other resources that can affect health outcomes.16 In this way, discrimination operates at both the interpersonal and institutional levels simultaneously to situate individuals on different health trajectories, fostering and reinforcing poor health behaviors and outcomes.16,17The association between discrimination and substance use has been previously documented for Latinos and other groups. However, reviews of the literature have called for more granular analysis of specific risk patterns. One specific area needing analysis is whether some subgroups of Latinos are at higher risk of substance use related to discrimination than others. The identification of subgroups is an important first step toward the development of targeted population-level approaches and tailored interventions.In the present study, we focused on subgroups based on gender, nativity, and ethnicity (country of origin or heritage country). These subgroups were based on ascribed characteristics that refer to immutable characteristics (vs achieved characteristics, such as education) that are given status value.18,19 The status value placed on these characteristics can drive discrimination; for example, when men are considered more valuable than women and when US-born individuals are considered more valuable than immigrants.18,19 At the same time, these characteristics (gender, nativity, and ethnicity) are also associated with substance use disorders.Gender differences in substance use disorders are not unique to Latinos. Across racial/ethnic groups, men consistently have higher prevalence of substance use disorders. Using data from the National Latino and Asian American Study, the lifetime prevalence of alcohol use disorders was 16.7% for Latino men and 4.3% for Latina women.20 Research also shows that Latino men generally reported higher levels of discrimination compared with Latina women.13,21 Data from the National Latino and Asian American Study showed that 39% of Latino men, compared with 29% of Latina women, reported discrimination.22 These authors suggested that these patterns might be the result of minority men being more exposed and vulnerable to racial bias from social institutions. These higher rates of substance use and discrimination among men also appeared to be jointly related. A recent study found that discrimination was associated with increased risk of drug abuse among Latino men, but not Latina women.6 This interaction might occur because of greater cultural acceptability among men overall to use substances to cope with stress compared with women. In contrast, women were found to rely on social support and to turn to food to cope with stress.23–25 Other specific factors, such as abuse history,26 were found to be more central in predicting risk of substance use disorders among Latina women. Thus, we expected that discrimination would have a stronger relationship with substance use disorders among Latino men than Latina women.Similar to health differences by gender, differences by nativity are not unique to Latinos. Overall, foreign-born individuals tend to be healthier than their US-born counterparts. Lifetime rates of substance use disorders were higher among US-born than foreign-born Latinos (19.6% vs 5.5%, respectively).20 Previous studies also found greater reporting of discrimination among US-born Latinos; 47% of US-born compared with 25% of foreign-born Latinos reported discrimination.22 However, discrimination might be more harmful to foreign-born Latinos because they are less likely to enjoy citizenship rights (e.g., voting privileges, access to educational scholarships) that might help temper some of the stressful effects of discrimination. From this perspective, we expected that discrimination would have a stronger relationship with substance use disorders among foreign-born than US-born Latinos.Finally, it is also important to consider ethnicity. There is some indication of variation in rates of substance use across these groups. Cubans were found to have lower odds of substance use disorders compared with Puerto Ricans.27 In addition, there was good evidence for variation in reporting of discrimination.28 For example, 40% of Puerto Ricans reported discrimination compared with 34% of Mexicans and 16% of Cubans.22 This variation might be attributed to gradations based on socioeconomic resources that differ by Latino ethnicity.29 Gradations based on socioeconomic resources could dictate the risks and resources individuals have exposure and access to, affecting coping mechanisms. Thus, we expected the relationship between discrimination and substance use disorders to vary by ethnicity as well.In sum, based on this literature, we hypothesized that discrimination would be associated with increased risk of substance use disorders among Latinos overall, and that the relationship between discrimination and substance use disorders would vary by ascribed characteristics. Specifically, we theorized that the relationship between discrimination and substance use disorders would be stronger among men compared with women, among foreign-born Latinos compared with US-born Latinos, and among Mexicans and Puerto Ricans compared with Cubans.     

Borders, laborers, and racialized medicalization Mexican immigration and US public health practices in the 20th century

Throughout the 20th century, US public health and immigration policies intersected with and informed one another in the country's response to Mexican immigration. Three historical episodes illustrate how perceived racial differences influenced disease diagnosis: a 1916 typhus outbreak, the midcentury Bracero Program, and medical deportations that are taking place today. Disease, or just the threat of it, marked Mexicans as foreign, just as much as phenotype, native language, accent, or clothing. A focus on race rendered other factors and structures, such as poor working conditions or structural inequalities in health care, invisible. This attitude had long-term effects on immigration policy, as well as on how Mexicans were received in the United States.     

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.     

Twelve-year trends in health insurance coverage among Latinos, by subgroup and immigration status

We examine twelve-year trends in the Latino uninsured population by ethnic subgroup and immigration status. From 1993 to 1999, most Latino subgroups, particularly Puerto Ricans, had large decreases in Medicaid coverage. For some subgroups these were offset by increases in employer coverage, but not for Mexicans, resulting in a four-percentage-point increase in their uninsured population. During 2000-2004, Medicaid/SCHIP expansions benefited most subgroups and mitigated smaller losses in employer coverage. However, during 1993-2004, the percentage of noncitizen Latinos lacking coverage increased by several percentage points. This was attributable to Medicaid losses during 1993-1999 and losses in employer coverage during 2000-2004.     

Impact of acculturation on cardiovascular risk factors among elderly Mexican Americans

PurposeHigher levels of acculturation among Latinos have been shown to be associated with a higher prevalence of cardiovascular (CV) risk factors in some studies of middle-age persons. The association of acculturation and prevalence of CV risk factors in elderly Latinos is less well established.MethodsAcculturation was measured using the validated bidimensional Acculturation Rating Scale for Mexican Americans-II. We conducted a cross-sectional analysis of the association of acculturation with prevalence of CV risk factors among 1789 elderly men and women from the Sacramento Area Latino Study on Aging using multivariate linear and logistic regression. We tested for the interaction of acculturation with risk factors by nativity status.ResultsMedian age was 69.8 years. Higher acculturation was associated with lower systolic blood pressure, lower low-density lipoprotein, higher high-density lipoprotein, and lower prevalence of CV disease after age and sex adjustment. Higher acculturation remained associated with lower level of low-density lipoprotein and higher level of high-density lipoprotein after full adjustment. Nativity status did not affect these results.ConclusionsContrary to other reports in middle-aged persons, higher levels of acculturation were associated with better lipid profiles and no significant differences in other CV risk factors by acculturation level in elderly Latinos.     

Latino populations: a unique opportunity for epidemiological research of asthma

Asthma is a significant health problem among Latinos, the largest minority population in the US. Asthma prevalence, morbidity and mortality are highest in Puerto Ricans, intermediate in Dominicans and Cubans, and lowest in Mexicans and Central Americans. From a cultural and social perspective, Latinos represent a wide variety of national origins and ethnic and cultural groups, with a full spectrum of social class. From a genetic perspective, Latinos have descended from Native American, European and African populations. Here, we review results from recent genetic and clinical studies to illustrate the unique opportunity Latino groups offer for studying the interaction between racial, genetic and environmental contributions to asthma and drug responsiveness.     

Risk of smoking initiation among Mexican immigrants before and after immigration to the United States

Research has suggested that Latinos are less likely to initiate smoking than non-Latino whites. This advantage may be due in part to social and structural factors that deter smoking initiation among Latino immigrants, such as entry into the restrictive regulatory environment surrounding smoking in the U.S. and decreased exposure to family smoking influences, given that immigrants often leave parents and siblings behind in countries of origin. Although available data do not support a direct test of this hypothesis this study conducts an indirect test by comparing risk of initiation among Mexican immigrants before and after immigration to the U.S. If such factors influence initiation among Mexican immigrants, their risk should decline after immigration, relative to risk before immigration, since they are subject to these forces only after moving to the U.S.     

Physical-psychiatric comorbidity: patterns and explanations for ethnic group differences

Objective: This paper examines ethnic differences in the co-occurrence of physical and psychiatric health problems (physical-psychiatric comorbidity) for women and men. The following ethnic groups are included: Non-Latino Whites, African Americans, Caribbean Blacks, Spanish Caribbean Blacks, Mexicans, Cubans, Puerto Ricans, Other Latinos, Chinese, Filipinos, Vietnamese, and Other Asian Americans. In addition, the study assesses the extent to which social factors (socioeconomic status, stress exposure, social support) account for ethnic differences in physical-psychiatric comorbidity (PPC).

Design: This study uses data from the Collaborative Psychiatric Epidemiology Surveys (CPES) (N?=?12,787). Weighted prevalence rates of physical-psychiatric comorbidity (PPC) – the co-occurrence of physical and psychiatric health problems – are included to examine ethnic group differences among women and men. Multinomial logistic regression analysis was used to determine group differences in PPC before and after adjusting for social factors.

Results: Puerto Rican men have significantly higher risk of PPC in comparison to Non-Latino White men. Among women, Blacks and Cubans were more likely than Non-Latino Whites to experience PPC as opposed to ‘Psychiatric Only’ health problems. Social factors account for the Puerto Rican/Non-Latino White difference in comorbid health among men, but have little explanatory power for understanding ethnic differences in comorbidity among women.

Conclusion: These findings have implications for medical care and can guide intervention programs in targeting a specific constellation of co-occurring physical and psychiatric health problems for diverse ethnic groups in the United States. As comorbidity rates increase, it is crucial to identify the myriad factors that give rise to ethnic group differences therein.     

Subjective Social Status and Self-Reported Health Among US-born and Immigrant Latinos

Subjective social status is associated with a range of health outcomes. Few studies have tested the relevance of subjective social status among Latinos in the U.S.; those that have yielded mixed results. Data come from the Latino subsample of the 2003 National Latino and Asian American Study (N = 2554). Regression models adjusted for socioeconomic and demographic factors. Stratified analyses tested whether nativity status modifies the effect of subjective social status on health. Subjective social status was associated with better health. Income and education mattered more for health than subjective social status among U.S.-born Latinos. However, the picture was mixed among immigrant Latinos, with subjective social status more strongly predictive than income but less so than education. Subjective social status may tap into stressful immigrant experiences that affect one’s perceived self-worth and capture psychosocial consequences and social disadvantage left out by conventional socioeconomic measures.