Parental migration and self-efficacy among rural-origin adolescents in China: Patterns and mechanisms.

Large-scale rural-to-urban migration has shaped the socialization contexts of rural adolescents in China and can potentially impact their developmental outcomes. In this study, using data from the first wave of the China Education Panel Study collected in 2013, we focused on self-efficacy, an important but under-studied facet of noncognitive development, and assessed how it was influenced by family migration status. We also explored the mediating role of family and school resources. We compared three groups of rural-origin adolescents with different family migration statuses: rural left-behind children (LBC), rural not-left-behind children (NLBC), and rural-to-urban migrant children (MC). Structural equation modeling was performed to estimate the main effects of rural-origin groups on self-efficacy and the mediating effects of family income, family social capital, and school social capital for the significant group effects on self-efficacy. We found similar levels of self-efficacy among MC and NLBC, who in turn, exhibited greater self-efficacy than LBC. Discrepancies in family and school resources mediated the self-efficacy gaps between LBC and their MC and NLBC counterparts. Notably, when their disadvantages in family and school resources were controlled for, LBC were more efficacious than MC and NLBC, indicating LBC's resilience and the potential for promoting self-efficacy in LBC by providing adequate resources and support.

The Racial Configuration of Parent Couples and Premature Birth: an Analysis of the Utah Population Database.

In this paper, we analyze detailed maternal and paternal race information in a 25-year time series of birth record data to consider racial inequities in premature births experienced by women of color and women within interracial parent couples. We analyze birth outcomes within Utah, a historically racially homogeneous state experiencing growing racial diversity and interracial marriage over the past two decades. Our analyses consider disparities in preterm birth according to maternal race and the interracial status of couples for all birth certificate records within the Utah Population Database from 1989 to 2015 (N = 1,148,818). Our results, consistent with a dyadic perspective on minority stress, indicate that maternal race and interracial parent-couple status are each significantly associated with heightened risk of premature birth. The odds of preterm birth are significantly greater among all four racialized groups in the analyses (African Americans, Asians, Native Americans, and Native Hawaiian or Pacific Islanders) as compared to White women. Furthermore, we find that mothers in mixed-race parent couples with either a white or a black father experience a greater risk of preterm birth than mothers parenting with a father of the same race. Our results suggest that in order to capture the complete perspective on racial-ethnic disparities in adverse birth outcomes, outcomes pivotal for subsequent health outcomes over the life course, it is critical to address racism's toxic effects across multiple levels of lived experience-from the individual level, to the parent dyad, to the local community and beyond.

Unequal Returns of Employment on Self-Rated Health: Asian-White Differences.

BACKGROUND: Previous research has shown that employment status is one of the most powerful socioeconomic resources utilized to promote health and well-being. However, racial and ethnic minorities often experience diminished returns of socioeconomic resources compared to non-Hispanic Whites. This analysis explores the association between employment status and self-rated health among Asians and non-Hispanic Whites, and whether race or ethnicity moderates this association. METHODS: We used data from the 2016 National Asian American Survey, a nationally representative survey of Asians from ten ethnic backgrounds. We measured the association between employment status and self-rated health, using race and ethnicity as the primary moderators. Age, gender, income, education, nativity status, and English proficiency were used as controls. Pooled (by race) and stratified (by ethnicity) logistic regressions were estimated. RESULTS: The pooled logistic regressions showed that employment was associated with lower odds of poorer self-rated health among Asians and Whites. Race, however, moderated this relationship, indicating a stronger protective effect of employment for Whites. In the stratified logistic regressions, employment was not associated with lower odds of poorer self-rated health across all of the assessed Asian ethnic subgroups. Ethnicity moderated the association between employment and self-rated health, suggesting a stronger protective effect of employment for Whites than for Chinese, Hmong, Koreans, Japanese, and Filipinos. CONCLUSION: The protective health benefits of employment do not operate the same for Whites and Asians. Discrimination and unequal labor market and working conditions may weaken the positive health returns of employment for Asians compared to their White counterparts.

Associations between everyday and major discrimination and health status among a diverse national sample of ten Asian ethnic subgroups.

PURPOSE: We examined the associations between major and everyday discrimination and self-rated health among a national sample of ten Asian ethnic subgroups, including Vietnamese, Chinese, Hmong, Cambodians, Pakistanis, Indians, Bangladeshis, Japanese, Filipinos, and Koreans. METHODS: We used data from the 2016 National Asian American Survey (n = 4427). Logistic regression analyses were conducted to explore the associations between major and everyday discrimination and self-rated health among ten Asian ethnic subgroups, controlling for relevant sociodemographic factors. RESULTS: Findings showed that major discrimination was associated with higher odds of poorer self-rated health among Asians as a group. Subgroup analyses revealed that encounters with major discrimination were associated with poorer self-rated health among Vietnamese, Filipinos, Cambodians, and Hmong. Everyday discrimination was associated with poorer self-rated health only among Hmong. CONCLUSION: Overall, the negative health consequences of everyday and major discrimination vary by Asian ethnic subgroup. Targeting certain forms of discrimination facing specific Asian ethnic groups is needed to reduce their risk of adverse health outcomes.

Illness, Social Disadvantage, and Sexual Risk Behavior in Adolescence and the Transition to Adulthood.

This study investigated the influence of illness on sexual risk behavior in adolescence and the transition to adulthood, both directly and through moderation of the impact of social disadvantage. We hypothesized positive effects for social disadvantages and illness on sexual risk behavior, consistent with the development of faster life history strategies among young people facing greater life adversity. Using the first two waves of the National Longitudinal Study of Adolescent to Adult Health, we developed a mixed-effects multinomial logistic regression model predicting sexual risk behavior in three comparisons: risky nonmonogamous sex versus safer nonmonogamous sex, versus monogamous sex, and versus being sexually inactive, by social characteristics, illness, interactions thereof, and control covariates. Multiple imputation was used to address a modest amount of missing data. Subjects reporting higher levels of illness had lower odds of having safer nonmonogamous sex (OR = 0.84, p < .001), monogamous sex (OR = 0.82, p < .001), and being sexually inactive (OR = 0.74, p < .001) versus risky nonmonogamous sex, relative to subjects in better health. Illness significantly moderated the sex (OR = 0.88, p < .01), race/ethnicity (e.g., OR = 1.21, p < .001), and childhood SES (OR = 0.94; p < .01) effects for the sexually inactive versus risky nonmonogamous sex comparison. Substantive findings were generally robust across waves and in sensitivity analyses. These findings offer general support for the predictions of life history theory. Illness and various social disadvantages are associated with increased sexual risk behavior in adolescence and the transition to adulthood. Further, analyses indicate that the buffering effects of several protective social statuses against sexual risk-taking are substantially eroded by illness.

Self-rated Health Disparities Among Asian Americans: Mediating Roles of Education Level and Household Income.

Asian Americans represent an understudied racial category in health disparity research. Using data from the National Asian American Survey, we examined self-rated health (SRH) disparities in eight Asian subgroups compared to Whites, explored the moderating effect of nativity status, and investigated the mediating effect of socioeconomic status. None of the Asian subgroups fared better than Whites. Across Asian subgroups, South Asians, Japanese, and Filipinos had the best SRH, with Cambodians being the most disadvantaged. Nativity was a significant moderator in that SRH disadvantages were only manifested among immigrants for Chinese, Korean, Hmong, and Vietnamese and only among natives for Filipinos. For most groups showing SRH disadvantages, SES played partial mediating roles. Education showed a higher explanatory power than income for inter-ethnic SRH disparities. Contrary to popular perception, Asian Americans are not the model minority in terms of SRH. Cultural influences on SRH reporting biases were discussed.

Socioeconomic differentials in hypertension based on JNC7 and ACC/AHA 2017 guidelines mediated by body mass index: Evidence from Nepal demographic and health survey.

BACKGROUND: Unlike developed countries, higher socioeconomic status (SES-education, and wealth) is associated with hypertension in low and middle-income countries (LMICs) with limited evidence. We examined the associations between SES and hypertension in Nepal and the extent to which these associations vary by sex and urbanity. The body mass index (BMI) was examined as a secondary outcome and assessed as a potential mediator. MATERIALS AND METHODS: We analyzed the latest Nepal Demographic and Health Survey data (N = 13,436) collected between June 2016 and January 2017, using a multistage stratified sampling technique. Participants aged 15 years or older from selected households were interviewed with an overall response rate of 97%. Primary outcomes were hypertension and normal blood pressure defined by the widely used Seventh Report of the Joint National Committee (JNC7) and the American College of Cardiology/American Heart Association (ACC/AHA) 2017. RESULTS: The prevalence of hypertension was higher in Nepalese men than women. The likelihood of being hypertensive was significantly higher in the higher education group compared with the lowest or no education group for men (OR 1.89 95% CI: 1.36, 2.61) and for women (OR 1.20 95% CI: 0.79, 1.83). People in the richest group were more likely to be hypertensive compared with people in the poorest group for men (OR 1.66 95% CI: 1.26, 2.19) and for women (OR 1.60 95% CI: 1.20, 2.12). The associations between SES (education) and hypertension were partially modified by sex and fully modified by urbanity. BMI mediated these associations. CONCLUSIONS: The higher SES was positively associated with the higher likelihood of having hypertension in Nepal according to both JNC7 and ACC/AHA 2017 guidelines. These associations were mediated by BMI, which may help to explain broader socioeconomic differentials in cardiovascular disease (CVD) and related risk factors, particularly in terms of education and wealth. Our study suggests that the mediating factor of BMI should be tackled to diminish the risk of CVD in people with higher SES in LMICs.

Continuity of Care: Perspectives of Uninsured Free Clinic Patients.

BACKGROUND: Continuity of care is vital to the success of a health-care system because it improves patient satisfaction and health outcomes, and reduces hospitalizations and emergency room visits. OBJECTIVE: The purpose of this study was to examine free clinic patients' perspectives of continuity of care in the United States. METHOD: A convenience sample of free clinic patients who were the age of 18 or older and spoke English or Spanish participated in a self-administered survey from January to April in 2017 (N = 580). RESULTS: Better instructions from providers were associated with higher levels of continuity of care (P < .01). Higher levels of stress and worse self-rated general health were related to lower levels of continuity of care (P < .05 for stress, P < .01 for general health). Being employed was associated with lower levels of continuity of care (P < .05). Non-US born English speakers and Spanish speakers rated continuity of care higher than US born English speakers (P < .01). CONCLUSION: Even if a patient is unable to see the same physician over time, quality instructions from a well-coordinated provider team may enhance continuity of care from patient perspectives. The social context of patients such as working poor individuals is very important for providers to understand in order to identify barriers to continuity of care.

Peer Smoking and Smoking-related Beliefs Among College Students in Bangladesh.

OBJECTIVES: Smoking is a significant public health issue in Bangladesh. The purpose of this study was to examine peer smoking and smoking-related beliefs among college students in Bangladesh. METHODS: College students at two universities in Dhaka, Bangladesh participated in a self-administered survey in May and June 2017. RESULTS: First, being a current or former smoker is associated with lower levels of beliefs among respondents that they would not smoke even with smoker friends or nervousness, and lower levels of intentions that they would not smoke, while current smokers and former smokers have different smoking-related beliefs. Second, having smoker friends is associated with lower levels of intentions that they would not smoke. Third, higher levels of normative beliefs that it is important not to smoke are associated with higher levels of beliefs that they would not smoke even with smoker friends or nervousness, higher levels of intentions that they would not smoke, and higher levels of avoidance of smoking. CONCLUSIONS: Smoking-related beliefs and perceived norms in individuals' social networks are important components in promoting tobacco cessation in Bangladesh. But it is challenging to prevent or intervene in smoking because of the high rates of smoking in this country and the high prevalence of smokers in individuals' social networks. Future studies should examine the most effective interventions to combat smoking in high-smoking social networks, such as using mobile apps or social media, and evaluate the effectiveness of such interventions.

Transportation and Other Nonfinancial Barriers Among Uninsured Primary Care Patients.

INTRODUCTION: Nonfinancial barriers are frequent causes of unmet need in health-care services. The significance of transportation barriers can weigh more than the issues of access to care. The purpose of this cross-sectional study was to examine transportation and other nonfinancial barriers among low-income uninsured patients of a safety net health-care facility (free clinic). METHODS: The survey data were collected from patients aged 18 years and older who spoke English or Spanish at a free clinic, which served uninsured individuals in poverty in the United States. RESULTS: Levels of transportation barriers were associated with levels of other nonfinancial barriers. Higher levels of nonfinancial barriers were associated with elevation in levels of stress and poorer self-rated general health. Higher educational attainment and employment were associated with an increase in other nonfinancial barriers. CONCLUSION: Focusing only on medical interventions might not be sufficient for the well-being of the underserved populations. Future studies should examine integrative care programs that include medical treatment and social services together and evaluate such programs to improve care for underserved populations.