Syndemics of Severity and Frequency of Elder Abuse: A Cross-Sectional Study in Mexican Older Females

Background: Elder abuse is a common phenomenon with important effects on the health and well-being of older adults. There are important gaps in elder abuse measurement, as it is usually reported as the absence or presence of elder abuse, disregarding its severity and frequency. Objectives: Identify different ways of measuring severity and frequency of elder abuse and assess whether different experiences of severity and frequency suggest syndemic relationships. Methods: Through a sample of 534 non-institutionalized Mexican older women, we assessed how severity (i.e., number of abusive experiences and number of types of abuses) and frequency (i.e., if abusive experiences had happened few or many times) correlate among them. For each of these measures we estimated a multinomial model to examine associations with social support, functional impairments, socioeconomic status, food insecurity, depression, and comorbidities, while controlling for key socio-demographic variables. Results: 30.5% of the older women reported psychological abuse, 8.2% financial exploitation, 5.1% caregiver neglect, 3.5% physical abuse, and 1.2% sexual abuse. In terms of frequency, 77.8% of the women self-reported having never been abused or only once in the last 12 months, whereas 13.1% reported abusive experiences repeating few times, and 9.9% repeating many times. In terms of severity, 66.7% of the older women had not been abused, 22.3% had suffered one type of abuse, and 11.1% two or more. Similarly, 15.0% reported one abusive experience, 8.1% two, and 10.3% three or more abusive events during the last 12 months. Severity measures showed similar associations: social support and high socioeconomic level as protective factors among those with less severe abuse, whereas increased depression, food insecurity and functional impairments were associated with more severe experiences of elder abuse. Frequency followed a different pattern, depressive symptoms were significantly associated with those with few experiences (compared to those with none or once), while functional impairments were associated with many experiences of elder abuse. Conclusions: It is relevant to assess elder abuse through its severity and frequency as inter-individual variability and the complexity of the experience shows different determinants suggesting a syndemic approach. This has important clinical and policy implications

The Contextual Effects of Violence and Poverty on Cardiometabolic Risk Biomarkers: A Longitudinal Multilevel Study in Urban Municipalities in Mexico

Thesis advisor: David T. TakeuchiThesis advisor: Graciela Teruel-BelismelisPoverty and violence within cities frequently concentrate in the same places and evidence suggests these exposures have deleterious consequences on health. The 2007 homicide increase in both rich and poor Mexican municipalities and the available biomarkers in a public panel study offer a unique opportunity to test each contextual effect in isolation on an innovative health outcome. Using an ecological framework, the main hypothesis of the dissertation is that, in urban environments, exposure to higher levels of contextual violence works as a stressor that wears down the body by increasing the levels of cardiovascular risk. This effect was hypothesized to be independent from poverty but with significant interactions and with heterogeneous effects among subpopulations. Multilevel cross-sectional and longitudinal analyses were conducted treating the data as a natural experiment using the homicide rate increase as treatment. The outcomes were two indices and single biomarkers that reflect cardiovascular risk in three waves of data corresponding to the years 2002, 2006, and 2012. Results showed that three complementary statistical approaches provided evidence indicating that exposure to cumulative violence at the municipality level yielded higher cardiovascular risk when controlling for individual covariates like victimization and household expenditure. The significant threshold for homicide rates was 35 and the differences between exposed and unexposed municipalities was between 1.5% & 8.3%, while the threshold for changes in the homicide rates between 2006 and 2012 was 10, with an effect size of 7%. Poverty and violence were not correlated in Mexico during the homicide rate spike, so the effects were independent. Unexpectedly, they did not show interaction effects: affluent and violent municipalities were the most stressful contexts. These effects were higher in women, in individuals in the two lowest socioeconomic quintiles and had significant impact in cohorts younger than 40 years old. The dissertation expands the ecosocial approach by exploring independent effects that shape multiple stressful contexts. It demonstrates that violence is a public health concern in Mexico that has indirect effects in the whole population, which not only worsens the obesity epidemic, but also demands a new perspective on assessing the burden of violence on everyday life.Thesis (PhD) — Boston College, 2017.Submitted to: Boston College. Graduate School of Social Work.Discipline: Social Work

Syndemics of Severity and Frequency of Elder Abuse: A Cross-Sectional Study in Mexican Older Females

Background: Elder abuse is a common phenomenon with important effects on the health and well-being of older adults. There are important gaps in elder abuse measurement, as it is usually reported as the absence or presence of elder abuse, disregarding its severity and frequency.Objectives: Identify different ways of measuring severity and frequency of elder abuse and assess whether different experiences of severity and frequency suggest syndemic relationships.Methods: Through a sample of 534 non-institutionalized Mexican older women, we assessed how severity (i.e., number of abusive experiences and number of types of abuses) and frequency (i.e., if abusive experiences had happened few or many times) correlate among them. For each of these measures we estimated a multinomial model to examine associations with social support, functional impairments, socioeconomic status, food insecurity, depression, and comorbidities, while controlling for key socio-demographic variables.Results: 30.5% of the older women reported psychological abuse, 8.2% financial exploitation, 5.1% caregiver neglect, 3.5% physical abuse, and 1.2% sexual abuse. In terms of frequency, 77.8% of the women self-reported having never been abused or only once in the last 12 months, whereas 13.1% reported abusive experiences repeating few times, and 9.9% repeating many times. In terms of severity, 66.7% of the older women had not been abused, 22.3% had suffered one type of abuse, and 11.1% two or more. Similarly, 15.0% reported one abusive experience, 8.1% two, and 10.3% three or more abusive events during the last 12 months. Severity measures showed similar associations: social support and high socioeconomic level as protective factors among those with less severe abuse, whereas increased depression, food insecurity and functional impairments were associated with more severe experiences of elder abuse. Frequency followed a different pattern, depressive symptoms were significantly associated with those with few experiences (compared to those with none or once), while functional impairments were associated with many experiences of elder abuse.Conclusions: It is relevant to assess elder abuse through its severity and frequency as inter-individual variability and the complexity of the experience shows different determinants suggesting a syndemic approach. This has important clinical and policy implications

Food insecurity measurement and prevalence estimates during the COVID-19 pandemic in a repeated cross-sectional survey in Mexico

Objective: To validate the telephone modality of the Latin American and Caribbean Food Security Scale (ELCSA) included in three waves of a phone survey to estimate the monthly household food insecurity prevalence during the COVID-19 pandemic in Mexico. Design: We examined the reliability and internal validity of the ELCSA scale in three repeated waves of cross-sectional surveys with Rasch models. We estimated the monthly prevalence of food insecurity in the general population and in households with and without children and compared them with a national 2018 survey. We tested concurrent validity by testing associations of food insecurity with socio-economic status and anxiety. Setting: ENCOVID-19 is a monthly telephone cross-sectional survey collecting information on the well-being of Mexican households during the pandemic lockdown. Surveys used probabilistic samples, and we used data from April (n 833), May (n 850) and June 2020 (n 1674). Participants: Mexicans 18 years or older who had a mobile telephone. Results: ELCSA had an adequate model fit and food insecurity was associated, within each wave, with more poverty and anxiety. The COVID-19 lockdown was associated with an important reduction in food security, decreasing stepwise from 38·9 % in 2018 to 24·9 % in June 2020 in households with children. Conclusions: Telephone surveys were a feasible strategy to monitor reductions in food security during the COVID-19 lockdown

Pre-COVID-19 Social Determinants of Health Among Mexican Migrants in Los Angeles and New York City and Their Increased Vulnerability to Unfavorable Health Outcomes During the COVID-19 Pandemic

COVID-19 has disproportionally affected underrepresented minorities (URM) and low-income immigrants in the United States. The aim of the study is to examine the underlying vulnerabilities of Mexican immigrants in New York City (NYC) and Los Angeles (LA), its correspondence with area-level COVID-19 morbidity and mortality, and to document the role of trusted and culturally sensitive services offered during the pandemic through the Ventanillas de Salud (i.e. VDS, Health Windows) program. The study uses a mixed-methods approach including a cross-sectional survey of Mexican immigrants in LA and NYC collected in the Mexican Consulates at the onset of the pandemic, complemented with a georeferencing analysis and key informant interviews. Data suggested an increased vulnerability to COVID-19 given participants reported health status, health care profile and place of residence, which coincided with the georeferencing analysis. The key informant interviews confirmed the vulnerability of this population and the supporting role of VDS in helping immigrants navigate health systems and disseminate health information. Mexican immigrants had an increased vulnerability to COVID-19 at the individual, geographic and systemic levels. Trusted and culturally sensitive services are needed to overcome some of the barriers and risk factors that increase the vulnerability of URM and immigrant populations to COVID-19

Incorporating Public Insecurity Indicators: A New Approach to Measuring Social Welfare in Mexico

Social Welfare (SW) is a multidimensional and contextual concept. It is generally adjusted to reflect the prevailing social realities of a given context (Grasso & Canova, 2008). It consists of a material dimension, including economic indicators such as income, employment, level of schooling, and access to social security services (Di Pasquale, 2008; Mæstad & Norheim, 2012). The other dimension of social welfare is subjective and includes elements such as happiness and satisfaction with life (Diener, 1994, 2000).ITESO, A.C.Boston College, School of Social WorkUniversidad Iberoamericana Ciudad de Méxic

Prevalencia mensual de trastorno de ansiedad generalizada durante la pandemia por Covid-19 en México

Objective. Estimate the prevalence of generalized anxiety disorder (GAD) from April to June 2020. Materials and methods. Repeated cross-sections design based in the Encovid-19, a series of monthly mobile surveys with represen- tative samples of Mexico (N= 833-1 674).The questionnaire includes the GAD-2 scale, and, in July, the GAD-7 scale was added; we examined its internal validity with confirmatory factor analysis and its concurrent validity with sociodemo- graphic variables. Using GAD-7 as criterion, we analyzed the predictive validity of the GAD-2.We estimated the monthly prevalence with the GAD-2. Results. The GAD-7 and the GAD-2 are reliable and valid.The GAD-2 has a sensitivity of 0.87 and a specificity of 0.90.The monthly prevalence remains high and stable, between 30.7 and 32.6%. GAD concentrated in women, unemployed and persons with low socioeconomic status. Conclusions. GAD is a public health problem that worsened during the Covid-19 pandemic

Migration as a determinant of childhood obesity in the United States and Latin America

International migration has economic and health implications. The acculturation process to the host country may be linked to childhood obesity. We use the Community Energy Balance (CEB) framework to analyze the relationship between migration and childhood obesity in Mexican households with international migrants. Using longitudinal data from the Mexican Family Life Survey (MxFLS), we examine how migrant networks affect childhood obesity in origin communities. We also review binational health programs that could be effective at tackling childhood obesity in migrant households from Mexico. Children embedded in migrant networks are at greater risk of developing overweight or obesity, suggesting a significant relationship between childhood obesity and international migration in Mexican households. Based on our search criteria, our analysis of health outreach programs shows that Ventanillas de Salud (VDS)/Health Windows has great promise to prevent childhood obesity in a culturally sensitive and trustful environment. The CEB framework is useful to understand how migration contributes to the risk of childhood overweight and obesity in migrant households. VDS is a feasible and replicable strategy with great potential to address childhood obesity among migrant families accounting for the dynamic and binational determinants of childhood obesity