Exploring the Hispanic health paradox in mental health outcomes: Evidence from the US-Mexico border

Background: Research has established that Hispanic immigrants experience better health outcomes than their US-born counterparts. However, it is unclear whether the immigrant advantage holds for mental health. The purpose of this study is to examine mental health disparities by nativity status in an underserved Hispanic population along the southern border. Methods: We collected data (N=713, weighted 733,644 adults) in four counties (90% Hispanic) along the Texas-Mexico border from March through August 2018 utilizing a dual-frame sampling design (random-digit dial telephone survey and field survey in randomly-selected colonias). We assessed several mental health outcomes (depression, anxiety, poor mental health days, PTSD symptomology). We estimated multivariate regressions to examine the association between nativity status and each outcome, controlling for individual characteristics, perceived discrimination, material hardship, adverse childhood experiences, and social support. We employed Blinder-Oaxaca decomposition to determine whether differences in mental health outcomes by nativity are attributable to differences in sociodemographic characteristics, social support, or other stressors. Results: Two-fifths of participants were foreign-born. Forty-five percent lacked healthcare coverage, 30% had not completed high school, and 22% had household incomes Conclusion: This study extends the Hispanic paradox to mental health with findings supporting an immigrant advantage in mental health outcomes. However, this advantage is mitigated by duration of residence and structural inequalities

Understanding the Intention to Use Telehealth Services in Underserved Hispanic Border Communities: Cross-Sectional Study

Background: Despite the United States having one of the leading health care systems in the world, underserved minority communities face significant access challenges. These communities can benefit from telehealth innovations that promise to improve health care access and, consequently, health outcomes. However, little is known about the attitudes toward telehealth in these communities, an essential first step toward effective adoption and use. Objective: The purpose of this study is to assess the factors that shape behavioral intention to use telehealth services in underserved Hispanic communities along the Texas-Mexico border and examine the role of electronic health (eHealth) literacy in telehealth use intention. Methods: We used cross-sectional design to collect data at a community health event along the Texas-Mexico border. The area is characterized by high poverty rates, low educational attainment, and health care access challenges. Trained bilingual students conducted 322 in-person interviews over a 1-week period. The survey instrument assessed sociodemographic information and telehealth-related variables. Attitudes toward telehealth were measured by asking participants to indicate their level of agreement with 9 statements reflecting different aspects of telehealth use. For eHealth literacy, we used the eHealth Literacy Scale (eHEALS), an 8-item scale designed to measure consumer confidence in finding, evaluating, and acting upon eHealth information. To assess the intention to use telehealth, we asked participants about the likelihood that they would use telehealth services if offered by a health care provider. We analyzed data using univariate, multivariate, and mediation statistical models. Results:Participants were primarily Hispanic (310/319, 97.2%) and female (261/322, 81.1%), with an average age of 43 years. Almost three-quarters (219/298) reported annual household incomes below $20,000. Health-wise, 42.2% (136/322) self-rated their health as fair or poor, and 79.7% (255/320) were uninsured. The overwhelming majority (289/319, 90.6%) had never heard of telehealth. Once we defined the term, participants exhibited positive attitudes toward telehealth, and 78.9% (254/322) reported being somewhat likely or very likely to use telehealth services if offered by a health care provider. Based on multivariate proportional odds regression analysis, a 1-point increase in telehealth attitudes reduced the odds of lower versus higher response in the intention to use telehealth services by 23% (OR 0.77, 95% CI 0.73-0.81). Mediation analysis revealed that telehealth attitudes fully mediated the association between eHealth literacy and intention to use telehealth services. For a 1-point increase in eHEALS, the odds of lower telehealth use decreased by a factor of 0.95 (5%; OR 0.95, 95% CI 0.93-0.98; P Conclusions: Telehealth promises to address many of the access challenges facing ethnic and racial minorities, rural communities, and low-income populations. Findings underscore the importance of raising awareness of telehealth and promoting eHealth literacy as a key step in fostering positive attitudes toward telehealth and furthering interest in its use

Three essays on economic instability, social context & outcomes in early adulthood

This dissertation addresses the effects of economic disadvantage and economic instability on educational and family outcomes in early adulthood. In two related essays, I explore the influence of childhood poverty exposure on educational attainment (Chapter 2) and homeleaving (Chapter 3) in early adulthood using data from the children of the female respondents in the National Longitudinal Survey of Youth 1979. I apply Bronfenbrenner\u27s (1979) ecological framework and examine the extent to which family processes, peer and school contexts and neighborhood environment serve as mechanisms through which childhood poverty shapes these outcomes. In Chapter 2, I find that persistent and long-term childhood poverty reduce educational attainment even when family and school contexts are considered. Further, peer environment in early adolescence appears to reduce the influence of poverty exposure on educational attainment in early adulthood more than family processes or school context. In Chapter 3, I find that persistent and long-term childhood poverty is directly associated with the likelihood of leaving home by age 20 for reasons other than school attendance, even after family processes, peer and school contexts and neighborhood environment are considered. In contrast to results for Chapter 2, I find peer, school and neighborhood contexts do not reduce the association between childhood poverty and homeleaving; instead, family processes mediate the association between childhood poverty exposure and the path to homeleaving somewhat. In Chapter 4, I examine the effect of economic instability on relationship dissolution and among married and cohabiting parents using four waves of data from the Fragile Families and Child Wellbeing Study. Few studies have compared differences in relationship stability among married and cohabiting parents who have just had a child. My results highlight the importance of economic circumstances and social norms regarding fathers\u27 role as breadwinner in shaping relationship stability for married parents. I also find that relationship quality mediates the effects of economic strain on relationship outcomes. Further, differences in the determinants of relationship stability and relationship quality for married and cohabiting parents suggest that marriage and cohabitation remain two distinct institutions even for those who have selected into parenthood

Three essays on economic instability, social context & outcomes in early adulthood

This dissertation addresses the effects of economic disadvantage and economic instability on educational and family outcomes in early adulthood. In two related essays, I explore the influence of childhood poverty exposure on educational attainment (Chapter 2) and homeleaving (Chapter 3) in early adulthood using data from the children of the female respondents in the National Longitudinal Survey of Youth 1979. I apply Bronfenbrenner\u27s (1979) ecological framework and examine the extent to which family processes, peer and school contexts and neighborhood environment serve as mechanisms through which childhood poverty shapes these outcomes. In Chapter 2, I find that persistent and long-term childhood poverty reduce educational attainment even when family and school contexts are considered. Further, peer environment in early adolescence appears to reduce the influence of poverty exposure on educational attainment in early adulthood more than family processes or school context. In Chapter 3, I find that persistent and long-term childhood poverty is directly associated with the likelihood of leaving home by age 20 for reasons other than school attendance, even after family processes, peer and school contexts and neighborhood environment are considered. In contrast to results for Chapter 2, I find peer, school and neighborhood contexts do not reduce the association between childhood poverty and homeleaving; instead, family processes mediate the association between childhood poverty exposure and the path to homeleaving somewhat. In Chapter 4, I examine the effect of economic instability on relationship dissolution and among married and cohabiting parents using four waves of data from the Fragile Families and Child Wellbeing Study. Few studies have compared differences in relationship stability among married and cohabiting parents who have just had a child. My results highlight the importance of economic circumstances and social norms regarding fathers\u27 role as breadwinner in shaping relationship stability for married parents. I also find that relationship quality mediates the effects of economic strain on relationship outcomes. Further, differences in the determinants of relationship stability and relationship quality for married and cohabiting parents suggest that marriage and cohabitation remain two distinct institutions even for those who have selected into parenthood

Social Determinants of Sexual Behavior and Awareness of Sexually Transmitted Infections (STI) Among Low-Income HIV+ or STI At-Risk Hispanic Residents Receiving Care at the U.S.–Mexico Border

U.S.–Mexico border communities are uniquely vulnerable to sexually transmitted infection (STI) transmission given the economic and social challenges these communities face. This study examines how marginalized statuses of U.S. border residents are associated with STI awareness and sexual behaviors. We surveyed low-income residents receiving STI testing and/or HIV/AIDS care in the lower Rio Grande Valley of southernmost Texas. Respondents aged 18+ took a self-administered survey available in English or Spanish in a clinic waiting room (N = 282). Approximately 52% of respondents reported being HIV+, and 32% of respondents reported having a prior STI other than HIV. Although most respondents had heard of HPV (72%), awareness of the HPV vaccine was low across all subgroups (28%), including women (\u3c 35%), reflecting previous findings that border residents are less knowledgeable about the HPV vaccine. Almost half of respondents reported always using a condom (45%), which is higher than elsewhere in the U.S. Male and non-Hispanic respondents had higher estimated prevalence ratios (PR) of lifetime partners [PR 1.39 (95% confidence interval 1.43–3.68), PR 1.88 (1.04–3.41), respectively] and sexual partners met online [PR 3.73 (1.00–14.06), PR 19.98 (5.70–70.10), respectively]. Sexual minority, non-Hispanic, and male respondents had higher adjusted odds ratios (AOR) of utilizing the internet to find sexual partners than their peers [AOR 2.45 (1.60–3.87), AOR 1.52 (1.11–2.07), AOR 1.97 (1.20–3.24), respectively], placing them at greater STI-transmission risk. We found diversity in dimensions of STI awareness and sexual behaviors in our sample. Results can help tailor public health interventions to the unique STI risks of marginalized groups in border communities