Jacqueline M. Torres

Migration Circumstances, Psychological Distress, and Self-Rated Physical Health for Latino Immigrants in the United States

OBJECTIVES We determined the impact of premigration circumstances on postmigration psychological distress and self-rated physical health among Latino immigrants. METHODS We estimated ordinary least squares and logistic regression models for Latino immigrants in the 2002-2003 National Latino and Asian American Study (n = 1603). RESULTS Mean psychological distress scores (range = 10-50) were 14.8 for women and 12.7 for men; 35% of women and 27% of men reported fair or poor physical health. A third of the sample reported having to migrate; up to 46% reported unplanned migration. In multivariate analyses, immigration-related stress was significantly associated with psychological distress, but not with self-rated health, for both Latino men and women. Having to migrate was associated with increased psychological distress for Puerto Rican and Cuban women respondents and with poorer physical health for Puerto Rican migrant men. Unplanned migration was significantly associated with poorer physical health for all Latina women respondents. CONCLUSIONS The context of both pre- and postmigration has an impact on immigrant health. Those involved in public health research, policy, and practice should consider variation in immigrant health by migration circumstances, including the context of exit and other immigration-related stressors.

I want to be taking my own last breath: patients' reflections on illness when presenting to the emergency department at the end of life.

OBJECTIVE To understand perceptions regarding their illness of patients who present to the Emergency Department at the end of life. METHODS Semistructured one-on-one interviews were performed with a convenience sample of seriously ill, Emergency Department (ED) patients with advanced illness presenting to an urban, public hospital. A bilingual Latina health promoter used a predetermined discussion guide to conduct all interviews. Non-English- or Non-Spanish-speaking patients and those with uncontrolled symptoms or cognitive deficits were excluded. All interviews were recorded and transcribed, and grounded theory methodology was used to analyze the results. RESULTS Thirteen patients with advanced illness participated, 8 of whom were Spanish-speaking only. Because of difficulty accessing care and financial concerns, patients with advanced illness present to EDs when their pain or other symptoms are out of control. The majority derive great comfort and strength from their faith in God, who they believe determines their fate. Most listed spending time with family, and not being a burden, as most important at the end of life, and many expressed a preference to die at home surrounded by loved ones. Almost none had spoken to physicians about their care preferences. CONCLUSIONS Patients with advanced illness present to the ED of a safety net hospital when symptoms are out of control. They have many financial concerns, want to spend their remaining days with family, and do not want to be a burden. Most derive immense comfort from faith in God, but do not feel they have control over their own fate.

Paramedic and Emergency Medical Technicians Views on Opportunities and Challenges When Forgoing and Halting Resuscitation in the Field

OBJECTIVES The objective was to assess paramedic and emergency medical technicians (EMT) perspectives and decision-making after a policy change that allows forgoing or halting resuscitation in prehospital atraumatic cardiac arrest. METHODS Five semistructured focus groups were conducted with 34 paramedics and 2 EMTs from emergency medical services (EMS) agencies within Los Angeles County (LAC), 6 months after a policy change that allowed paramedics to forgo or halt resuscitation in the field under certain circumstances. RESULTS Participants had an overwhelmingly positive view of the policy; felt it empowered their decision-making abilities; and thought the benefits to patients, family, EMS, and the public outweighed the risks. Except under certain circumstances, such as when the body was in public view or when family members did not appear emotionally prepared to have the body left on scene, they felt the policy improved care. Assuming that certain patient characteristics were present, decisions by paramedics about implementing the policy in the field involve many factors, including knowledge and comfort with the new policy, family characteristics (e.g., agreement), and logistics regarding the place of arrest (e.g., size of space). Paramedic and EMT experiences with and attitudes toward forgoing resuscitation, as well as group dynamics among EMS leadership, providers, police, and ED staff, also play a role. CONCLUSIONS Participants view the ability to forgo or halt resuscitation in the field as empowering and do not believe it presents harm to patients or families under most circumstances. Factors other than patient clinical characteristics, such as knowledge and attitudes toward the policy, family emotional preparedness, and location of arrest, affect whether paramedics will implement it.

Comparison of the Mental Health of Female Adult Film Performers and Other Young Women in California

OBJECTIVE This study compared self-reported mental health status and current depression of female adult film performers and other young women. METHODS A cross-sectional structured online survey adapted from the California Womens Health Survey (CWHS) was self-administered to a convenience sample of 134 current female adult film performers via the Internet. Bivariate and multivariate analyses were used to compare data for these women with data for 1,773 women of similar ages who responded to the 2007 CWHS. Main outcome measures were self-reported mental health status, measured with the Behavioral Risk Factor Surveillance Survey core-instrument quality-of-life questions, and current depression, measured with the Patient Health Questionnaire-8. RESULTS Performers reported a mean of 7.2 days of poor mental health in the past 30 days, compared with 4.8 days for CWHS respondents, and 33% met criteria for current depression, compared with 13% of CWHS respondents (p<.01). As children, the adult film performers were more likely to have been victims of forced sex (37% compared with 13% of CWHS respondents), to have lived in poverty (24% and 12%), and to have been placed in foster care (21% and 4%) (p<.01). In the past 12 months, 50% of the performers reported living in poverty and 34% reported experiencing domestic violence, compared with 36% and 6%, respectively, of CWHS respondents (p<.01). As adults, 27% had experienced forced sex, compared with 9% of CWHS respondents (p<.01). CONCLUSIONS Female adult film performers have significantly worse mental health and higher rates of depression than other California women of similar ages.

Pathways to Health Risk Exposure in Adult Film Performers

Despite being part of a large and legal industry in Los Angeles, little is known about adult film performers’ exposure to health risks and when and how these risks might occur. The objective was to identify exposure to physical, mental, and social health risks and the pathways to such risks among adult film performers and to determine how risks differ between different types of performers, such as men and women. Semi-structured in-depth interviews were conducted with 18 female and ten male performers as well as two key informants from the industry. Performers and key informants were recruited through Protecting Adult Welfare, adult film venues, and snowball sampling. Performers engaged in risky health behaviors that included high-risk sexual acts that are unprotected, substance abuse, and body enhancement. They are exposed to physical trauma on the film set. Many entered and left the industry with financial insecurity and suffered from mental health problems. Women were more likely than men to be exposed to health risks. Adult film performers, especially women, are exposed to health risks that accumulate over time and that are not limited to sexually transmitted diseases.

Civic Stratification and the Exclusion of Undocumented Immigrants from Cross-border Health Care

This paper proposes a theoretical framework and an empirical example of the relationship between the civic stratification of immigrants in the United States, and their access to healthcare. We use the 2007 Pew Hispanic Center/Robert Wood Johnson Foundation Hispanic Healthcare Survey, a nationally representative survey of U.S. Latinos (N = 2,783 foreign-born respondents) and find that immigrants who are not citizens or legal permanent residents are significantly more likely to be excluded from care in both the United States and across borders. Legal-status differences in cross-border care utilization persisted after controlling for health status, insurance coverage, and other potential demographic and socioeconomic predictors of care. Exclusion from care on both sides of the border was associated with reduced rates of receiving timely preventive services. Civic stratification, and political determinants broadly speaking, should be considered alongside social determinants of population health and health care.

A longitudinal analysis of cross-border ties and depression for Latino adults

Recent scholarship suggests a significant association between cross-border ties, or ties maintained with family and friends in countries and communities of origin, and the mental health of immigrants and their descendants. To date, this research has been exclusively cross-sectional, precluding conclusions about a causal association between cross-border ties and mental health outcomes. In the present study we undertake a longitudinal analysis of the relationship between cross-border ties and depression measured over a ten-year period for a sample of immigrant and U.S.-born Latinos. Data are from the Sacramento Area Latino Study on Aging (1998-2008), a population-based, prospective study of Latin American-origin adults 60 years and older. We find that cross-border ties reported at baseline were significantly associated with depression in subsequent study waves, even after controlling for the presence of depression at baseline, albeit with substantial differences by gender and nativity. Specifically, communication with family and friends in Latin America and travel to Latin America at baseline were each significantly associated with greater odds of depression for immigrant women, but with lower odds of depression for U.S.-born Latina women over the study period. Travel to Latin America at baseline was significantly associated with lower odds of depression for Latino men across the study. Across all models we control for depressive symptomatology at baseline to account for the reciprocal nature of depressive symptoms and engagement with social ties, including cross-border ties. Our findings suggest that cross-border ties may represent a unique source of both resilience and risk for the long-term mental health of immigrant Latinos and their descendants.

A life-course perspective on legal status stratification and health

Scholars have expressed growing interest in the relationship between legal status stratification and health. Nevertheless, the extant research often lacks theoretical underpinnings. We propose the life-course perspective as a theoretical lens with which to understand relationships between legal status stratification and health outcomes. In particular, the life-course perspective guides researchers׳ attention to historical contexts that have produced differential social, political, and economic outcomes for immigrants based on legal status, and to the potentially long-term and intergenerational relationships between legal status stratification and health. We review four key dimensions of the life-course perspective and make recommendations for future directions in public health research on legal status and health.

A Portrait of Older Californians With Disabilities Who Rely on Public Services to Remain Independent

Low-income older adults with disabilities in California depend on a variety of public programs to help them remain in their own homes. The availability of those services has been in flux since 2009 because of cuts caused by the recession. This article reports on a qualitative study of 33 California seniors who depend on fragile arrangements of paid and unpaid assistance. Thematic analyses of in-depth interviews conducted with these older adults and their caregivers indicate that the disability needs of these individuals are often unstable, with both physical and mental health status sometimes changing day to day. Most have nowhere else to turn for help if their public services are cut. All share the common goal of staying at home and maintaining their independence. Public services serve as a crucial link in the support networks of these individuals.

Icd Social Codes: An Underutilized Resource for Tracking Social Needs

Background: Social determinants of health (SDH) data collected in health care settings could have important applications for clinical decision-making, population health strategies, and the design of performance-based incentives and penalties. One source for cataloging SDH data is the International Statistical Classification of Diseases and Related Health Problems (ICD). Objective: To explore how SDH are captured with ICD Ninth revision SDH V codes in a national inpatient discharge database. Materials and Methods: Data come from the 2013 Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample, a national stratified sample of discharges from 4363 hospitals from 44 US states. We estimate the rate of ICD-9 SDH V code utilization overall and by patient demographics and payer categories. We additionally estimate the rate of SDH V code utilization for: (a) the 5 most common reasons for hospitalization; and (b) the 5 conditions with the highest rates of SDH V code utilization. Results: Fewer than 2% of overall discharges in the National Inpatient Sample were assigned an SDH V code. There were statistically significant differences in the rate of overall SDH V code utilization by age categories, race/ethnicity, sex, and payer (all P<0.001). Nevertheless, SDH V codes were assigned to <7% of discharges in any demographic or payer subgroup. SDH V code utilization was highest for major diagnostic categories related to mental health and alcohol/substance use-related discharges. Conclusions: SDH V codes are infrequently utilized in inpatient settings for discharges other than those related to mental health and alcohol/substance use. Utilization incentives will likely need to be developed to realize the potential benefits of cataloging SDH information.