Acculturation and Self-Rated Health among Latino and Asian Immigrants to the United States

The ways in which immigrant health profiles change with shifts in acculturation is of increasing interest to scholars and policy makers in the United States, but little is known about the mechanisms that may link acculturation and self-rated health, particularly for Asians. Utilizing the National Latino and Asian American Study (NLAAS) and its data on foreign-born Latinos (N = 1,199) and Asians( N = 1,323) (Pennelletal.2004), we investigate and compare the associations between acculturation and self-rated health for immigrants to the United States from six major ethnic subgroups (Chinese, Filipino, Vietnamese, Mexican, Cuban, and Puerto Rican). Using comprehensive measures of acculturation, we demonstrate that across ethnic groups, and despite the widely varying contexts of the sending countries and receiving communities, native-language dominance is associated with worse self-rated health relative to bilingualism, and measures of lower acculturation--coethnic ties and remittances—are associated with better self-rated health; and moreover, these associations are only partially mediated by socioeconomic status, and not mediated by acculturative stress, discrimination, social support, or health behaviors. We speculate that immigrants who maintain a native language while also acquiring English, as has been shown for other immigrant outcomes, attain a bicultural fluency, which also enables good health. Surprisingly, we do not find strong associations between duration of time in the United States or age at migrationﾗ measures frequently used to proxy acculturationﾗwith self-rated health. Our findings illustrate the complexity of measuring acculturation and its influence on health for immigrants

Basic science232. Certolizumab pegol prevents pro-inflammatory alterations in endothelial cell function

Background: Cardiovascular disease is a major comorbidity of rheumatoid arthritis (RA) and a leading cause of death. Chronic systemic inflammation involving tumour necrosis factor alpha (TNF) could contribute to endothelial activation and atherogenesis. A number of anti-TNF therapies are in current use for the treatment of RA, including certolizumab pegol (CZP), (Cimzia ®; UCB, Belgium). Anti-TNF therapy has been associated with reduced clinical cardiovascular disease risk and ameliorated vascular function in RA patients. However, the specific effects of TNF inhibitors on endothelial cell function are largely unknown. Our aim was to investigate the mechanisms underpinning CZP effects on TNF-activated human endothelial cells. Methods: Human aortic endothelial cells (HAoECs) were cultured in vitro and exposed to a) TNF alone, b) TNF plus CZP, or c) neither agent. Microarray analysis was used to examine the transcriptional profile of cells treated for 6 hrs and quantitative polymerase chain reaction (qPCR) analysed gene expression at 1, 3, 6 and 24 hrs. NF-κB localization and IκB degradation were investigated using immunocytochemistry, high content analysis and western blotting. Flow cytometry was conducted to detect microparticle release from HAoECs. Results: Transcriptional profiling revealed that while TNF alone had strong effects on endothelial gene expression, TNF and CZP in combination produced a global gene expression pattern similar to untreated control. The two most highly up-regulated genes in response to TNF treatment were adhesion molecules E-selectin and VCAM-1 (q 0.2 compared to control; p > 0.05 compared to TNF alone). The NF-κB pathway was confirmed as a downstream target of TNF-induced HAoEC activation, via nuclear translocation of NF-κB and degradation of IκB, effects which were abolished by treatment with CZP. In addition, flow cytometry detected an increased production of endothelial microparticles in TNF-activated HAoECs, which was prevented by treatment with CZP. Conclusions: We have found at a cellular level that a clinically available TNF inhibitor, CZP reduces the expression of adhesion molecule expression, and prevents TNF-induced activation of the NF-κB pathway. Furthermore, CZP prevents the production of microparticles by activated endothelial cells. This could be central to the prevention of inflammatory environments underlying these conditions and measurement of microparticles has potential as a novel prognostic marker for future cardiovascular events in this patient group. Disclosure statement: Y.A. received a research grant from UCB. I.B. received a research grant from UCB. S.H. received a research grant from UCB. All other authors have declared no conflicts of interes

Family structure differences in health care utilization among U.S. children

This study explores the relationship between family structure and children's access to health care using data from the 2001-2003 waves of the child sample files from the U.S. National Health Interview Survey. Specifically, we investigate the extent to which family structure types predict children's utilization of preventive health care, and barriers to care. We then explore whether observed differences across family structures can be attributed to differences in demographic characteristics, socioeconomic status (SES), and child health status. Using logistic regression models, we document substantial variation in health care usage and barriers to health care across a variety of family structures. Of note is the finding that the children of single mothers demonstrate extremely different patterns of health care access than do the children of single fathers, and the importance of SES as a risk factor for diminished levels of access to health care varies by family type. SES plays a major role in mediating the relationship between access to care for children in single mother and cohabiting families (when contrasted against children in two married parent families), but less of a role for children living with stepparents, a single father, or with parents and other relatives.Family structure Children Socioeconomic status Health care USA Utilization Access to care

The role of social support and integration for understanding socioeconomic disparities in self-rated health and hypertension

This paper examines socioeconomic (socioeconomic status, SES) disparities in self-rated health and hypertension among 29,816 US adults aged 25 and older using data from the 2001 wave of the National Health Interview Survey. Our purpose is to examine how influential measures of social support and social integration are for each health outcome, and whether support and integration operate by mediating, or buffering, the effects of SES on health. Multivariate regression models show no significant influence of emotional support, but do indicate that many aspects of social integration are directly associated with self-rated health and hypertension, although these measures do not mediate the relationship between SES and health. However, interaction tests show substantial evidence that measures of social integration buffer some of the negative effects of low SES, particularly the negative influence of not working on self-rated health. In addition, findings indicate potential evidence of help-seeking behavior among adults who did not finish high school or who report financial barriers to medical care. Overall, our findings suggest that social programs designed to foster social integration (e.g., free or low-cost bus fare to promote visits with friends and family) may improve health among persons with low levels of education, who are not working, or who have problems accessing medical care because of financial problems.Health disparities Socioeconomic status Social support Social integration Self-rated health Hypertension USA

Gender inequalities in US adult health: The interplay of race and ethnicity

Gender differences in adult health are well documented, but only recently has research begun to investigate how race and ethnicity condition gendered health disparities. This paper contributes to this line of inquiry by assessing gender differences in morbidity across five major US racial and ethnic populations. Using data from the 1997-2001 waves of the National Health Interview Survey, the analysis examines differences in men and women's self-rated health, functional limitations, and life-threatening medical conditions for whites, blacks, Mexicans, Puerto Ricans, and Cubans. For each health outcome, we investigate the utility of socioeconomic factors in accounting for observed disparities. Contrary to finding universal excess in female morbidity, the results show that the magnitude of gender difference varies considerably by racial/ethnic group, health outcome, and comparison category. The most striking findings are the consistently higher levels of functional limitations for all women compared to men in their same racial/ethnic group and the poorer health of black women relative to both white and black men for all health measures, after adjustment for socioeconomic and background factors. The gender gap for all other health measures is more variable, and for Mexican women a difference is only evident for functional limitations and only when compared to Mexican men. Our results underscore the need for more research on the role of race and ethnicity in shaping gendered health inequalities and the mechanisms that lead to such variable patterns of difference across and within US racial and ethnic populations.USA Gender Morbidity Racial/ethnic disparities Socioeconomic status

Gender, acculturation, and smoking behavior among U.S. Asian and Latino immigrants

In this paper we examine smoking prevalence and frequency among Asian and Latino U.S. immigrants, focusing on how gender differences in smoking behavior are shaped by aspects of acculturation and the original decision to migrate. We draw on data from 3249 immigrant adults included in the 2002-2003 National Latino and Asian American Study. Findings confirm the gender gap in smoking, which is larger among Asian than Latino immigrants. While regression models reveal that gender differences in smoking prevalence, among both immigrant groups, are not explained with adjustment for measures of acculturation and migration decisions, adjustment for these factors does reduce gender differences in smoking frequency to non-significance. Following, we examine gender-stratified models and test whether aspects of migration decisions and acculturation relate more strongly to smoking behavior among women; we find that patterns are complex and depend upon pan-ethnic group and smoking measure. © 2014 Elsevier Ltd

The mental well-being of Central American transmigrant men in Mexico

To understand the mental health status of Central American migrant men travelling through Mexico to the U.S., we analysed the association between migration-related circumstances/stressors and psychological disorders. In-person interviews and a psychiatric assessment were conducted in 2010 and 2014 with 360 primarily Honduran transmigrant young adult males. The interviews were conducted at three Casas del Migrante (or migrant safe houses) in the migration-corridor cities of Monterrey, and Guadalupe, Nuevo Leon; and Saltillo, Coahuila. The results indicated high levels of migration-related stressors including abuse and a high prevalence of major depressive episodes (MDEs), alcohol dependency, and alcohol abuse. Nested logistic regression models were used to separately predict MDEs, alcohol dependency, and alcohol abuse, assessing their association with migration experiences and socio-demographic characteristics. Logistic regression models showed that characteristics surrounding migration (experiencing abuse, migration duration, and attempts) are predictive of depression. Alcohol dependency and abuse were both associated with marital status and having family/friends in the intended U.S. destination, while the number of migration attempts also predicted alcohol dependency. The results provide needed information on the association between transit migration through Mexico to the U.S. among unauthorised Central American men and major depressive disorder and alcohol abuse and dependency

COVID-19 Patient Vaccine Program Design and Implementation: An Academic Children\u27s Hospital\u27s Model, Approach, and Outcomes

To slow the spread of the 2019 novel coronavirus disease (COVID-19) and reduce the associated morbidity and mortality, the Children\u27s National Hospital developed a multidisciplinary, collaborative vaccine program aimed at equitably and expeditiously vaccinating the pediatric population of the surrounding community. Interdepartmental collaboration, professional expertise, and community partnerships allowed for a dynamic and successful program design that began as large volume-centralized vaccine clinics and expanded to smaller volume ambulatory clinics. This strategy proved successful at meeting local vaccine demand; however, strategies to improve vaccine uptake in communities with high rates of hesitancy are still needed to maximize vaccine equity