Jeff A. Dennis

Negative Acculturation and Nothing More? Cumulative Disadvantage and Mortality during the Immigrant Adaptation Process among Latinos in the United States†

Foreign- and U.S.-born Hispanic health deteriorates with increasing exposure and acculturation to mainstream U.S. society. Because these associations are robust to (static) socioeconomic controls, negative acculturation has become their primary explanation. This overemphasis, however, has neglected important alternative structural explanations. Examining Hispanic mortality using the 1998–2006 U.S. National Health Interview Survey-Linked Mortality File according to nativity, immigrant adaptation measures, and health behaviors, this study presents indirect but compelling evidence that suggests negative acculturation is not the only or main explanation for this deterioration.

Young maternal age and low birth weight risk: An exploration of racial/ethnic disparities in the birth outcomes of mothers in the United States

Abstract This study considers how low birth weight (LBW) prevalence varies by race/ethnicity and maternal age and explores mechanisms that explain disparities. Results show that maternal age patterns in LBW risk for African Americans differ from Whites and foreign- and U.S.-born Hispanics. Background socioeconomic disadvantage, together with current socioeconomic status and smoking during pregnancy, explain almost all of the LBW disparity between white teenage mothers and their older counterparts. These findings suggest that social disadvantage is a primary driver in unfavorable birth outcomes among white teenage mothers compared to older white mothers. Alternatively, background disadvantage and other social characteristics explain very little of the LBW disparities among African Americans and U.S.- and foreign-born Hispanics. Overall, these results indicate LBW disparities by maternal age are a complex product of socioeconomic disadvantage and current social and behavioral factors, such that LBW risk does not operate uniformly by race/ethnicity or maternal age.

A Tale of Three Paradoxes: The Weak Socioeconomic Gradients in Health Among Hispanic Immigrants and Their Relation to the Hispanic Health Paradox and Negative Acculturation

Although Latino immigrants come from countries with high levels of inequality, their socioeconomic gradients in health are generally weaker than those among their US-born co-ethnics and much weaker than those of US-born non-Hispanic (NH) whites. We review this literature among Latin American immigrants looking at the role of: factors related to conditions in the country of origin, or “gradient importation”; migration-related factors, such as Socioeconomic Status (SES)-graded health selectivity in emigration and return; destination-based factors, including SES-graded protection and selection; and data artifacts, which might be more likely to occur at lower levels of SES. Despite the relative scarcity of studies on the social gradients in health among immigrants, recent research has provided interesting insights on the potential mechanisms driving the Hispanic Health Paradox and on the potential role of socioeconomic status on “acculturation” in health. We discuss which of the reviewed mechanisms may be more relevant in late life, point out potential avenues for future research, and reflect upon the steepness of white gradients in the United States.

Importation, SES-selective Acculturation, and the Weaker SES-health Gradients of Mexican Immigrants in the United States.

Abstract Previous studies find U.S. immigrants have weaker socioeconomic gradients in health relative to non-Hispanic Whites and their U.S.-born co-ethnics. Several explanations have been advanced but few have been tested empirically. We use data from the Mexican Family Life Survey and the U.S. National Health Interview Survey, including longitudinal data in the former measuring socioeconomic status (SES) and health previous to emigration, to test if (1) immigrants “import” their gradients from the sending country, or if (2) they may be changing as a result of SES-graded acculturation among Mexican migrant men in two health indicators: obesity and current smoking. We find evidence consistent with the first hypothesis: the gradients of migrants measured prior to coming to the U.S. are not statistically different from those of nonmigrants, as the gradients of each are relatively weak. Although the gradients for obesity and smoking appear to weaken with time spent in the U.S., the differences are not significant, suggesting little support for the selective acculturation hypothesis.

Complementary and Alternative Medicine Use Among US Adults With Headache or Migraine: Results from the 2012 National Health Interview Survey

Given the safety concerns regarding pharmacological agents, and the considerable impact of headache and migraine on the sufferers quality of life, many people seek other treatment options beyond conventional medication and care to address their symptoms; this includes complementary and alternative medicine (CAM). Some CAM interventions have shown promising results in clinical trials of headache and migraine management. Nonetheless, there has been little research exploring the reasons for using CAM, and the types of CAM used, among this population.

Impact of time spent in the trauma bay on mortality outcomes among level 1 trauma patients

Introduction The majority of trauma-related deaths occur within the first 24 h of injury, and time elapsed until intervention for an injury is one of the greatest causes of preventable death in mature trauma centers. This study seeks to determine if there is a correlation between time spent in the trauma bay and mortality outcomes. Methods A retrospective analysis of Level 1 trauma patients from 1 January 2010 to 1 January 2016 in a single center. Results Charts from 1678 Level 1 trauma patients with 1290 (76.9%) blunt and 388 (23.1%) penetrating injuries were analyzed. Of these, 345 patients died and 237 (68.7%) died within the first 24 h. Multivariate analysis yields an inverse correlation between increased times spent in the trauma bay and mortality, with controls for injury severity, age, and race/ethnicity and with deaths in the trauma bay excluded (p < 0.001). Each additional minute spent in the trauma bay increases odds of surviving by 1%. However, increase in ISS and decrease in TRISS were directly correlated with reduced time in the trauma bay for both blunt and penetrating traumas. Results did not differ based on mechanism of injury or destination after the trauma bay. Conclusion Reduced time spent in trauma bay was not correlated with improved mortality outcomes in Level 1 trauma patients. Findings do not necessarily suggest that increased trauma bay time would reduce mortality, but rather current evaluation procedures may prioritize trauma patients appropriately. Instinctive adjustment by emergency care providers to move more severely injured patients out of the trauma bay quicker and other additional variables could account for the measured phenomena. This is the first study to examine trauma bay times and mortality outcomes.

The Association of Unreported Sleep Disturbances and Systemic Inflammation: Findings from the 2005-2008 NHANES

Background/Objective Sleep apnea is associated with elevated inflammatory markers. A subgroup of patients never report sleep disturbances to their physician. The inflammatory status of this subgroup is not known. The present study aims to evaluate two inflammatory markers, C-reactive protein (CRP) and red cell distribution width (RDW), in those with unreported sleep disturbances and compares these findings to those with and without reported sleep disorders. We also investigate the utility of RDW as an inflammatory marker in sleep disorders. Methods Sample includes 9,901 noninstitutionalized, civilian, nonpregnant adults from the 2005-2008 National Health and Nutrition Examination Survey, a nationally representative, cross-sectional U.S. study. Sleep questionnaire and laboratory data were used to compare inflammatory markers (CRP and RDW) in five subgroups of individuals: reporting physician-diagnosed sleep apnea, reporting another physician-diagnosed sleep disorder, reported sleep disturbance to physician with no resulting diagnosis, unreported sleep disturbance (poor sleep quality not reported to physician), and no diagnosed sleep disorder or sleep disturbance. Results Individuals with unreported sleep disturbance had significantly higher odds of elevated RDW (>13.6%) when compared to those without a sleep disturbance in adjusted models (OR=1.33). Those with unreported sleep disturbance had significantly higher odds of elevated CRP levels (>1 mg/L) than those without sleep disturbances (OR 1.34), although the association was not significant when adjusted for obesity and other controls. Conclusion Self-identified unreported sleep disturbances are associated with significantly higher odds of elevated RDW than those without sleep disturbances. RDW may serve as a valuable indicator in identifying individuals at higher risk for sleep apnea and other sleep disorders.