Krista M. Perreira

Prevalence of Major Cardiovascular Risk Factors and Cardiovascular Diseases Among Hispanic/Latino Individuals of Diverse Backgrounds in the United States

CONTEXT Major cardiovascular diseases (CVDs) are leading causes of mortality among US Hispanic and Latino individuals. Comprehensive data are limited regarding the prevalence of CVD risk factors in this population and relations of these traits to socioeconomic status (SES) and acculturation. OBJECTIVES To describe prevalence of major CVD risk factors and CVD (coronary heart disease [CHD] and stroke) among US Hispanic/Latino individuals of different backgrounds, examine relationships of SES and acculturation with CVD risk profiles and CVD, and assess cross-sectional associations of CVD risk factors with CVD. DESIGN, SETTING, AND PARTICIPANTS Multicenter, prospective, population-based Hispanic Community Health Study/Study of Latinos including individuals of Cuban (n = 2201), Dominican (n = 1400), Mexican (n = 6232), Puerto Rican (n = 2590), Central American (n = 1634), and South American backgrounds (n = 1022) aged 18 to 74 years. Analyses involved 15,079 participants with complete data enrolled between March 2008 and June 2011. MAIN OUTCOME MEASURES Adverse CVD risk factors defined using national guidelines for hypercholesterolemia, hypertension, obesity, diabetes, and smoking. Prevalence of CHD and stroke were ascertained from self-reported data. RESULTS Age-standardized prevalence of CVD risk factors varied by Hispanic/Latino background; obesity and current smoking rates were highest among Puerto Rican participants (for men, 40.9% and 34.7%; for women, 51.4% and 31.7%, respectively); hypercholesterolemia prevalence was highest among Central American men (54.9%) and Puerto Rican women (41.0%). Large proportions of participants (80% of men, 71% of women) had at least 1 risk factor. Age- and sex-adjusted prevalence of 3 or more risk factors was highest in Puerto Rican participants (25.0%) and significantly higher (P < .001) among participants with less education (16.1%), those who were US-born (18.5%), those who had lived in the United States 10 years or longer (15.7%), and those who preferred English (17.9%). Overall, self-reported CHD and stroke prevalence were low (4.2% and 2.0% in men; 2.4% and 1.2% in women, respectively). In multivariate-adjusted models, hypertension and smoking were directly associated with CHD in both sexes as were hypercholesterolemia and obesity in women and diabetes in men (odds ratios [ORs], 1.5-2.2). For stroke, associations were positive with hypertension in both sexes, diabetes in men, and smoking in women (ORs, 1.7-2.6). CONCLUSION Among US Hispanic/Latino adults of diverse backgrounds, a sizeable proportion of men and women had adverse major risk factors; prevalence of adverse CVD risk profiles was higher among participants with Puerto Rican background, lower SES, and higher levels of acculturation.

Making It in America: High School Completion by Immigrant and Native Youth

Using data from the National Longitudinal Study of Adolescent Health (Add Health), we find that first-generation youth of Hispanic, Asian, and African heritage obtain more education than their parents, but the second generation and third or higher generations lose ground. Differences in dropout rates by race-ethnicity and immigrant generation are driven by differences in human, cultural, and social capital. Low levels of family human capital, school social capital, and community social capital place the children of immigrants at risk of dropping out. However, cultural capital and immigrant optimism buffer first-generation Hispanic youth and the children of Asian immigrants from the risk of dropping out of high school. While human and social capital resources improve with immigrant generation, cultural capital diminishes.

Becoming an American Parent Overcoming Challenges and Finding Strength in a New Immigrant Latino Community

One in five children living in the United States is an immigrant or a child of an immigrant, and 62% of these children are Latino. Through qualitative methods, this study identifies ways that Latino immigrant parents with adolescent children cope with their new environment and how that environment shapes their parenting practices. Two primary themes emerge: overcoming new challenges and finding new strengths. Immigrant parents discuss the challenges of overcoming fears of the unknown; navigating unfamiliar work, school, and neighborhood environments; encountering and confronting racism; and losing family connections and other forms of social capital. In response to these challenges, immigrant parents discuss developing bicultural coping skills, increasing parent-child communication, empathizing with and respecting their adolescent children, and fostering social supports. The results fit well with a risk and protective factor framework and provide a basis for improving policies and programs to support effective parenting in Latino immigrant families.

The role of migration in the development of depressive symptoms among Latino immigrant parents in the USA

Nearly one out of every four children in the US is a child of immigrants. Yet few studies have assessed how factors at various stages of migration contribute to the development of health problems in immigrant populations. Most focus only on post-migration factors influencing health. Using data from the Latino Adolescent Migration, Health, and Adaptation Project, this study assessed the extent to which pre-migration (e.g., major life events, high poverty), migration (e.g., unsafe and stressful migration experiences), post-migration (e.g., discrimination, neighborhood factors, family reunification, linguistic isolation), and social support factors contributed to depressive symptoms among a sample of Latino immigrant parents with children ages 12-18. Results indicated that high poverty levels prior to migration, stressful experiences during migration, as well as racial problems in the neighborhood and racial/ethnic discrimination upon settlement in the US most strongly contribute to the development of depressive symptoms among Latino immigrant parents. Family reunification, social support, and familism reduce the likelihood of depressive symptoms.

The Physical and Psychological Well-Being of Immigrant Children

Poor childhood health contributes to lower socioeconomic status in adulthood. Subsequently, low socioeconomic status among parents contributes to poor childhood health outcomes in the next generation. This cycle can be particularly pernicious for vulnerable and low-income minority populations, including many children of immigrants. And because of the rapid growth in the numbers of immigrant children, this cycle also has implications for the nation as a whole. By promoting the physical well-being and emotional health of children of immigrants, health professionals and policy makers can ultimately improve the long-term economic prospects of the next generation.Despite their poorer socioeconomic circumstances and the stress associated with migration and acculturation, foreign-born children who immigrate to the United States typically have lower mortality and morbidity risks than U.S. children born to immigrant parents. Over time, however, and across generations, the health advantage of immigrant children fades. For example, researchers have found that the share of adolescents who are overweight or obese, a key indicator of physical health, is lowest for foreign-born youth, but these shares grow larger for each generation and increase rapidly as youth transition into adulthood.Access to health care substantially influences the physical and emotional health status of immigrant children. Less likely to have health insurance and regular access to medical care services than nonimmigrants, immigrant parents delay or forgo needed care for their children. When children finally receive care, it is often in the emergency room after an urgent condition has developed. To better promote the health of children of immigrants, health researchers and reformers must improve their understanding of the unique experiences of immigrant children; increase access to medical care and the capacity of providers to work with multilingual and multicultural populations; and continue to improve the availability and affordability of health insurance for all Americans.

Race/Ethnicity and Nativity Differences in Alcohol and Tobacco Use During Pregnancy

OBJECTIVES We examined race/ethnicity and nativity correlates of prenatal substance use. METHODS Using data on a nationally representative cohort of pregnant women in US cities (N=4185), we evaluated the relative importance of socioeconomic status, paternal health behaviors, social support, and maternal stress and health history in explaining variations in prenatal substance use by race/ethnicity and nativity. RESULTS Maternal stress and health history appeared to fully explain differences in alcohol use by nativity, but these and other factors could not explain differences in prenatal smoking. For all races/ethnicities, paternal health behaviors were most strongly associated with maternal substance use. Except among Black women, socioeconomic background bore little relation to prenatal substance use after adjustment for more proximal risk factors (e.g., paternal and maternal health behaviors). Social support was most protective among Hispanic women. CONCLUSIONS Foreign-born immigrant women are at equal risk of prenatal alcohol use compared with similarly situated US-born women and should not be overlooked in the design of interventions for at-risk women. Furthermore, the inclusion of fathers and the development of social support structures for at-risk women can strengthen interventions.

Troubled Times, Troubled Relationships: How Economic Resources, Gender Beliefs, and Neighborhood Disadvantage Influence Intimate Partner Violence

We evaluate race/ethnicity and nativity-based disparities in three different types of intimate partner violence (IPV) and examine how economic hardship, maternal economic dependency, maternal gender beliefs, and neighborhood disadvantage influence these disparities. Using nationally representative data from urban mothers of young children who are living with their intimate partners (N = 1,886), we estimate a series of unadjusted and adjusted logit models on mothers’ reports of physical assault, emotional abuse, and coercion. When their children were age 3, more than one in five mothers were living with a partner who abused them. The prevalence of any IPV was highest among Hispanic (26%) and foreign-born (35%) mothers. Economic hardship, economic dependency on a romantic partner, and traditional gender beliefs each increased women’s risk for exposure to one or more types of IPV, whereas neighborhood conditions were not significantly related to IPV in adjusted models. These factors also explained most of the racial/ethnic and nativity disparities in IPV. Policies and programs that reduce economic hardship among women with young children, promote women’s economic independence, and foster gender equity in romantic partnerships can potentially reduce multiple forms of IPV.

The color of health: skin color, ethnoracial classification, and discrimination in the health of Latin Americans.

Latin America is one of the most ethnoracially heterogeneous regions of the world. Despite this, health disparities research in Latin America tends to focus on gender, class and regional health differences while downplaying ethnoracial differences. Few scholars have conducted studies of ethnoracial identification and health disparities in Latin America. Research that examines multiple measures of ethnoracial identification is rarer still. Official data on race/ethnicity in Latin America are based on self-identification which can differ from interviewer-ascribed or phenotypic classification based on skin color. We use data from Brazil, Colombia, Mexico, and Peru to examine associations of interviewer-ascribed skin color, interviewer-ascribed race/ethnicity, and self-reported race/ethnicity with self-rated health among Latin American adults (ages 18-65). We also examine associations of observer-ascribed skin color with three additional correlates of health - skin color discrimination, class discrimination, and socio-economic status. We find a significant gradient in self-rated health by skin color. Those with darker skin colors report poorer health. Darker skin color influences self-rated health primarily by increasing exposure to class discrimination and low socio-economic status.

Trajectories of Delinquency From Adolescence to Adulthood

Rising immigration rates to the United States have been associated with increased public sentiment against immigrant populations and fears that immigration will lead to escalations in crime and delinquency. However, surprisingly few researchers have studied delinquency among immigrant youth overall or in comparison with U.S.-born youth. Guided by a life-course perspective, this article uses three waves of the National Longitudinal Study of Adolescent Health to describe longitudinal variations in delinquency by gender, race/ethnicity, immigrant generation, coethnic community concentration, and their interactions. The article finds that first-generation Asian females and second-generation Hispanic females have the highest risk of delinquency during early adolescence. During late adolescence, Asian and Hispanic third-plus generation youth have the highest risk of delinquency. However, as youth transition to adulthood, the rates of delinquency for all population groups converge.

“It Turned My World Upside Down”: Latino Youths’ Perspectives on Immigration

Few studies have examined the migration and acculturation experiences of Latino youth in a newly emerging Latino community, communities that historically have had low numbers of Latino residents. This study uses in-depth interview data from the Latino Adolescent, Migration, Health, and Adaptation (LAMHA) project, a mixed-methods study, to document the experiences of Latino youth (aged 14-18) growing up in one emerging Latino community in the southeastern region of North Carolina. Using adolescent’s own words and descriptions, this study shows how migration can turn an adolescent’s world upside down, and it discovers the adaptive strategies that Latino immigrant youth use to turn their world right-side-up as they adapt to life in the United States.