Access to Health Care Across Generational Status for Mexican-Origin Immigrants in California

The Patient Protection and Affordable Care Act (ACA) of 2010 expands health insurance coverage to a substantial number of persons without health insurance. In California, Latinos, especially Mexican immigrants, have one of the highest rates of uninsurance, making the ACA particularly important for that group. Using the 2007 California Health Interview Survey, this study examines how the generation in the U.S. of individuals of Mexican-origin is associated with their access to health insurance, doctor visits, and emergency room visits in California compared to that of U.S.-born non-Latino Whites. Results indicate that third generation Mexican Americans have similar levels of being insured, having a doctor visit, and having an ER visit compared to Whites, controlling for demographic, socioeconomic, and health status. First generation (immigrant) Mexicans have the least access to health care services with lower odds than Whites of accessing care across all measures. Second generation Mexican Americans also have lower odds than Whites, however, the differences are not as pronounced as for the first generation. This study finds that there are important differences in access to health care among Mexican Americans by generational status, with the greatest disparities for the generations closest to the immigrant experience. Implementation of the ACA will benefit Mexican Americans across generational statuses, but gaps will likely remain for first and second generation Mexican Americans.Le Patient Protection and Affordable Care Act (ACA), voté en 2010, étend la couverture d'assurance-maladie à un grand nombre de personnes qui en étaient jusqu’à présent dénués. Cette loi est particulièrement importante pour les Latinos de Californie, et en particulier pour les immigrés mexicains, le groupe ethnique qui présente l'un des taux de non-assurance les plus élevés. En se basant sur l'enquête 2007 California Health Interview Survey, cette étude examine le lien entre la génération des individus d'origine mexicaine vivant aux Etats-Unis et leur accès à l'assurance-maladie, aux médecins et aux urgences en Californie comparé aux Blancs non latinos nés aux Etats-Unis. Les résultats indiquent que les Américains d’origine mexicaine de troisième génération ont des taux similaires de non-assurance, de visites chez le médecin et de visites aux urgences à ceux des Blancs, pour des statuts démographique, socioéconomique, et de santé comparables. Les Mexicains de première génération (immigrants) sont ceux qui ont le moins accès aux services de santé avec moins de chances que les Blancs d'accéder aux soins pour tous les groupes de mesures. Les Américains d’origine mexicaine de deuxième génération ont également moins accès aux soins que les Blancs mais les différences sont moins prononcées que pour la première génération. Cette étude montre qu'il existe des différences notables au niveau de l'accès aux soins entre les Américains d’origine mexicaine en fonction du degré de génération, les disparités les plus importantes concernant les générations les plus proches de la date d'arrivée dans le pays. L'application de l'ACA va bénéficier aux Américains d’origine mexicaine des différentes générations mais des écarts vont probablement perdurer pour les première et deuxième générations.La Ley de Protección al Paciente y Cuidado Asequible (ACA por sus siglas en inglés) de 2010 amplía la cobertura del seguro de salud a un importante número de personas que carece de dicho seguro. En California, los latinos, especialmente los inmigrantes mexicanos, registran una de las tasas más altas de no-asegurados, lo que convierte a ACA en una ley especialmente importante para ellos. Usando la Encuesta de Salud de California de 2007, este estudio examina como la generación a la que pertenecen los individuos de origen mexicano en California afecta su acceso a seguro médico, a consultas médicas y a consultas en la sala de emergencias en comparación con los blancos no-latinos nacidos en Estados Unidos. Controlando demografía, nivel socioeconómico y estado de salud, los resultados indican que la tercera generación de estadounidenses de origen mexicano tienen un nivel similar de cobertura, consultas médicas y atención en salas de emergencias comparados con los blancos. La primera generación de mexicanos (inmigrantes) registra el menor acceso a los servicios de cuidados de salud y menor probabilidad que los blancos de acceder a cuidados en todas las categorías. La segunda generación de estadounidenses de origen mexicano también tienemenos probabilidades que los blancos, aunque las diferencias no son tan pronunciadas como en la primera generación. Este estudio concluye que existen importantes diferencias en el acceso al cuidado de salud entre los estadounidenses de origen mexicano dependiendo de la generación a la que pertenecen, con las diferencias más grandes en la generación más cercana a la experiencia migratoria.. La implementación de ACA beneficiará a las distintas generaciones de estadounidenses de origen mexicano, aunque probablemente sigan existiendo deficiencias para la primera y segunda generación

The Health of Aging Lesbian, Gay and Bisexual Adults in California

Examines rates of diabetes, hypertension, poor mental health, physical disability, and fair or poor self-reported health status among homosexual adults ages 50 to 70 compared with their heterosexual peers. Recommends enhancing policies and practices

Independence at Risk: Older Californians With Disabilities Struggle to Remain at Home as Public Supports Shrink

Presents findings about aging Californians with disabilities who depend on paid public programs and unpaid help to live at home. Makes policy recommendations, including consolidating long-term care programs and enhancing support for caregivers

The Health Status and Unique Health Challenges of Rural Older Adults in California

Examines the demographics, health, and levels of physical activity and food insecurity of rural seniors compared with those of urban and suburban seniors. Outlines environmental and social risk factors that require context-specific policies and programs

Holding On: Older Californians With Disabilities Rely on Public Services to Remain Independent

Presents findings from a study of low-income older Californians with disabilities receiving Medicare, Medi-Cal, and In-Home Supportive Services; their unmet physical, mental health, and social needs; and limited care options. Outlines policy implications

Access to Health Care Across Generational Status for Mexican-Origin Immigrants in California

The Patient Protection and Affordable Care Act (ACA) of 2010 expands health insurance coverage to a substantial number of persons without health insurance. In California, Latinos, especially Mexican immigrants, have one of the highest rates of uninsurance, making the ACA particularly important for that group. Using the 2007 California Health Interview Survey, this study examines how the generation in the U.S. of individuals of Mexican-origin is associated with their access to health insurance, doctor visits, and emergency room visits in California compared to that of U.S.-born non-Latino Whites. Results indicate that third generation Mexican Americans have similar levels of being insured, having a doctor visit, and having an ER visit compared to Whites, controlling for demographic, socioeconomic, and health status. First generation (immigrant) Mexicans have the least access to health care services with lower odds than Whites of accessing care across all measures. Second generation Mexican Americans also have lower odds than Whites, however, the differences are not as pronounced as for the first generation. This study finds that there are important differences in access to health care among Mexican Americans by generational status, with the greatest disparities for the generations closest to the immigrant experience. Implementation of the ACA will benefit Mexican Americans across generational statuses, but gaps will likely remain for first and second generation Mexican Americans

The Health of Aging Lesbian, Gay and Bisexual Adults in California

Research on the health of lesbian, gay and bisexual (LGB) adults generally overlooks the chronic conditions that are the most common health concerns of older adults. This brief presents unique population-level data on aging LGB adults (ages 50-70) documenting that they have higher rates of several serious chronic physical and mental health conditions compared to similar heterosexual adults. Although access to care appears similar for aging LGB and heterosexual adults, aging LGB adults generally have higher levels of mental health services use and lesbian/bisexual women report greater delays in getting needed care. These data indicate a need for general health care and aging services to develop programs targeted to the specific needs of aging LGB adults, and for LGB-specific programs to increase attention to the chronic conditions that are common among all older adults

Cumulative psychological stress and cardiovascular disease risk in middle aged and older women: Rationale, design, and baseline characteristics

Although a growing body of evidence indicates strong links between psychological stress (stress) and untoward cardiovascular disease (CVD) outcomes, comprehensive examination of these effects remains lacking. The "Cumulative Psychological Stress and Cardiovascular Disease Risk in Middle Aged and Older Women" study is embedded within the landmark Women's Health Study (WHS) follow-up cohort and seeks to evaluate the individual and joint effects of stressors (cumulative stress) on incident CVD risk, including myocardial infarction, stroke, coronary revascularization and CVD death. GWAS data will be used for exploratory analyses to identify any genes associated with stress and CVD. This study prospectively follows 25,335 women (mean age 72.2 ± 6.04 years) without CVD who returned a short mailed stress questionnaire at baseline and 3 years of follow-up inquiring about their experiences with stress including perceived stress, work stress, work-family spillover, financial stress, traumatic and major life events, discrimination and neighborhood environment/stressors. Other domains ascertained were sleep, anger, cynical hostility, depression, anxiety, social support, intimate partner relations, and volunteer and social activities. Higher levels of cumulative stress were associated with younger age and black race/ethnicity, divorced or separated marital status, increased prevalence of obesity, smoking, diabetes, depression and anxiety (p<0.001 for each). Findings from this study will provide clinically important, new information about associations of cumulative stress, environmental, lifestyle and genetic factors with incident CVD risk in aging women