Impact of change over time in self-reported discrimination on blood pressure: implications for inequities in cardiovascular risk for a multi-racial urban community.

Objectives: The 21st century has seen a rise in racism and xenophobia in the United States. Few studies have examined the health implications of heightened institutional and interpersonal racism. This study examines changes in reported discrimination and associations with blood pressure over time among non-Latino Blacks (NLBs), Latinos, and non-Latino Whites (NLWs) in an urban area, and variations by nativity among Latinos.Design: Data from a probability sample of NLB, Latino, and NLW Detroit, Michigan residents were collected in 2002-2003, with follow-up at the same addresses in 2007-2008. Surveys were completed at 80% of eligible housing units in 2008 (n = 460). Of those, 219 participants were interviewed at both time points and were thus included in this analysis. Discrimination patterns across racial/ethnic groups and associations with blood pressure were examined using generalized estimating equations.Results: From 2002 to 2008, NLBs and Latinos reported heightened interpersonal and institutional discrimination, respectively, compared with NLWs. There were no differences in associations between interpersonal discrimination and blood pressure. Increased institutional discrimination was associated with stronger increases in systolic and diastolic blood pressure for NLBs than NLWs, with no differences between Latinos and NLWs. Latino immigrants experienced greater increases in blood pressure with increased interpersonal and institutional discrimination compared to US-born Latinos.Conclusions: Together, these findings suggest that NLBs and Latinos experienced heightened discrimination from 2002 to 2008, and that increases in institutional discrimination were more strongly associated with blood pressure elevation among NLBs and Latino immigrants compared to NLWs and US-born Latinos, respectively. These findings suggest recent increases in discrimination experienced by NLBs and Latinos, and that these increases may exacerbate racial/ethnic health inequities.

Neighborhood stressors and psychological distress among U.S. Latinos: Measuring the protective effects of social support from family and friends.

We examined whether social support from family and friends, separately, reduce the deleterious effect of neighborhood stressors on psychological distress among Latinos by subgroup. Utilizing data from a nationally representative sample of 2,524 Latinos (National Latino and Asian American Survey), we found that neighborhood stressors were associated with higher distress among people with low and average levels of family support, although there was no significant association between neighborhood stressors and distress among those with high levels of family support. Although both family and friend support reduced the deleterious mental health impact of neighborhood stressors, when mutually adjusted, only family support remained statistically significant as a stress buffer and only for Mexicans and Cubans.

Cross-border Ties as Sources of Risk and Resilience: Do Cross-border Ties Moderate the Relationship between Migration-related Stress and Psychological Distress for Latino Migrants in the United States?

Few studies have examined the associations between health and the cross-border ties that migrants maintain with their family members in communities of origin. We draw on theory related to social ties, ethnic identity, and mental health to examine cross-border ties as potential moderators of the association between migration-related stress and psychological distress among Latino migrants. Using data from the National Latino and Asian American Survey, we find that remittance sending is associated with significantly lower levels of psychological distress for Cuban migrants, and difficulty visiting home is associated with significantly greater psychological distress for Puerto Rican migrants. There were significant associations between migration-related stressors and psychological distress, although these associations fell to nonsignificance after accounting for multiple testing. We found little evidence that cross-border ties either buffer or exacerbate the association between migration-related stressors and psychological distress. We consider the findings within the current political and historical context of cross-border ties and separation.

Contextualizing nativity status, Latino social ties, and ethnic enclaves: an examination of the 'immigrant social ties hypothesis'.

OBJECTIVES: Researchers have posited that one potential explanation for the better-than-expected health outcomes observed among some Latino immigrants, vis-à-vis their US-born counterparts, may be the strength of social ties and social support among immigrants. METHODS: We examined the association between nativity status and social ties using data from the Chicago Community Adult Health Study's Latino subsample, which includes Mexicans, Puerto Ricans, and other Latinos. First, we used ordinary least squares (OLS) regression methods to model the effect of nativity status on five outcomes: informal social integration; social network diversity; network size; instrumental support; and informational support. Using multilevel mixed-effects regression models, we estimated the association between Latino/immigrant neighborhood composition and our outcomes, and whether these relationships varied by nativity status. Lastly, we examined the relationship between social ties and immigrants' length of time in the USA. RESULTS: After controlling for individual-level characteristics, immigrant Latinos had significantly lower levels of social ties than their US-born counterparts for all the outcomes, except informational support. Latino/immigrant neighborhood composition was positively associated with being socially integrated and having larger and more diverse social networks. The associations between two of our outcomes (informal social integration and network size) and living in a neighborhood with greater concentrations of Latinos and immigrants were stronger for US-born Latinos than for immigrant Latinos. US-born Latinos maintained a significant social ties advantage over immigrants - regardless of length of time in the USA - for informal social integration, network diversity, and network size. CONCLUSION: At the individual level, our findings challenge the assumption that Latino immigrants would have larger networks and/or higher levels of support and social integration than their US-born counterparts. Our study underscores the importance of understanding the contexts that promote the development of social ties. We discuss the implications of these findings for understanding Latino and immigrant social ties and health outcomes.

Integrating social epidemiology into immigrant health research: a cross-national framework.

Scholarship on immigrant health has steadily increased over the past two decades. This line of inquiry is often approached as a "specialty" topic involving a discrete de-contextualized population, rather than a topic that is central for understanding patterns of population health within and between sending and receiving countries. Frequently immigrant health research employs theoretical frameworks (e.g., acculturation) that emphasize cultural explanations, while less commonly utilized is the "social determinants of health" framework, which emphasizes social and structural explanations. Drawing upon literature in the fields of economics, sociology of immigration, and social epidemiology, we present a conceptual framework for understanding immigrant health from a cross-national perspective. We discuss the theoretical foundations of this framework; the methodological challenges for undertaking research on immigration and health using this framework; examples of emerging research in this area; and directions for future research. Progress in immigrant health research and population health improvements can be achieved through an enhanced understanding of population health patterns in sending and receiving societies. Immigrant health research needs to be better integrated into social epidemiology. Concurrently, immigrant health research offers conceptual, empirical, and analytic opportunities to advance social epidemiological research. Together, scholarship in immigrant health and social epidemiology can make significant contributions toward one of their mutual and ultimate goals: to improve knowledge about population health.

Neighborhood context and hypertension outcomes among Latinos in Chicago.

Although a health advantage in hypertension has been documented among Latinos, this advantage appears to be eroding. Of particular concern is the observation that Latinos are less likely to be screened and treated for hypertension and to having it controlled. Scholars have suggested that, above and beyond individual-level factors, neighborhood characteristics may be important predictors of health and health care. We analyzed 2001-2003 data from the Chicago Community Adult Health Study to examine (a) the relationship between the Latino and immigrant composition of neighborhoods in Chicago and several outcomes among Latinos: having hypertension, utilizing hypertension-related health care, and being treated for hypertension; and (b) whether there was a differential effect of neighborhood Latino/immigrant concentration by language of interview and nativity status. We controlled for additional neighborhood characteristics relevant to hypertension and to the availability and accessibility of health care resources. Neighborhoods with higher concentrations of immigrants and Latinos were associated with Latinos having lower odds of hypertension (OR = 0.60, p = 0.03). However, among those with hypertension, our results point to deleterious effects on hypertension care (OR = 0.55, p = 0.06) and treatment (OR = 0.54, p = 0.04) associated with living in neighborhoods with higher concentrations of immigrants and Latinos. We detected no significant interaction effects between immigrant/Latino neighborhood composition and language of interview or being an immigrant in this sample. These results suggest that improving access to care for Latinos with hypertension requires enhanced placement of community clinics and other safety-net health centers in neighborhoods with higher proportions of immigrants and Latinos.

More than culture: structural racism, intersectionality theory, and immigrant health.

Explanations for immigrant health outcomes often invoke culture through the use of the concept of acculturation. The over reliance on cultural explanations for immigrant health outcomes has been the topic of growing debate, with the critics' main concern being that such explanations obscure the impact of structural factors on immigrant health disparities. In this paper, we highlight the shortcomings of cultural explanations as currently employed in the health literature, and argue for a shift from individual culture-based frameworks, to perspectives that address how multiple dimensions of inequality intersect to impact health outcomes. Based on our review of the literature, we suggest specific lines of inquiry regarding immigrants' experiences with day-to-day discrimination, as well as on the roles that place and immigration policies play in shaping immigrant health outcomes. The paper concludes with suggestions for integrating intersectionality theory in future research on immigrant health.

Associations between physical activity and overweight among U.S. youth by immigrant generation: results from the 2007 National Survey of Children's Health.

BACKGROUND: This study examines relations between parent and youth physical activity (PA; days per week), sports participation, and overweight (BMI≥85th percentile) among U.S. youth, and whether this relationship varies by immigrant generation and sex. METHODS: Participants included 28,691 youth ages 10-17 years from the 2007 National Survey of Children's Health. Youth were grouped into first, second, and third or higher generation. Primary analyses include Chi-square and post hoc tests to assess mean differences, and adjusted logistic regressions to test associations between weight status and independent variables. RESULTS: Each additional day youth participated in PA decreased their odds of overweight (OW) by 10% [OR: 0.90 (0.87-0.94)]; participation in sports significantly reduced their odds of OW by 17% [OR: 0.83 (0.71-0.98)]. First generation boys who participated in sports had 70% lower odds of OW [OR: 0.30 (0.11-0.83)] compared with first generation boys who did not participate in sports. For third generation girls, participation in sports reduced the odds of OW by 23% [OR: 0.77 (0.62-0.96)] compared with those who did not participate in sports. CONCLUSION: The protective influence of PA on youth's risk of OW varies by immigrant generation and sex. Parent PA was not related to youth's risk of OW.

Language of interview, self-rated health, and the other Latino health puzzle.

OBJECTIVES: We investigated whether the conventional Spanish translation of the self-rated health survey question helps explain why Latinos' self-rated health is worse than Whites' despite more objective health measures showing them to be as healthy as or healthier than are Whites. METHODS: We analyzed the relationship between language of interview and self-rated health in the Chicago Community Adult Health Study (2001-2003) and the 2003 Behavioral Risk Factor Surveillance System. RESULTS: Being interviewed in Spanish was associated with significantly higher odds of rating health as fair or poor in both data sets. Moreover, adjusting for language of interview substantially reduced the gap between Whites and Latinos. Spanish-language interviewees were more likely to rate their health as fair (regular in Spanish) than as any other choice, and this preference was strongest when compared with categories representing better health (good, very good, and excellent). CONCLUSIONS: Our findings suggest that translation of the English word "fair" to regular induces Spanish-language respondents to report poorer health than they would in English. Self-rated health should be interpreted with caution, especially in racial/ethnic comparisons, and research should explore alternative translations.

Toward a dynamic conceptualization of social ties and context: implications for understanding immigrant and Latino health.

Researchers have posited that social ties and social support may contribute to better-than-expected health outcomes among Mexican immigrants vis-à-vis their US-born counterparts. However, in our review of studies examining social ties and health by immigration-related variables among this group, we found little support for this hypothesis. To better understand the social factors that contribute to the health of Mexicans in the United States, we conducted a qualitative analysis of social relationships and social context among first- and second-generation Mexican women. Our results highlight the interplay between immigration processes and social ties, draw attention to the importance of identity support and transnational social relationships, and suggest ways to reconceptualize the relationship between social contexts, social ties, and immigrant and Latino health.

Beyond acculturation: immigration, discrimination, and health research among Mexicans in the United States.

Evidence suggests that, despite their lower socio-economic status, certain health outcomes are better for first-generation Mexican immigrants than their US-born counterparts. Socio-cultural explanations for this apparent epidemiological paradox propose that culture-driven health behaviors and social networks protect the health of the first generation and that, as immigrants acculturate, they lose these health-protecting factors. However, the prominence granted to acculturation within these explanations diverts attention from structural and contextual factors, such as social and economic inequalities, that could affect the health of immigrants and their descendants. The aim of this study is to offer a conceptual redirection away from individual-centered acculturation models towards a more complex understanding of immigrant adaptation in health research. To this end, 40 qualitative in-depth interviews were conducted with first- and second-generation Mexican immigrant women in Southeastern Michigan. The women's narratives highlighted a key process linked to their integration into US society, in which the second generation experienced a more pervasive and cumulative exposure to "othering" than the first generation. The findings point to "othering" and discrimination as potential pathways through which the health of immigrants and their descendants erodes. The paper concludes by proposing a conceptual model that locates "othering" processes within a structural framework, and by drawing implications for research on immigrant health and on discrimination and health.

Addressing urban health in Detroit, New York City, and Seattle through community-based participatory research partnerships.

OBJECTIVE: This study describes key activities integral to the development of 3 community-based participatory research (CBPR) partnerships. METHODS: We compared findings from individual case studies conducted at 3 urban research centers (URCs) to identify crosscutting adaptations of a CBPR approach in the first 4 years of the partnerships' development. RESULTS: Activities critical in partnership development include sharing decision-making, defining principles of collaboration, establishing research priorities, and securing funding. Intermediate outcomes were sustained CBPR partnerships, trust within the partnerships, public health research programs, and increased capacity to conduct CBPR. Challenges included the time needed for meaningful collaboration, concerns regarding sustainable funding, and issues related to institutional racism. CONCLUSIONS: The URC experiences suggest that CBPR can be successfully implemented in diverse settings.