Search

This paper examines the experiences of adolescents from mixed migratory status families affected by deportation. We analyze the impacts on their mental and emotional health when they are separated from one parent in the United States, forcibly displaced with another to Oaxaca, and experience the consequences of their deportation in Mexico. We use a qualitative and ethnographic methodology. This paper focuses on data from semi-structured interviews and focus groups with 15 parents who had been deported from the United States and 53 adolescents who moved with them to Mexico. The data was collected between 2018 and 2020. The main findings show the existence of emotions that are sustained in the transnational flow and acquire new nuances upon return. They also show the emergence of new conditions related to family separation, all of which have an impact on the adolescents' well-being and on important areas of their lives, such as education. The research contributes to knowledge in two main ways: 1) it addresses the impacts of parental deportation on the well-being of adolescents in mixed-status families, which have typically focused on children; 2) it studies how parental deportation affects the mental and emotional health of adolescents de facto deported to Mexico, a field still little studied. • De facto deportation has mental health consequences among adolescents. • The forced nature of de facto deportation produces helplessness, aggression and anger. • The code of silence associated with deportation generates fear, stress, anxiety. • Ambiguous loss is accentuated at important moments in academic and developmental life. • Family separation and de facto deportation affect school performance. [ABSTRACT FROM AUTHOR]

Many Latinx and Indigenous Mexican populations in the United States Southwest live in unincorporated communities in the US-Mexico borderlands called colonias. These environmental justice communities often lack basic infrastructure, including healthcare services, prompting many to seek services across the border. However, due to geopolitical factors more vulnerable caregivers are limited to utilize healthcare services in the US. This paper reports the experiences and healthcare decision-making of caregivers living in colonias in the US-Mexico border region who care for children with respiratory health conditions. This study was carried out from September to December 2020. Focus groups and interviews were conducted with Latinx and Indigenous Mexican caregivers of children with asthma or respiratory distress. Qualitative interviews elicited caregivers' perspectives on the environmental factors affecting children's chronic health conditions and use of healthcare services. The analysis employed the concept of structure vulnerability to theorize geography as a structural determinant of health for caregivers faced with making healthcare decisions for their suffering from respiratory health conditions. A survey was administered to collect basic sociodemographic information. A total of 36 caregivers participated in the study. Structural factors including unincorporated community status and government inaction intersected with social determinants of health to prompt caregivers to cross the US-Mexico border to access healthcare services in Mexico for their children. Yet, more vulnerable caregivers (i.e., those without documentation status in the US) and their children, accessing healthcare services in the US was not an option limiting caregivers' ability to meet their children's healthcare needs. In such cases, geography acts as a structural determinant of health. This study shows the importance of geography in health. Rural unincorporated colonias located in the borderlands are precariously located and lack basic critical infrastructure including healthcare access. Within such places, historically and socially marginalized populations become invisible, are subject to the health effects of environmental hazards, and are limited depending on their positionality and thus vulnerability to healthcare services. • Municipal unincorporation contributes to health disparities among Latinx families in US-Mexico borderlands. • Latinx children in colonias are disproportionately exposed to environmental toxins. • Geography acts as a structural determinant of health for Latinx families in colonias. • A binational approach to health services should be prioritized for families in the borderlands. [ABSTRACT FROM AUTHOR]

A rising emphasis on patient involvement in clinical research and healthcare improvement has led to the steady incorporation of patients and caregivers into this work. However, interactional factors shaping recruitment processes are not well understood. In this paper, we present a qualitative analysis of interviews with twenty-six patients, family members, engagement staff and healthcare providers who are engaged in healthcare improvement work in the United States. We focus on how stakeholders account for recruitment decisions to participate in healthcare improvement work. We find that expressions of and judgments about patients' and caregivers' cultural health capital shape providers' decisions to extend invitations to participate in healthcare improvement work. These findings extend current conceptualizations of cultural health capital beyond the clinical encounter to reveal factors shaping patient recruitment into healthcare improvement work. In theorizing how cultural health capital shapes action in this new setting, we found that healthcare providers, engagement staff, and patients/caregivers attended to different aspects of cultural health capital when accounting for why they extended or received a recruitment pitch. We further found that participating in healthcare improvement work led to a boost in cultural health capital for patients and caregivers, which they could use to develop transmissible forms of cultural health capital for less centrally involved patients and caregivers. Finally, we describe how participants in healthcare improvement collaboratives account for a lack of diversity among partners. These findings help us hypothesize the consequences of recruitment processes that rely on displays and judgments of cultural health capital and identify possibilities for change. Using the case of healthcare improvement work in Collaborative Learning Health Systems, our findings advance past work on cultural health capital in medical sociology by theorizing the role of cultural health capital in recruitment processes. • Providers recruit patients for healthcare improvement work with subjective criteria. • Providers often recruit high-resourced, privileged patients that they "vibe" with. • Partners build cultural health capital from doing healthcare improvement work. • Recruiting for cultural health capital may exclude patients from diverse backgrounds. • The role of recruitment should be considered to improve partner representation. [ABSTRACT FROM AUTHOR]

Abstract: Health worker migration is an issue of first order concern in global health policy circles and continues to be the subject of much policy debate. In this paper, we contribute to the discussion by studying the impact of economic conditions on the migration of physicians from developing countries. To our knowledge, this is one of the first papers to do so. A major contribution of this paper is the introduction of a new panel dataset on migration to the US and the UK from 31 sub-Saharan Africa countries. The data spans the period 1975–2004. Using this data, we estimate the impact of changes in economic conditions on physician migration. In our preferred specification that allows for country-specific time trends, we find that a temporary one percentage point decline in GDP per capita increases physician migration in the next period by approximately. 3 percent. In our IV models a one percentage point decline in GDP per capita increases physician migration in the next period by between 3.4 and 3.6 percent. Overall, our results suggest a significant effect of developing country economic conditions on physician migration. [Copyright &y& Elsevier]

While the overall impact of the COVID-19 pandemic on U.S. population health has been devastating, it has not affected everyone equally. The risks of hospitalization and death from the disease are relatively low for the population as a whole, but much higher for specific subpopulations defined by age, health status, and race or ethnicity. The extent to which Americans perceive these disparities is an open question, with potentially important political implications. Recognition of unequal impacts may prime concerns about justice and fairness, making Americans more concerned and willing to support government intervention. On the other hand, belief that the pandemic primarily threatens "other people" or out-groups may reduce, rather than increase, a person's concern. Partisanship and media consumption habits are also likely to play a role in these perceptions, as they do in most issues related to COVID-19. In this paper, we use original survey data from the Cooperative Election Study (N = 1000) to explore Americans' perceptions of which groups are most harmed by the pandemic, the demographic and political determinants of these perceptions, and the relationship of these perceptions with their opinions about COVID-related mitigation policy. We find that, on average, people perceived accurately that certain groups (e.g., Black Americans, older people) were more affected, but these group perceptions varied by demographic and political characteristics of respondents. We find, in contrast with recent experimental evidence, that the perception that populations of color were harmed was associated with more support for pandemic mitigation strategies. More research should investigate the relationships among pandemic politics and the racial dynamics of the target populations most affected. • In fall 2020, survey participants recognized groups harmed by COVID based on age. • They had lower recognition of racial groups harmed, lowest for Native Americans. • Perceptions of groups harmed varies by information exposure and politics. • Perceiving group disparities was associated with more support for pandemic policy. • The racial dynamics surrounding the politics of COVID-19 requires more attention. [ABSTRACT FROM AUTHOR]

Socioeconomic inequalities in childhood Body Mass Index (BMI) are becoming increasingly more pronounced across the world. Although countries differ in the direction and strength of these inequalities, cross-national comparative research on this topic is rare. This paper draws on harmonized longitudinal cohort data from four wealthy countries—Germany, the Netherlands, the United Kingdom (UK), and the United States (US)—to 1) map cross-country differences in the magnitude of socioeconomic inequalities in childhood BMI, and 2) to examine cross-country differences in the role of three energy-balance-related behaviors—physical activity, screen time, and breakfast consumption—in explaining these inequalities. Children were aged 5–7 at our first timepoint and were followed up at age 8–11. We used data from the German National Educational Panel Study, the Dutch Generation R study, the UK Millennium Cohort Study and the US Early Childhood Longitudinal-Kindergarten Study. All countries revealed significant inequalities in childhood BMI. The US stood out in having the largest inequalities. Overall, inequalities between children with low versus medium educated parents were smaller than those between children with high versus medium educated parents. The role of energy-balance-related behaviors in explaining inequalities in BMI was surprisingly consistent. Across countries, physical activity did not, while screen time and breakfast consumption did play a role. The only exception was that breakfast consumption did not play a role in the US. Cross-country differences emerged in the relative contribution of each behavior in explaining inequalities in BMI: Breakfast consumption was most important in the UK, screen time explained most in Germany and the US, and breakfast consumption and screen time were equally important in the Netherlands. Our findings suggest that what constitutes the most effective policy intervention differs across countries and that these should target both children from medium as well as low educated families. • All countries showed substantial socioeconomic inequalities in childhood BMI. • In all countries, inequalities in BMI steepen over course of primary school. • Protective factors among the most advantaged seem to mainly drive inequalities. • Across most countries, underlying mechanisms for inequalities in BMI are similar. • The relative contribution of each mechanism to BMI inequalities differs per country. [ABSTRACT FROM AUTHOR]

This paper explores differences in how primary care doctors process the clinical presentation of depression by African American and African-Caribbean patients compared with white patients in the US and the UK. The aim is to gain a better understanding of possible pathways by which racial disparities arise in depression care. One hundred and eight doctors described their thought processes after viewing video recorded simulated patients presenting with identical symptoms strongly suggestive of depression. These descriptions were analysed using the CliniClass system, which captures information about micro-components of clinical decision making and permits a systematic, structured and detailed analysis of how doctors arrive at diagnostic, intervention and management decisions. Video recordings of actors portraying black (both African American and African-Caribbean) and white (both White American and White British) male and female patients (aged 55 years and 75 years) were presented to doctors randomly selected from the Massachusetts Medical Society list and from Surrey/South West London and West Midlands National Health Service lists, stratified by country (US v.UK), gender, and years of clinical experience (less v. very experienced). Findings demonstrated little evidence of bias affecting doctors' decision making processes, with the exception of less attention being paid to the potential outcomes associated with different treatment options for African American compared with White American patients in the US. Instead, findings suggest greater clinical uncertainty in diagnosing depression amongst black compared with white patients, particularly in the UK. This was evident in more potential diagnoses. There was also a tendency for doctors in both countries to focus more on black patients' physical rather than psychological symptoms and to identify endocrine problems, most often diabetes, as a presenting complaint for them. This suggests that doctors in both countries have a less well developed mental model of depression for black compared with white patients. [ABSTRACT FROM AUTHOR]

Physical activity is an important determinant of obesity and overall health for children, but significant race/ethnic and nativity disparities exist in the amount of physical activity that children receive, with immigrant children particularly at risk for low levels of physical activity. In this paper, we examine and compare patterns in physical activity levels for young children of U.S.-born and immigrant mothers from seven race/ethnic and nativity groups, and test whether physical activity is associated with subjective (parent-reported) and objective (U.S. Census) neighborhood measures. The neighborhood measures include parental-reported perceptions of safety and physical and social disorder and objectively defined neighborhood socioeconomic disadvantage and immigrant concentration. Using restricted, geo-coded Early Childhood Longitudinal Study-Kindergarten (ECLS-K) data (N = 17,510) from 1998 to 1999 linked with U.S. Census 2000 data for the children's neighborhoods, we utilize zero-inflated Poisson (ZIP) models to predict the odds of physical inactivity and expected days of physical activity for kindergarten-aged children. Across both outcomes, foreign-born children have lower levels of physical activity compared to U.S.-born white children. This disparity is not attenuated by a child's socioeconomic, family, or neighborhood characteristics. Physical and social disorder is associated with higher odds of physical inactivity, while perceptions of neighborhood safety are associated with increased expected days of physical activity, but not with inactivity. Immigrant concentration is negatively associated with both physical activity outcomes, but its impact on the probability of physical inactivity differs by the child's race/ethnic and nativity group, such that it is particularly detrimental for U.S.-born white children's physical activity. Research interested in improving the physical activity patterns of minority and second-generation immigrant children should consider how neighborhood context differentially impacts the health and physical activity of children from various racial, ethnic and nativity backgrounds. [ABSTRACT FROM AUTHOR]

Research in several countries shows higher Covid-19 vaccination willingness and uptake among physicians than nurses. Our paper aims to characterize and explain this difference. In early 2021, we surveyed 1047 U.S. primary care professionals who served adolescents, ages 11–17. The national sample included physicians (71%) as well as nurses and advanced practice providers. The survey assessed the three domains of the Increasing Vaccination Model: thinking and feeling , social processes , and direct behavior change. Covid-19 vaccine uptake was higher among physicians than among nurses and advanced practice providers (91% vs. 76%, p <.05). Overall, in the thinking and feeling domain, higher confidence in Covid-19 vaccination, higher perceived susceptibility to the disease, and stronger anticipated regret were associated with higher vaccine uptake (all p <.05). In the social processes domain, perceiving more positive social norms for Covid-19 vaccination, receiving recommendations to get the vaccine, and wanting to help others were associated with higher vaccine uptake (all p <.05). In the direct behavior change domain, receiving an invitation to get the vaccine and better access to vaccination were associated with higher uptake (both p <.05). Of these variables, most of the thinking and feeling and social processes variables mediated the association of training with vaccine uptake. Physicians had higher Covid-19 vaccine uptake than nurses and advanced practice providers, corresponding with their more supportive vaccine beliefs and social experiences. Efforts to reach the remaining unvaccinated cohort can build on these findings. • Covid-19 vaccine uptake among advanced practice providers and nurses was lower than in physicians. • Vaccine confidence and social norms explained the difference in Covid-19 vaccine uptake. • Recommendations from employers and providers suppressed some differences in vaccination. • Behavioral nudges – invitation and incentives – were associated with more vaccine uptake. • Offers directions and contexts for future vaccination interventions and programs in the U.S. [ABSTRACT FROM AUTHOR]

Social scientists have long demonstrated that socioeconomic resources benefit health. More recently, scholars have begun to examine the potential stratification in the health returns different groups receive for a given resource. Motivated by fundamental cause theory, this paper examines homeownership as a salient health resource with potentially stratified benefits. Homeowners have significantly greater housing quality, wealth, neighborhood quality and integration, and physical and mental health than renters. However, there are compelling theoretical reasons to expect the health advantage of homeownership to be unequally distributed across racial and ethnic groups. Regression analyses of 71,874 household heads in the United States from the 2012 March Current Population Survey initially suggest all homeowners experience a significant health advantage. Further examination finds robust evidence for a homeowner health advantage among Whites, on par with the difference between the married and divorced. The advantage among minority households is considerably smaller, and not significant among Latinos or Asians. Conditioning on a broad array of observable characteristics, White homeowners emerge as exceptionally healthy compared to White renters and all minority groups. This leads to the unexpected finding that racial/ethnic differences in health are concentrated among homeowners. The findings demonstrate the interactive nature of racial/ethnic stratification in health through both access to and returns from socioeconomic resources. [ABSTRACT FROM AUTHOR]

Abstract: The increases in suicide among middle-aged baby boomers (born between 1946 and 1964) in the United States since 1999 suggest a changing epidemiology of suicide. Using data from 1935 to 2010, this paper conducts age-period-cohort analyses to determine the impact of cohorts in shaping temporal patterns of suicide in the United States. The analysis demonstrates that age, period and cohort effects are all important in determining suicide trends. Net of age and period effects, the cohort pattern of suicide rates is U-shaped, with cohorts born between 1915 and 1945 possessing among the very lowest suicide rates. Suicide rates begin to rise with boomers and subsequent cohorts exhibit increasingly higher rates of suicide. The general pattern exists for both men and women but is especially pronounced among males. The average suicide rate over the entire period for males is about 28 per 100,000, 95% CI [27.4, 28.7]. For males born in 1930–34, the suicide rate is estimated to be 17.4 per 100,000, 95% CI [15.9, 18.8]; for males born between 1955 and 1959, the rate is essentially the same as the average for the period while for males born between 1985 and 1989, the suicide rate is estimated to be 37.8 per 100,000, 95% CI [33.1, 43.4]. The results dispute popular claims that boomers exhibit an elevated suicide rate relative to other generations, but boomers do appear to have ushered in new cohort patterns of suicide rates over the life course. These patterns are interpreted within a Durkheimian framework that suggests weakened forms of social integration and regulation among postwar cohorts may be producing increased suicide rates. [Copyright &y& Elsevier]

Abstract: There is considerable policy interest in the impact of macroeconomic conditions on health-related behaviours and outcomes. This paper sheds new light on this issue by exploring the relationship between macroeconomic conditions and an indicator of problem drinking derived from state-level data on alcoholism-related Google searches conducted in the US over the period 2004–2011. We find the current recessionary period coincided with an almost 20% increase in alcoholism-related searches. Controlling for state and time-effects, a 5% rise in unemployment is followed in the next 12 months by an approximate 15% increase in searches. The use of Internet searches to inform on health-related behaviours and outcomes is in its infancy; but we suggest that the data provides important real-time information for policy-makers and can help to overcome the under-reporting in surveys of sensitive information. [Copyright &y& Elsevier]

Abstract: While it is well documented that economic expansions provide widespread and immediate financial benefits, the evidence on how an economic downturn affects individual''s health behaviors is surprisingly mixed. In this paper, we take a structural approach to investigate the effects of wages and working hours on health behaviors of low-educated persons using variations in wages and hours caused by changes in local economic activity. In the empirical analysis, we adopt a two-sample instrumental variables approach to combine the data on individual health behaviors from the Behavioral Risk Factor Surveillance System (BRFSS) and the National Health Interview Survey (NHIS) with the data on individual employment from the Current Population Survey (CPS). The total sample size of the combined CPS-BRFSS data for the time period of 1984–2005 is 967,594, while that of the combined CPS-NHIS data for the time period of 1976–2001 is 364,078. We find that increases in wages caused by economic expansions are associated with greater consumption of cigarettes in the United States. We also find that increases in hours of work caused by economic expansions are associated with more cigarette consumption, but less physical activity and physician visits. More importantly, the evidence suggests that most of such effects associated with changes in hours of work can be attributed to the changes at the extensive margin of employment, meaning the changes in employment status, rather than the changes at the intensive margin, meaning changes in hours of work conditional on being employed. These findings imply that changes in employment may have heterogeneous impacts on time-intensive and less time-intensive health behaviors and also provide additional evidence on the importance of time in health production, particularly for time-intensive activities. [Copyright &y& Elsevier]

Abstract: This study examines the interactive contextual effect of income inequality on health. Specifically, we hypothesize that income inequality will moderate the relationships between individual-level risk factors and health. Using National Health Interview Survey data 1984–2007 (n = 607,959) and U.S. Census data, this paper estimates the effect of the dramatic increase in income inequality in the U.S. over the past two decades on the gradient of socioeconomic status on two measures of health (i.e., physical functioning and activity limitations). Results indicate that increasing income inequality strengthens the protective effects of family income, employment, college education, and marriage on these two measures of health. In contrast, high school education''s protective effect (relative to less than a high school education) weakens in the context of increasing income inequality. In addition, we find that increasing income inequality exacerbates men''s disadvantages in physical functioning and activity limitations. These findings shed light on research about growing health disparities in the U.S. in the last several decades. [Copyright &y& Elsevier]

Abstract: This paper examined the importance of household and economic contextual factors as determinants of ethnic disparities in adolescent body mass index (BMI). Individual-level data from the National Longitudinal Survey of Youth 1997 for the years 1997 through 2000 were combined with economic contextual data on food prices, outlet density and median household income. The Oaxaca–Blinder decomposition method was used to examine the factors that could help explain ethnic disparities in BMI. Ethnic differences in household demographic, parental socioeconomic status (SES), and economic contextual factors explained the majority of the male black–white (63%), male Hispanic–white (78%) and female Hispanic–white (62%) BMI gaps but less than one-half of the female black–white BMI gap (44%). We found that adding the economic contextual factors increased the explained portion of the ethnic BMI gap for both female and male adolescents: the economic contextual factors explained 28% and 38% of the black–white and Hispanic–white BMI gaps for males and 13% and 8% of the black–white and Hispanic–white BMI gaps for females, respectively. Parental SES was more important in explaining the Hispanic–white BMI gap than the black–white BMI gap for both genders, whereas neighborhood economic contextual factors were more important in explaining the male BMI gap than the female BMI gap for both black–white and Hispanic–white ethnic disparities. A significantly large portion of the ethnic BMI gap, however, remained unexplained between black and white female adolescents. [Copyright &y& Elsevier]

Abstract: Although the population of homeschooled children in the United States is large and growing, little is known about their access to and utilization of preventive health care services. This paper compares the health care access and utilization of homeschooled children and public school children in the United States using data from the nationally-representative 2007 National Survey of Children''s Health. Using logistic regression models, this study finds that homeschooled children were significantly less likely than public school children to have access to a medical home, to visit a health care professional annually, and to receive the Human Papillomavirus vaccine. They were not statistically less likely to have health insurance, to receive annual dental care, or to receive Tetanus or Meningitis vaccinations. This research suggests that public health practitioners, medical providers, researchers, and educators should be attentive to the health care needs of homeschooled children. [Copyright &y& Elsevier]

Abstract: This paper examines the associations between Chinese and Korean immigrant parents’ early life material and food deprivation and their concern about their child’s diet or weight, preferences for heavier children, and weight-promoting diet and child weight, alongside the moderating role of parents’ acculturation toward American culture. In 2010, Chinese and Korean immigrant parents of children ages 3–8 years in the United States (N = 130) completed interviews which asked about their perceived early life material deprivation and food insecurity, acculturation, child feeding practices, and evaluations of whether their child weighed more or less than the ideal, and child consumption of soda and candy. Independent measures of child and parent BMI were also obtained. Regression analyses revealed that parents’ early life food insecurity was associated with the evaluation that their child should weigh more than they do and greater consumption of soda and sweets by their child, among the least acculturated parents. Parental material deprivation was associated with more laissez-faire child feeding practices: less monitoring, less concern about the child’s weight or diet, and less perceived responsibility for the child’s diet, but only among less acculturated parents. Overall, the results suggest that immigrant parents’ child feeding practices and body size evaluations are shaped by material hardship in childhood, but these influences may fade as acculturation occurs. [Copyright &y& Elsevier]

Almost half of renters in the United States are rent-burdened, meaning that they pay more than 30% of their income toward housing costs. Rental assistance through programs administered by the U.S. Department of Housing and Urban Development, alleviates these financial strains for around 5 million households. However, due to budgetary constraints, fewer than one in four eligible households actually receive this assistance and waitlists average two years nationally. Using longitudinal data from a cohort of 400 low-income adults living in New Haven, CT, this paper investigates how access to rental assistance affects mental health through two analytical methods that address selection into rental assistance. First, we performed a cross-sectional analysis to identify how psychological distress differs among those receiving and those on a waitlist for rental assistance. Second, we used a within-person fixed-effects analysis to compare changes in individuals following entry into rental assistance. We find that those receiving rental assistance report significantly less psychological distress than those on waiting lists and that transitions into rental assistance are associated with statistically non-significant decreases in psychological distress. Our findings suggest that expanding rental assistance may be one potential step toward improving the mental health of low-income individuals in the United States. • Lack of affordable housing is associated with poor mental health. • We find that rent assistance is associated with reduced psychological distress. • Addressing unmet need for rental assistance may improve mental health. [ABSTRACT FROM AUTHOR]