Alana M. W. LeBrón

Cautious Citizenship: The Deterring Effect of Immigration Issue Salience on Health Care Use and Bureaucratic Interactions among Latino US Citizens

Research shows that health care use among Latino immigrants is adversely affected by restrictive immigration policy. A core concern is that immigrants shy away from sharing personal information in response to policies that expand bureaucratic monitoring of citizenship status across service-providing organizations. This investigation addresses the concern that immigration politics also negatively influences health care utilization among Latino US citizens. One implication is that health insurance expansions may not reduce health care inequities among Latinos due to concern about exposure to immigration law enforcement authorities. Using data from the 2015 Latino National Health and Immigration Survey, we examine the extent to which the politics of immigration deters individuals from going to health care providers and service-providing institutions. Results indicate that Latino US citizens are less likely to make an appointment to see a health care provider when the issue of immigration is mentioned. Additionally, Latino US citizens who know someone who has been deported are more inclined to perceive that information shared with health care providers is not secure. We discuss how cautious citizenship, or risk-avoidance behaviors toward public institutions in order to avoid scrutiny of citizenship status, informs debates about reducing health care inequities.

Policing Us Sick: The Health of Latinos in an Era of Heightened Deportations and Racialized Policing

© American Political Science Association, 2018 PS • April 2018 293 ........................................................................................................................................................................................................................................................................................................ ........................................................................................................................................................................................................................................................................................................

Impact of change over time in self-reported discrimination on blood pressure: implications for inequities in cardiovascular risk for a multi-racial urban community

ABSTRACT Objectives: The 21st century has seen a rise in racism and xenophobia in the United States. Few studies have examined the health implications of heightened institutional and interpersonal racism. This study examines changes in reported discrimination and associations with blood pressure over time among non-Latino Blacks (NLBs), Latinos, and non-Latino Whites (NLWs) in an urban area, and variations by nativity among Latinos. Design: Data from a probability sample of NLB, Latino, and NLW Detroit, Michigan residents were collected in 2002–2003, with follow-up at the same addresses in 2007–2008. Surveys were completed at 80% of eligible housing units in 2008 (n = 460). Of those, 219 participants were interviewed at both time points and were thus included in this analysis. Discrimination patterns across racial/ethnic groups and associations with blood pressure were examined using generalized estimating equations. Results: From 2002 to 2008, NLBs and Latinos reported heightened interpersonal and institutional discrimination, respectively, compared with NLWs. There were no differences in associations between interpersonal discrimination and blood pressure. Increased institutional discrimination was associated with stronger increases in systolic and diastolic blood pressure for NLBs than NLWs, with no differences between Latinos and NLWs. Latino immigrants experienced greater increases in blood pressure with increased interpersonal and institutional discrimination compared to US-born Latinos. Conclusions: Together, these findings suggest that NLBs and Latinos experienced heightened discrimination from 2002 to 2008, and that increases in institutional discrimination were more strongly associated with blood pressure elevation among NLBs and Latino immigrants compared to NLWs and US-born Latinos, respectively. These findings suggest recent increases in discrimination experienced by NLBs and Latinos, and that these increases may exacerbate racial/ethnic health inequities.

Correlates of Interpersonal Ethnoracial Discrimination Among Latino Adults with Diabetes: Findings from the REACH Detroit Study

ABSTRACT The purpose of this study is to identify the social and economic correlates of reported experiences of interpersonal ethnoracial discrimination among Latino adults in Detroit. We examine whether the correlates of interpersonal ethnoracial discrimination vary according to the domain of discrimination and compare findings for individual domains of discrimination to a composite measure of experiences of discrimination. This study suggests that the frequency of reported discrimination is moderately high, and relatively common among Latinos with diabetes who live in Detroit. The findings demonstrate that immigration and ethnicity-related factors, such as greater comfort speaking Spanish and being born in the United States, were persistent correlates of more frequent encounters of interpersonal ethnoracial discrimination. Implications for social work research and practice are presented.

Discrimination and Depressive Symptoms Among Latina/o Adolescents of Immigrant Parents.

Discrimination is associated with negative mental health outcomes for Latina/o adolescents. While Latino/a adolescents experience discrimination from a number of sources and across contexts, little research considers how the source of discrimination and the context in which it occurs affect mental health outcomes among Latina/o children of immigrants. We examined the association between source-specific discrimination, racial or ethnic background of the source, and school ethnic context with depressive symptoms for Latina/o adolescents of immigrant parents. Using multilevel linear regression with time-varying covariates, we regressed depressive symptoms on source-specific discrimination, racial or ethnic background of the source of discrimination, and school percent Latina/o. Discrimination from teachers (β = 0.06, p < .05), students (β = 0.05, p < .05), Cubans (β = 0.19, p < .001), and Latinas/os (β = 0.19, p < .001) were positively associated with depressive symptoms. These associations were not moderated by school percent Latina/o. The findings indicate a need to reduce discrimination to improve Latina/o adolescents’ mental health.

Storytelling in Community Intervention Research: Lessons Learned From the Walk Your Heart to Health Intervention

Background: Contextually and culturally congruent interventions are urgently needed to reduce racial, ethnic, and socioeconomic inequities in physical activity and cardiovascular disease.Objectives: To examine a community-based participatory research (CBPR) process that incorporated storytelling into a physical activity intervention, and consider implications for reducing health inequities.Methods: We used a CBPR process to incorporate storytelling in an existing walking group intervention. Stories conveyed social support and problem-solving intervention themes designed to maintain increases in physical activity over time, and were adapted to the walking group context, group dynamics, challenges, and traditions.Lessons Learned: After describing of the CBPR process used to adapt stories to walking group sites, we discuss challenges and lessons learned regarding the adaptation and implementation of stories to convey key intervention themes.Conclusions: A CBPR approach to incorporating storytelling to convey intervention themes offers an innovative and flexible strategy to promote health toward the elimination of health inequities.

Antihypertensive Medication Use: Implications for Inequities in Cardiovascular Risk and Opportunities for Intervention

Abstract:Antihypertensive medication use protects against adverse health effects of hyper-tension. Residents of low-income urban communities are disproportionately Black and Latino, and may experience heightened cardiovascular health risks due to reduced medication use. We estimate the odds of antihypertensive medication use by race/ethnicity and socioeconomic position. Data are from the Healthy Environments Partnership Community Survey, restricted to 377 hypertensive participants. Antihypertensive medication use was defined as people with hypertension who were taking antihypertensive medication. Racial/ethnic and socioeconomic differences in medication use were examined using multivariate logistic regression. Odds of antihypertensive medication use were lower for people with incomes 1.00–1.99 times the poverty level (OR=0.75, p=.05) compared with those ≥2.00 times poverty, and for Latinos (OR=0.48, p<.01) and Whites (OR=0.50, p<.01) compared with Blacks. Findings suggest a need to improve hypertension screening and treatment for residents of low-to moderate-income urban communities, with attention to subgroups who may have limited health care access.

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.

Racial/Ethnic Discrimination and Diabetes-Related Outcomes Among Latinos with Type 2 Diabetes

Discrimination is associated with adverse health outcomes, but few studies have examined the association of discrimination with diabetes-related outcomes including mental health and glycemic control, particularly for immigrant and US-born Latinos. We analyzed survey data (n = 222) collected at baseline of a diabetes intervention. Using multiple linear regression, we examined the association of racial/ethnic discrimination with depressive symptoms, diabetes-related distress, and HbA1c, and variation in these associations by nativity and, for immigrants, length of US residence. Racial/ethnic discrimination was positively associated with depressive symptoms (b = 2.57, SE = 0.45, p < 0.01) and diabetes-related distress (b = 0.30, SE = 0.09, p < 0.01). We could not reject the null hypothesis of no cross-sectional association of racial/ethnic discrimination with HbA1c (b = − 0.27, SE = 0.18, p = 0.14). Although racial/ethnic discrimination did not directly affect HbA1c, racial/ethnic discrimination had a significant mediating effect on HbA1c through diabetes-related distress (p = 0.02). Results suggest that racial/ethnic discrimination is detrimental for health for Latinos with diabetes.

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

OBJECTIVE This 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 METHODS The 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. RESULTS Participants 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. CONCLUSIONS This 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.