Variations in Healthcare Access and Utilization Among Mexican Immigrants: The Role of Documentation Status

The objective of this study is to identify differences in healthcare access and utilization among Mexican immigrants by documentation status. Cross-sectional survey data are analyzed to identify differences in healthcare access and utilization across Mexican immigrant categories. Multivariable logistic regression and the Blinder-Oaxaca decomposition are used to parse out differences into observed and unobserved components. Mexican immigrants ages 18 and above who are immigrants of California households and responded to the 2007 California Health Interview Survey (2,600 documented and 1,038 undocumented immigrants). Undocumented immigrants from Mexico are 27% less likely to have a doctor visit in the previous year and 35% less likely to have a usual source of care compared to documented Mexican immigrants after controlling for confounding variables. Approximately 88% of these disparities can be attributed to predisposing, enabling and need determinants in our model. The remaining disparities are attributed to unobserved heterogeneity. This study shows that undocumented immigrants from Mexico are much less likely to have a physician visit in the previous year and a usual source of care compared to documented immigrants from Mexico. The recently approved Patient Protection and Affordable Care Act will not reduce these disparities unless undocumented immigrants are granted some form of legal status

Stressful Social Comparisons and Daily Stressors: Examining Their Role as Psychosocial Explanations in Socioeconomic Health Disparities

My dissertation examines particular psychosocial pathways--subjective social status, daily hassles, and daily interpersonal stressors--underlying health disparities. Subjective social status, a measure of stressful social comparisons, constitutes an important, yet understudied mechanism linking socioeconomic status and health. Few studies have examined the effects of subjective social status among U.S. Latinos, the nation's largest and one of its fastest growing ethnic-minority groups.Stress research has focused on major events and chronic stress, largely overlooking the effects of daily hassles, particularly among African Americans--a group disproportionately burdened by high levels of stress and poverty. A majority of daily hassles involve interpersonal conflict. Individuals experiencing chronic pain may be especially susceptible to the effects of interpersonal conflict as arguments with significant others could result in increased emotional reactivity and compromised symptom management. Prior studies have relied on an aggregatemeasure of interpersonal stress, potentially obscuring important variability in health effects. Thus, my research, through three studies, investigates whether subjective social status, daily hassles, and interpersonal stress serve as health determinants and potential mediators of the status-health relationship among racial/ethnic minorities and chronic pain populations.The first study among U.S. Latinos found a strong inverse relationship betweensubjective social status and poor health, especially among immigrant Latinos. This finding supports the prevailing notion that stressful social comparisons robustly influence health and partially account for the status-health relationship. The second study among whites and African Americans, found that daily hassles do not mediate the status-health relationship. Rather, traumatic events are more closely tied to status and have the greatest impact on health. The third study among rheumatoid arthritis patients found a positive association between status andexposure to spouse/partner conflicts, a result that substantially nuances existing literature documenting a general inverse status-stress relationship. This study also found that increases in negative interpersonal spouse/partner events result in a significant rise in emotional reactivity.Future socioeconomic health disparities research should account for relative status, a meaningful measure for examining how social disadvantage causes stress. These investigations should also focus on the effects of interpersonal spouse/partner conflicts and strategies to reduce their frequency and incidence. Researchers may wish to incorporate multiple stressors, paying attention to the effects of early life challenges and their particular implications in forming thecontext for experiencing and responding to chronic stressors and daily hassles. This research furthers our understanding of the intermediate, psychosocial chain of events that lead to poor health

Corner Store Inventories, Purchases, and Strategies for Intervention: A Review of the Literature

Introduction: An increasingly popular strategy to improve the food retail environment and promote healthy eating in low-income and minority communities is the corner store conversion. This approach involves partnering with small ‘corner’ food stores to expand access to high-quality fruits, vegetables, and other healthy foods. Methods: We conducted a structured review of the literature to assess inventories and sales in corner stores, as well as to identify intervention strategies employed by corner store conversions. Results: Our review returned eight descriptive studies that discussed corner store inventories and sales, as well as ten intervention studies discussing six unique corner store conversion interventions in the United States, the Marshall Islands, and Canada. Common intervention strategies included: 1) partnering with an existing store, 2) stocking healthy foods, and 3) social marketing and nutrition education. We summarize each strategy and review the effectiveness of overall corner store conversions at changing peoples’ food purchasing, preparation, and consumption behaviors. Conclusions: Consumption of fresh, healthy, affordable foods could be improved by supporting existing retailers to expand their selection of healthy foods and promoting healthy eating at the neighborhood level. Additional corner store conversions should be conducted to determine the effectiveness and importance of specific intervention strategies

Unexpected benefits of and lessons learned from shifting to virtual focus group discussions in the BEECON trial.

ObjectiveThe COVID-19 pandemic has forced many human subjects research to halt in-person activities and pivot to virtual engagement, including Focus Groups (FGs). We highlight learnings from our experience of hosting virtual FGs from our BEhavioral EConomics for Oral health iNnovation (BEECON) study focusing on oral hygiene behaviors among low-income, predominantly Hispanic families, including practical tips and potential pitfalls to avoid for researchers considering virtual engagement.ResultsThere can be particular benefits to holding virtual sessions among minority parents of young children-to provide flexibility, comfort, and reduced logistical barriers for participation-while still facilitating friendly conversation with minimal distractions. However, extensive preparation is needed to ensure smooth execution and minimal distractions

A qualitative study of the multi-level influences on oral hygiene practices for young children in an Early Head Start program.

BackgroundIndividual child-level risk factors for Early Childhood Caries (ECC) have been studied, but broader family- and community-level influences on child oral hygiene behaviors are less well understood. This study explored multiple levels of influence on oral hygiene behaviors for young children in Early Head Start (EHS) to inform a future behavioral intervention targeting children from low-income families.MethodsTwenty-four semi-structured interviews were conducted with mothers of children under 4 years old, enrolled in the home visitor (HV) component of one EHS program in Los Angeles, CA, who participated in the BEhavioral EConomics for Oral health iNnovation pilot study (BEECON) in 2016-7. Audio-recordings of interviews were translated if needed, and transcribed in English, and coding and analysis was facilitated by Dedoose qualitative software. This investigation used general thematic analysis guided by the Fisher-Owens child oral health conceptual framework to identify influences on oral hygiene behaviors for the young children.ResultsMany mothers reported brushing their children's teeth twice/day, and concern that most children frequently resisted brushing. They identified children being sick or tired/asleep after outings as times when brushing was skipped. Several child-, family-, and community-level themes were identified as influences on child oral hygiene behaviors. At the child-level, the child's developmental stage and desire for independence was perceived as a negative influence. Family-level influences included the mother's own oral hygiene behaviors, other family role models, the mother's knowledge and attitudes about child oral health, and mothers' coping skills and strategies for overcoming challenges with brushing her child's teeth. Overall, mothers in the EHS-HV program were highly knowledgeable about ECC risk factors, including the roles of bacteria and sugar consumption, which motivated regular hygiene behavior. At the community-level, mothers discussed opportunities to connect with other EHS-HV families during parent meetings and playgroups that HV coordinated. A few mothers noted that EHS-HV playgroups included brushing children's teeth after snacking, which can be a potential positive influence on children's hygiene practices.ConclusionChild-, family- and community-level factors are important to consider to inform the development of tailored oral health preventive care programs for families in EHS-HV programs

A qualitative study of the multi-level influences on oral hygiene practices for young children in an Early Head Start program.

BackgroundIndividual child-level risk factors for Early Childhood Caries (ECC) have been studied, but broader family- and community-level influences on child oral hygiene behaviors are less well understood. This study explored multiple levels of influence on oral hygiene behaviors for young children in Early Head Start (EHS) to inform a future behavioral intervention targeting children from low-income families.MethodsTwenty-four semi-structured interviews were conducted with mothers of children under 4 years old, enrolled in the home visitor (HV) component of one EHS program in Los Angeles, CA, who participated in the BEhavioral EConomics for Oral health iNnovation pilot study (BEECON) in 2016-7. Audio-recordings of interviews were translated if needed, and transcribed in English, and coding and analysis was facilitated by Dedoose qualitative software. This investigation used general thematic analysis guided by the Fisher-Owens child oral health conceptual framework to identify influences on oral hygiene behaviors for the young children.ResultsMany mothers reported brushing their children's teeth twice/day, and concern that most children frequently resisted brushing. They identified children being sick or tired/asleep after outings as times when brushing was skipped. Several child-, family-, and community-level themes were identified as influences on child oral hygiene behaviors. At the child-level, the child's developmental stage and desire for independence was perceived as a negative influence. Family-level influences included the mother's own oral hygiene behaviors, other family role models, the mother's knowledge and attitudes about child oral health, and mothers' coping skills and strategies for overcoming challenges with brushing her child's teeth. Overall, mothers in the EHS-HV program were highly knowledgeable about ECC risk factors, including the roles of bacteria and sugar consumption, which motivated regular hygiene behavior. At the community-level, mothers discussed opportunities to connect with other EHS-HV families during parent meetings and playgroups that HV coordinated. A few mothers noted that EHS-HV playgroups included brushing children's teeth after snacking, which can be a potential positive influence on children's hygiene practices.ConclusionChild-, family- and community-level factors are important to consider to inform the development of tailored oral health preventive care programs for families in EHS-HV programs