Lisa M. Bates

Immigration and Generational Trends in Body Mass Index and Obesity in the United States: Results of the National Latino and Asian American Survey, 2002–2003

OBJECTIVES We examined patterns of body mass index (BMI) and obesity among a nationally representative sample of first-, second-, and third-generation Latinos and Asian Americans to reveal associations with nativity or country of origin. METHODS We used data from the National Latino and Asian American Survey (2002-2003) to generate nationally representative estimates of mean BMI and obesity prevalence and explored changes in the distribution of BMI by generational status. Analyses tested the association between generational status and BMI and examined whether this association varied by ethnicity, education, or gender. RESULTS We found substantial heterogeneity in BMI and obesity by country of origin and an increase in BMI in later generations among most subgroups. The data suggest different patterns for Latinos and Asian Americans in the nature and degree of distributional changes in BMI with generational status in the United States. CONCLUSIONS Generational status is associated with increased BMI and obesity among Latinos and Asian Americans. Aggregate estimates not accounting for nativity and country of origin may mask significant heterogeneity in the prevalence of obesity and patterns of distributional change, with implications for prevention strategies.

The effect of immigrant generation and duration on self-rated health among US adults 2003-2007

Global self-rated health (SRH) is increasingly a key indicator in the assessment of immigrant health. However, evidence of the impact on SRH of generational status, duration of residence in the US, and socioeconomic status (SES) among immigrants and their offspring is limited and inconsistent. We overcome limitations in existing research on this topic by using a uniquely large and diverse data source, the March Annual Social and Economic Supplement of the Current Population Survey (CPS; 2003-2007) (n = 637,209). As a result, we are able to disaggregate results by race/ethnicity, account for country of origin, and consider the role of multiple dimensions of SES. We find that overall first-generation immigrants in the US have lower odds of poor/fair SRH compared to the third-generation. This association is particularly strong for blacks and Hispanics but not significant for Asians. Among first-generation Asians and Hispanics, longer duration of residence is positively associated with poor/fair SRH. Finally, socioeconomic gradients in SRH tend to be less pronounced among the first-generation (versus the third) and, within the first-generation, among recent arrivals (versus those with longer durations). Our results highlight the importance of explicitly accounting for multiple immigration-related variables and their interactions with race/ethnicity and SES. Otherwise, studies may misestimate SRH differences by race/ethnicity and socioeconomic status. The continued growth of the US immigrant population and the second-generation underscore the need to examine patterns in immigrant health systematically.

“Another Mexican Birthweight Paradox? The Role of Residential Enclaves and Neighborhood Poverty in the Birthweight of Mexican-Origin Infants”

Examining whether contextual factors influence the birth outcomes of Mexican-origin infants in the US may contribute to assessing rival explanations for the so-called Mexican health paradox. We examined whether birthweight among infants born to Mexican-origin women in the US was associated with Mexican residential enclaves and exposure to neighborhood poverty, and whether these associations were modified by nativity (i.e. mothers place of birth). We calculated metropolitan indices of neighborhood exposure to Mexican-origin population and poverty for the Mexican-origin population, and merged with individual-level, year 2000 natality data (n=490,332). We distinguished between neighborhood exposure to US-born Mexican-origin population (i.e. ethnic enclaves) and neighborhood exposure to foreign-born (i.e. Mexico-born) Mexican-origin population (i.e. immigrant enclaves). We used 2-level hierarchical linear regression models adjusting for individual, metropolitan, and regional covariates and stratified by nativity. We found that living in metropolitan areas with high residential segregation of US-born Mexican-origin residents (i.e. high prevalence of ethnic enclaves) was associated with lower birthweight for infants of US-born Mexican-origin mothers before and after covariate adjustment. When simultaneously adjusting for exposure to ethnic and immigrant enclaves, the latter became positively associated with birthweight and the negative effect of the former increased, among US-born mothers. We found no contextual birthweight associations for mothers born in Mexico in adjusted models. Our findings highlight a differential effect of context by nativity, and the potential health effects of ethnic enclaves, which are possibly a marker of downward assimilation, among US-born Mexican-origin women.

Gender and health: Relational, intersectional, and biosocial approaches

Much of the research on sex/gender and health has been dominated by two foci: 1) empirical examinations of trends and explanations for sex differences in disease incidence and mortality and 2) sex-specific disease patterns and corresponding, often differential, investments of research and policy attention to “men’s health” and “women’s health” needs. Though these efforts have contributed to understanding the distribution and causes of disease and mortality – and have led to dramatic improvements in allocation of resources and in attention to previously neglected health issues affecting men andwomen – they often do not reflect contemporary gender/feminist theory and inadvertently reinforce outmoded binary constructions of sex (male vs. female) and gender (masculine vs. feminine), as well as treat sex and gender as easily separable. Indeed, the existence ofmale/female differences in health outcomes is often considered self-evident and confirming these differences is often privileged over exploring similarities. In this Special Issue, we strive to move the conceptualization of sex/gender and health away from these dominate foci with scholarship that utilizes contemporary feminist, relational approaches to gender (Connell, 2009; Ferree & Hess, 1987; Ridgeway, 2009; Schofield, Connell, Walker, Wood, & Butland, 2000), as well as prioritizing research on intersectional and biosocial approaches to gender and health (Fausto-Sterling, 2005; Hankivsky & Cormier, 2009; Hankivsky, 2011). By relational constructions of gender, we mean theory and research conceptualizing gender as a pervasive system of stratification that structures relationships and interactions between and among men and women, shapes access to resources and status, and signifies power (Connell, 1987; Scott, 1986). Gender is also conceived of as an agential process, whereby the meaning and expressions of gender are negotiated and “performed,” both shaped by and reproducing of social structure (Butler, 1990; West & Zimmerman, 1987). Hallmarks of these approaches are recognition of gender as dynamic and situational, attention to differences among women and among men, and

Gender and health inequities: A comment on the Final Report of the WHO Commission on the Social Determinants of Health

The Final Report of the World Health Organization (WHO) Commission on the Social Determinants of Health is a substantial and important contribution to understanding the social factors that shape global health inequities. Although gender is highlighted as a key social determinant of health, the reports conceptual approach inappropriately equates gender and health with womens health. This essay discusses the analytic and policy implications of this shortcoming.

Stress, coping, and depression: Testing a new hypothesis in a prospectively studied general population sample of U.S.-born Whites and Blacks

The scarcity of empirically supported explanations for the Black/White prevalence difference in depression in the U.S. is a conspicuous gap in the literature. Recent evidence suggests that the paradoxical observation of decreased risk of depression but elevated rates of physical illness among Blacks in the U.S. compared with Whites may be accounted for by the use of coping behaviors (e.g., alcohol and nicotine consumption, overeating) among Blacks exposed to high stress levels. Such coping behaviors may mitigate deleterious effects of stressful exposures on mental health while increasing the risk of physical ailments. The racial patterning in mental and physical health outcomes could therefore be explained by this mechanism if a) these behaviors were more prevalent among Blacks than Whites and/or b) the effect of these behavioral responses to stress was differential by race. The present study challenges this hypothesis using longitudinal, nationally-representative data with comprehensive DSM-IV diagnoses. Data are drawn from 34,653 individuals sampled in Waves 1 (2001-2002) and 2 (2004-2005) as part of the US National Epidemiologic Survey on Alcohol and Related Conditions. Results showed that a) Blacks were less likely to engage in alcohol or nicotine consumption at low, moderate, and high levels of stress compared to Whites, and b) there was a significant three-way interaction between race, stress, and coping behavior for BMI only (F = 2.11, df = 12, p = 0.03), but, contrary to the hypothesis, elevated BMI was protective against depression in Blacks at low, not high, levels of stress. Further, engagement in unhealthy behaviors, especially at pathological levels, did not protect against depression in Blacks or in Whites. In sum, the impact of stress and coping processes on depression does not appear to operate differently in Blacks versus Whites. Further research testing innovative hypotheses that would explain the difference in Black/White depression prevalence is warranted.

Gender and Crime Victimization Modify Neighborhood Effects on Adolescent Mental Health

OBJECTIVE: Leverage an experimental study to determine whether gender or recent crime victimization modify the mental health effects of moving to low-poverty neighborhoods. METHODS: The Moving to Opportunity (MTO) study randomized low-income families in public housing to an intervention arm receiving vouchers to subsidize rental housing in lower-poverty neighborhoods or to controls receiving no voucher. We examined 3 outcomes 4 to 7 years after randomization, among youth aged 5 to 16 years at baseline (n = 2829): lifetime major depressive disorder (MDD), psychological distress (K6), and Behavior Problems Index (BPI). Treatment effect modification by gender and family’s baseline report of recent violent crime victimization was tested via interactions in covariate-adjusted intent-to-treat and instrumental variable adherence-adjusted regression models. RESULTS: Gender and crime victimization significantly modified treatment effects on distress and BPI (P < .10). Female adolescents in families without crime victimization benefited from MTO treatment, for all outcomes (Distress B = –0.19, P = .008; BPI B = –0.13, P = .06; MDD B = –0.036, P = .03). Male adolescents in intervention families experiencing crime victimization had worse distress (B = 0.24, P = .004), more behavior problems (B = 0.30, P < .001), and nonsignificantly higher MDD (B = 0.022, P = .16) versus controls. Other subgroups experienced no effect of MTO treatment. Instrumental variable estimates were similar but larger. CONCLUSIONS: Girls from families experiencing recent violent crime victimization were significantly less likely to achieve mental health benefits, and boys were harmed, by MTO, suggesting need for cross-sectoral program supports to offset multiple stressors.

The intersection of sex, marital status, and cardiovascular risk factors in shaping stroke incidence: Results from the health and retirement study

OBJECTIVES: To examine the role of sex and marital status in the distribution and consequences of cardiovascular risk factors for stroke.

Racial differences in depression in the United States: how do subgroup analyses inform a paradox?

PurposeNon-Hispanic Blacks in the US have lower rates of major depression than non-Hispanic Whites, in national household samples. This has been termed a “paradox,” as Blacks suffer greater exposure to social stressors, a risk factor for depression. Subgroup analyses can inform hypotheses to explain this paradox. For example, it has been suggested that selection bias in household samples undercounts depression in Blacks; if selection is driving the paradox, Black–White differences should be most pronounced among young men with low education.MethodsWe examined Black–White differences in lifetime major depression in subgroups defined simultaneously by sex, age, and education using data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and the Collaborative Psychiatric Epidemiology Surveys (CPES).ResultsIn NESARC and CPES, Blacks had lower odds than Whites of lifetime major depression in 21 and 23 subgroups, respectively, of 24. All statistically significant differences were in subgroups favoring Blacks, and lower odds in Blacks were more pronounced among those with more education.ConclusionsThese results suggest that hypotheses to explain the paradox must posit global mechanisms that pertain to all subgroups defined by sex, age, and education. Results do not lend support for the selection bias hypothesis.

Stroke Incidence in Older US Hispanics: Is Foreign Birth Protective?

Background and Purpose— Although Hispanics are the fastest growing ethnic group in the United States, relatively little is known about stroke risk in US Hispanics. We compare stroke incidence and socioeconomic predictors in US- and foreign-born Hispanics with patterns among non-Hispanic whites. Methods— Health and Retirement Study participants aged 50+ years free of stroke in 1998 (mean baseline age, 66.3 years) were followed through 2008 for self- or proxy-reported first stroke (n=15 784; 1388 events). We used discrete-time survival analysis to compare stroke incidence among US-born (including those who immigrated before age 7 years) and foreign-born Hispanics with incidence in non-Hispanic whites. We also examined childhood and adult socioeconomic characteristics as predictors of stroke among Hispanics, comparing effect estimates with those for non-Hispanic whites. Results— In age- and sex-adjusted models, US-born Hispanics had higher odds of stroke onset than non-Hispanic whites (OR, 1.44; 95% CI, 1.08–1.90), but these differences were attenuated and nonsignificant in models that controlled for childhood and adulthood socioeconomic factors (OR, 1.07; 95% CI, 0.80–1.42). In contrast, in models adjusted for all demographic and socioeconomic factors, foreign-born Hispanics had significantly lower stroke risk than non-Hispanic whites (OR, 0.58; 95% CI, 0.41–0.81). The impact of socioeconomic predictors on stroke did not differ between Hispanics and whites. Conclusions— In this longitudinal national cohort, foreign-born Hispanics had lower incidence of stroke incidence than non-Hispanic whites and US-born Hispanics. Findings suggest that foreign-born Hispanics may have a risk factor profile that protects them from stroke as compared with other Americans.