Our Existence is a Political Issue: Examining the Political Participation of Undocumented Latinx Immigrants in the Midwest

The 2016 Presidential election pushed the debate about undocumented immigrants and immigration reform back into the forefront of the national conversation. It also increased the hostile rhetoric surrounding undocumented immigrants and mixed-status families, contrasting with how the previous presidential administration constructed these individuals. This renewed focus on immigration and immigration enforcement has led academic researchers and social work practitioners to seek out advocacy interventions for undocumented Latinx populations. Many of these interventions have focused on safely facilitating the political participation of undocumented Latinx immigrants. These studies have often measured the activities of undocumented immigrants by applying traditional measures of political participation. Traditional measures of political participation generally refer to activities aimed at creating change within the political process. Too often, these works view the political participation of undocumented immigrants through the lens of individuals being "undocumented and unafraid" or "living in the shadows” (García, 2021). This narrative assumes that undocumented Latinx immigrants view political participation through traditional definitions and categorizes individuals who do not engage in traditional forms of political participation as inactive. They have not considered that undocumented immigrants may have redefined political participation to include activities that they consider to be more accessible. These studies also do not consider how the events of the 2016 Presidential election have impacted how undocumented Latinx immigrants in the Midwest define and engage in political participation. I fill this gap in the literature around the political participation of undocumented Latinx immigrants through the context of three research questions: (1) How do undocumented Latinx immigrants in the Midwest define political participation? (2) Did the 2016 presidential election impact the political participation of undocumented Latinx immigrants in the Midwest, and if so, how? (3) How does inclusive subnational immigration policy influence the political participation of undocumented Latinx immigrants in the Midwest? To answer these questions, I conducted 32 in-depth interviews with undocumented Latinx immigrants living in the Midwest from June 2018 through April 2019. I find that respondents in my sample defined political participation in three different ways: 1) traditional definitions of political participation focusing on electoral politics and influencing voters within their networks, 2) individual engagement, and 3) everyday resistance forms of political participation. The 2016 Presidential election increased the levels of anger, fear, and disappointment within the undocumented community, but these emotions motivated them to increase their political participation. Finally, I find that inclusive subnational immigration policy helped buffer the hostile federal immigration policy and encouraged undocumented Latinx immigrants in the Midwest to engage in political participation. These results will help sociologists and social workers better understand how undocumented Latinx immigrants think about and engage in political participation.PHDSocial Work & SociologyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/175649/1/nre_1.pd

An Exploratory Study of the Impact of Gender on Health Behavior Among African American and Latino Men With Type 2 Diabetes

This study explores gender values and beliefs among Latino and African American men with diabetes and examines how these values and beliefs may influence their health behaviors. Participants were recruited from individuals who participated in one of three Racial and Ethnic Approaches to Community Health Detroit Partnership diabetes self-management interventions. One focus group was conducted with African American men (n = 10) and two focus groups were conducted with Latino men (n = 12) over a 3-month period. Sessions lasted 90 minutes, were audiotaped, and analyzed using thematic content analysis techniques. Two themes emerged that characterize gender identity and its relationship to health behavior in men: (a) men’s beliefs about being men (i.e., key aspects of being a man including having respect for themselves, authority figures, and peers; fulfilling the role as breadwinner; being responsible for serving as the leader of the family; and maintaining a sense of chivalry) and (b) influence of gender values and beliefs on health behavior (i.e., the need to maintain a strong image to the outside world, and the need to maintain control of themselves served as barriers to seeking out and engaging in diabetes self-management behaviors). Results suggest that gender values and beliefs may have implications for how health behaviors among men with diabetes. Future research should study the direct impact masculine identity has on health behaviors among men with diabetes.National Institute of Diabetes and Digestive and Kidney Disease (#R18 DK 078558-02).National Institutes of Health/NIDDK and Diversity Supplement (#R18 DK 078558-02).Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153294/1/Hawkins Watkins Kieffer Spencer Piatt Nicklett et al 2017 An Exploratory Study of the Impact.pdfDescription of Hawkins Watkins Kieffer Spencer Piatt Nicklett et al 2017 An Exploratory Study of the Impact.pdf : Main articl

Outcomes at 18 Months From a Community Health Worker and Peer Leader Diabetes Self-Management Program for Latino Adults

ObjectiveThis study evaluated the effectiveness of a community health worker (CHW) diabetes self-management education (DSME) program, followed by two different approaches to maintain improvements in HbA1c and other clinical and patient-centered outcomes over 18 months.Research design and methodsThe study randomized 222 Latino adults with type 2 diabetes and poor glycemic control from a federally qualified health center to 1) a CHW-led, 6-month DSME program or 2) enhanced usual care (EUC). After the 6-month program, participants randomized to the CHW-led DSME were further randomized to 1) 12 months of CHW-delivered monthly telephone outreach (CHW-only) or 2) 12 months of weekly group sessions delivered by peer leaders (PLs) with telephone outreach to those unable to attend (CHW+PL). The primary outcome was HbA1c. Secondary outcomes were blood pressure, lipid levels, diabetes distress, depressive symptoms, understanding of diabetes self-management, and diabetes social support. Assessments were conducted at baseline and at 6, 12, and 18 months.ResultsParticipants in the CHW intervention at the 6-month follow-up had greater decreases in HbA1c (-0.45% [95% CI -0.87, -0.03]; P < 0.05) and in diabetes distress (-0.3 points [95% CI -0.6, -0.03]; P < 0.05) compared with EUC. CHW+PL participants maintained HbA1c improvements at 12 and 18 months, and CHW-only participants maintained improvements in diabetes distress at 12 and 18 months. CHW+PL participants also had significantly fewer depressive symptoms at 18 months compared with EUC (-2.2 points [95% CI -4.1, -0.3]; P < 0.05). Participants in CHW-led DSME had significant improvements in diabetes social support and in understanding of diabetes self-management at 6 months relative to EUC, but these intervention effects were not sustained at 18 months.ConclusionsThis study demonstrates the effectiveness of a 6-month CHW intervention on key diabetes outcomes and of a volunteer PL program in sustaining key achieved gains. These are scalable models for health care centers in low-resource settings for achieving and maintaining improvements in key diabetes outcomes

Outcomes at 18 Months From a Community Health Worker and Peer Leader Diabetes Self-Management Program for Latino Adults.

ObjectiveThis study evaluated the effectiveness of a community health worker (CHW) diabetes self-management education (DSME) program, followed by two different approaches to maintain improvements in HbA1c and other clinical and patient-centered outcomes over 18 months.Research design and methodsThe study randomized 222 Latino adults with type 2 diabetes and poor glycemic control from a federally qualified health center to 1) a CHW-led, 6-month DSME program or 2) enhanced usual care (EUC). After the 6-month program, participants randomized to the CHW-led DSME were further randomized to 1) 12 months of CHW-delivered monthly telephone outreach (CHW-only) or 2) 12 months of weekly group sessions delivered by peer leaders (PLs) with telephone outreach to those unable to attend (CHW+PL). The primary outcome was HbA1c. Secondary outcomes were blood pressure, lipid levels, diabetes distress, depressive symptoms, understanding of diabetes self-management, and diabetes social support. Assessments were conducted at baseline and at 6, 12, and 18 months.ResultsParticipants in the CHW intervention at the 6-month follow-up had greater decreases in HbA1c (-0.45% [95% CI -0.87, -0.03]; P < 0.05) and in diabetes distress (-0.3 points [95% CI -0.6, -0.03]; P < 0.05) compared with EUC. CHW+PL participants maintained HbA1c improvements at 12 and 18 months, and CHW-only participants maintained improvements in diabetes distress at 12 and 18 months. CHW+PL participants also had significantly fewer depressive symptoms at 18 months compared with EUC (-2.2 points [95% CI -4.1, -0.3]; P < 0.05). Participants in CHW-led DSME had significant improvements in diabetes social support and in understanding of diabetes self-management at 6 months relative to EUC, but these intervention effects were not sustained at 18 months.ConclusionsThis study demonstrates the effectiveness of a 6-month CHW intervention on key diabetes outcomes and of a volunteer PL program in sustaining key achieved gains. These are scalable models for health care centers in low-resource settings for achieving and maintaining improvements in key diabetes outcomes

Using path analysis to model the process of change in HbA1c among African Americans and Latinos in a community health worker diabetes intervention

ObjectiveTo examine which components of a culturally tailored community health worker (CHW) intervention improved glycemic control and intermediate outcomes among Latina/o and African American participants with diabetes.MethodsThe sample included 326 African American and Latina/o adults with type 2 diabetes in Detroit, MI. CHWs provided interactive group diabetes self-management classes and home visits, and accompanied clients to a clinic visit during the 6-month intervention period. We used path analysis to model the processes by which each intervention component affected change in diabetes self-efficacy, diabetes-related distress, knowledge of diabetes management, and HbA1c.ResultsThe group-based healthy lifestyle component was significantly associated with improved knowledge. The group-based self-management section was significantly associated with reduced diabetes-related distress. Intervention class attendance was positively associated with self-efficacy. Diabetes self-management mediated the reductions in HbA1c associated with reductions in diabetes distress.ConclusionsPath analysis allowed each potential pathway of change in the intervention to be simultaneously analyzed to identify which aspects of the CHW intervention contributed to changes in diabetes-related behaviors and outcomes among African Americans and Latinas/os.Practice implicationsFindings reinforce the importance of interactive group sessions in efforts to improve diabetes management and outcomes among Latina/o and African American adults with diabetes

Using Path Analysis and Linear Regression to Test for Gender and Participation: Effects in a Culturally Tailored Diabetes Intervention for Latino Adults.

While the incidence and prevalence of type 2 diabetes is higher among Latino/as, Latino men are disproportionately affected and have poorer outcomes. We aimed to determine whether gender impacted any outcomes in a culturally tailored type 2 diabetes (T2D) intervention and to evaluate the effects of gender and intervention participation intensity on outcomes at 6-month follow-up. Nested path and regression models were compared with the likelihood ratio test and information criteria in a sample of Latino/a adults with T2D (n = 222) participating in a T2D community health worker (CHW)-led intervention. Path analysis showed that the effect of the intervention did not vary by gender. The intervention was associated with significant improvements in knowledge of T2D management 0.24 (0.10); p = 0.014, diabetes distress, -0.26 (0.12); p = 0.023, and self-efficacy, 0.61 (0.21); p = 0.005. At 6-month follow-up, improved self-management was associated with greater self-efficacy and Hemoglobin A1c (HbA1c) was lower by -0.18 (0.08); p = 0.021 for each unit of self-management behavior. Linear regressions showed that class attendance and home visits contributed to positive intervention results, while gender was non-significant. Pathways of change in a CHW-led culturally tailored T2D intervention can have a significant effect on participant behaviors and health status outcomes, regardless of gender

Everyday Discrimination, Diabetes-Related Distress, and Depressive Symptoms Among African Americans and Latinos with Diabetes

It is not known how discrimination might affect diabetes-related distress (DRD), an important correlate of diabetes outcomes. We examined correlates of discrimination and the influence of discrimination on DRD and depressive symptoms (DS) for African Americans and Latinos with type 2 diabetes. We analyzed survey data (n = 157) collected at enrollment into a diabetes management intervention. Using multiple linear regression, we examined correlates of discrimination and the association between discrimination and DRD and DS. Discrimination was significantly associated with higher DRD for Latinos (b 1.58, 95 % CI 1.08, 2.31, p < 0.05), but not significant for African Americans (b 0.96, 95 % CI 0.59, 1.57). Discrimination was marginally significantly associated with more DS for Latinos (b 1.43, 95 % CI 0.97, 2.12, p < 0.10), but not significant for African Americans (b 1.21, 95 % CI 0.87, 1.70). These findings suggest the need to address stressors unique to racial/ethnic minorities to improve diabetes-related outcomes