Hispanic Health Paradox at the Border: Substance, Alcohol, and Tobacco Use among Latinx Immigrants Seeking Free or Reduced-Cost Care in Southernmost Texas.

OBJECTIVE: Although substantial research has explored the Hispanic health paradox (HHP) and suggests that Latinx immigrants experience positive health outcomes relative to those born in the United States, less research has assessed the role of immigration status. Our aim was to examine this role in Latinx health. METHODS: Using survey data collected at two free/reduced-cost clinics in southernmost Texas, we examined differences in the mental and self-rated health, substance, alcohol, and tobacco use of low-income patients by undocumented/documented immigrant and US-born/naturalized citizen status (N = 588). RESULTS: Based on ordinary least squares regression results, undocumented Latinx immigrants report lower negative self-rated health (coefficient -0.27, 95% confidence interval -0.50 to -0.01) and lower depressive symptoms (coefficient -0.34, 95% confidence interval -0.67 to -0.02]) compared with their US citizen peers (P < 0.05). Logistic regression results suggest that undocumented and documented Latinx immigrants do not differ in alcohol, tobacco, or substance use relative to their citizen peers. CONCLUSIONS: Despite facing potentially adverse social environments, undocumented Latinx immigrants experience positive health outcomes relative to US-born/naturalized citizen peers.

Examining validity of body mass index calculated using height and weight data from the US driver license.

BACKGROUND: Driver license departments in many US states collect data on individuals' height and weight. These data can be useful to researchers in epidemiological and public health studies. As height and weight on driver license are self-reported, they may be prone to reporting bias. We compare height and weight obtained from driver license records and clinically measured height and weight, as well as body mass index (BMI) values calculated using the two data sources for the same individual. METHODS: We linked individual height and weight records obtained from the Driver License Division (DLD) in the Utah Department of Public Safety to clinical records from one of the largest healthcare providers in the state of Utah. We then calculated average differences between height, weight and BMI values separately for women and men in the sample, as well as discrepancies between the two sets of measures by age and BMI category. We examined how well self-reported height and weight from the driver licenses classify individuals into specific BMI categories based on clinical measures. Finally, we used two sets of BMI values to estimate individuals' relative risk of type II diabetes. RESULTS: Individuals, on average, tend to overestimate their height and underestimate their weight. Consequently, the value of BMI calculated using driver license records is lower than BMI calculated using clinical measurements. The discrepancy varies by age and by BMI category. Despite the discrepancy, BMI based on self-reported height and weight allows for accurate categorization of individuals at the higher end of the BMI scale, such as the obese. When used as predictors of relative risk of type II diabetes, both sets of BMI values yield similar risk estimates. CONCLUSIONS: Data on height and weight from driver license data can be a useful asset for monitoring population health in states where such information is collected, despite the degree of misreporting associated with self-report.

Beliefs and knowledge of cardiovascular-related disease among uninsured primary care patients: A cross-sectional study.

OBJECTIVE: The purpose of this study was to examine cardiovascular disease-related health beliefs and how they are influenced by knowledge and a sense of community among uninsured primary care patients. METHOD: This study was a cross-sectional study using a self-administered paper survey (January to April 2016). The study population included medically uninsured US-born English speakers, non-US-born English speakers, and Spanish speakers. RESULTS: Medically uninsured adults utilizing a free clinic (N = 374) participated in the survey. Increasing knowledge about major risk factors for developing cardiovascular disease helped enhance levels of perceived severity of cardiovascular disease and benefits of healthy diet and physical activity. Spanish speakers reported higher levels of perceived severity of cardiovascular disease but lower levels of knowledge compared to US-born or non-US-born English speakers. CONCLUSION: Spanish speakers may need different approaches to promote cardiovascular disease prevention due to their higher levels of perceived severity of cardiovascular disease but lower levels of cardiovascular disease-related knowledge compared to English speakers. Developing a healthy "community" in a clinic setting may be effective to promote cardiovascular disease-related health for underserved populations.

Tykes, Toddlers, Teens, and Twins of Robust Mothers: Do the Offspring of Twinning Mothers Share in Their Mother's Robust Phenotype?

Women who bear twins may possess a robust phenotype compared to non-twinning mothers. We examine mortality patterns for the singleton offspring of mothers of twins compared to the offspring of non-twinning mothers to determine whether they share the hypothesized robust phenotype of their mothers. Using data from the Utah Population Database, we show that both male and female singleton offspring of twinning mothers experience a survival disadvantage prior to age 5, no survival benefit or penalty between ages 5 and 49, and - for males only - a statistically significant survival advantage after age 50. We further examine the survival effects on singletons born before and after a twinset. We observe a survival disadvantage in early life for singleton offspring of twinning mothers born after the twinset for both sexes. In addition, we find a significant survival advantage at older ages in certain categories of male singleton offspring - a likely reflection of mortality selection. The findings suggest that while bearing twins may reflect a robust maternal phenotype, the toll of bearing twins may disadvantage subsequent offspring, especially during infancy.

Knowledge and beliefs about HPV among college students in Vietnam and the United States.

Any sexually active person has the possibility of contracting the human papillomavirus (HPV) sometime in their lifetime. HPV vaccines are effective in preventing HPV if obtained prior to viral exposure. Research on knowledge and beliefs of HPV and HPV vaccination among college students in Vietnam is significantly scarce. The purpose of this study is to examine the knowledge and beliefs about HPV among college students in Vietnam compared to college students in the US. This cross-cultural comparison will fill a void in current research on this subject. Over 900 college students (N=932: n=495 in Vietnam and n=437 in the US) participated in a self-administered survey on the knowledge and beliefs about HPV in September and October 2016. Vietnamese participants reported lower levels of knowledge and experiences with the HPV virus and vaccines (p<0.01). Additionally, Vietnamese participants also exhibited more barriers in obtaining the vaccination, as well as, HPV risk denial (p<0.01). The level of knowledge is an important predictor of barriers (p<0.01; ηp2=0.022) and risk denial (p<0.01; ηp2=0.116). On average, both Vietnamese and US participants could correctly answer less than half of the survey questions regarding HPV knowledge. Additionally, provider recommendations are potentially more important than informal connections (e.g. friends, family) to reduce barriers to HPV vaccination (p<0.01; ηp2=0.035) and denial of HPV risks (p<0.05; ηp2=0.008). The increase of knowledge about HPV prevention, including and vaccination, has the potential to be improved through provider interventions. Vietnam could take action toward promoting HPV vaccinations not only at an individual level but also at a national or local level. Further research may examine the effects of a lack of knowledge on HPV-related health outcomes.

Knowledge and Perceptions of Influenza Vaccinations Among College Students in Vietnam and the United States.

OBJECTIVES: Influenza is a significant worldwide public health issue. Knowledge and perceptions regarding the flu vaccination are associated with whether individuals obtain the vaccination. The purpose of this study was to examine how such perceptions were related to knowledge and self-efficacy regarding influenza and the flu vaccination in Vietnam and the US. METHODS: College students (n=932) in Vietnam (n=495) and the US (n=437) completed a self-administered survey regarding knowledge and perceptions of influenza vaccinations in September and October 2016. RESULTS: Vietnamese participants reported significantly lower levels of awareness about flu risk, higher levels of negative attitudes toward flu vaccination, lower levels of knowledge about the flu and vaccination, and lower levels of self-efficacy than US participants. Higher levels of flu and flu vaccination knowledge and self-efficacy regarding general responsible health practices were associated with lower levels of negative perceptions of flu risk and attitudes toward vaccination. At the same time, self-efficacy regarding responsible health practices was associated with higher levels of awareness of flu risk and lower levels of negative attitudes toward vaccination. Self-efficacy regarding exercise was associated with lower levels of perceptions of flu risk and higher levels of negative attitudes toward vaccination. CONCLUSIONS: Vietnam could benefit from influenza education based on this comparison with the US. In both countries, knowledge and self-efficacy were found to be important factors influencing perceptions of influenza risk and vaccination.

Perceived Environmental Pollution and Its Impact on Health in China, Japan, and South Korea.

OBJECTIVES: Environmental pollution is a significant global issue. Both objective (scientifically measured) environmental pollution and perceived levels of pollution are important predictors of self-reported health. The purpose of this study was to compare the associations between perceived environmental pollution and health in China, Japan, and South Korea. METHODS: Data were obtained from the East Asian Social Survey and the Cross-National Survey Data Sets: Health and Society in East Asia, 2010 (n=7938; China, n=3866; Japan, n=2496; South Korea, n=1576). RESULTS: South Koreans perceived environmental pollution to be the most severe, while Japanese participants perceived environmental pollution to be the least severe. Although the Japanese did not perceive environmental pollution to be very severe, their self-rated physical health was significantly related to perceived environmental pollution, while the analogous relationships were not significant for the Chinese or Korean participants. Better mental health was related to lower levels of perceived air pollution in China, as well as lower levels of perceived all types of pollution in Japan and lower levels of perceived noise pollution in South Korea. CONCLUSIONS: Physical and mental health and individual socio-demographic characteristics were associated with levels of perceived environmental pollution, but with different patterns among these three countries.

Perceived concern about the new strain of the influenza and obtaining the vaccine in China, Japan and South Korea.

This study compares the factors, which influence individuals from the countries of China, Japan and South Korea to obtain any type of influenza vaccines and their perceived concerns about the new strain of the influenza - pandemic (H1N1) 2009. The data analyzed was from the East Asian Social Survey (EASS), Cross-National Survey Data Sets: Health and Society in East Asia, 2010 (ICPSR 34608) (N=7938). The results of this study suggest that individuals who are concerned about the new strain of influenza are more likely to have obtained influenza vaccine. In these countries, perceived concerns may be directly related to vaccine-related behaviors. The results of this study also indicate that there are variations within each country regarding as to why individuals do or do not obtain the influenza vaccine. Over all, this project provides new insights about the acquisition of the influenza vaccine within China, Japan and South Korea, which will be useful for medical practice within these countries and future research.

Perceived benefits and barriers and self-efficacy affecting the attendance of health education programs among uninsured primary care patients.

Lifestyle interventions have shown to be effective in improving health status, health behaviors, and self-efficacy. However, recruiting participants to health education programs and ensuring the continuity of health education for underserved populations is often challenging. The goals of this study are: to describe the attendance of health education programs; to identify stages of change to a healthy lifestyle; to determine cues to action; and to specify factors affecting perceived benefits and barriers to healthy food choices and physical activity among uninsured primary care patients. Uninsured primary care patients utilizing a free clinic (N=621) completed a self-administered survey from September to December of 2015. US born English speakers, non-US born English speakers, and Spanish speakers reported different kinds of cues to action in attending health education programs. While self-efficacy increases perceived benefits and decreases perceived barriers for physical activity, it increases both perceived benefits and perceived barriers for healthy food choices. The participants who had attended health education programs did not believe that there were benefits for healthy food choices and physical activity. This study adds to the body of literature on health education for underserved populations.

Region of origin diversity in immigrant health: Moving beyond the Mexican case.

Research suggests that Mexican immigrants arrive in the United States with equivalent or better health than native-born whites but lose their advantage over time. We seek to examine systematically how well the patterns of initial advantage and deteriorating health apply to immigrants originating from other regions of the world - regions that represent a growing proportion of U.S. immigrants. We begin by identifying which of the groups in our study have a health advantage compared to U.S.-born whites and to Mexican immigrants. We then we assess changes in health over time, controlling for variation in the health profiles of cohorts upon arrival. We use logistic regression of self-rated health and heart conditions with data from the 2004-2013 National Health Interview Survey. The results reveal diversity and similarity in health outcomes across world regions of origin, both on arrival and over time. By comparing and contrasting cases previously examined in isolation, we clarify and qualify theories of the immigrant health paradox and health deterioration.

The Role of Health Literacy in Reducing Negative Perceptions of Breast Health and Treatment Among Uninsured Primary Care Patients.

Breast cancer is the second leading cause of cancer death among women in the United States. There are disparities in breast cancer mortality by race/ethnicity and socio-economic factors. Health literacy may have an impact on breast health disparities. In addition, learning about people's perceptions of breast health and treatment is important to understand why some do not seek a mammogram or treatment for breast cancer. The purpose of this study is to examine the association between health literacy and negative perceptions of breast health and treatment among female uninsured primary care patients utilizing a free clinic for underserved populations. Women utilizing a free clinic who were aged 40 years or older (N = 276) participated in a self-administered survey from September to December in 2015. Higher levels of health literacy were associated with lower levels of negative perceptions of breast cancer and treatment. Non-US born English speakers reported higher levels of negative perceptions of breast cancer and treatment than US born English speakers and Spanish speakers. While there were no significant differences in health literacy among the groups, US born English speakers were less likely to have had a mammogram in the past 3 years compared with non-US born English speakers and Spanish speakers. Future research should consider where women are obtaining information and how the method of exposure shapes their attitudes towards breast health and in turn, their rates of examinations for breast cancer. Cultural factors may be also important determinants of the perceptions and need to be further examined.

Why Uninsured Free Clinic Patients Don't Apply for Affordable Care Act Health Insurance in a Non-expanding Medicaid State.

Even after the introduction of the Patient Protection and Affordable Care Act (ACA), uninsured visits remain high, especially in states that opted out of Medicaid expansion. Since the ACA does not provide universal coverage, free clinics serve as safety nets for the un- or under-insured, and will likely continue serving underserved populations. The purpose of this study is to examine factors influencing intentions to not apply for health insurance via the ACA among uninsured free clinic patients in a state not expanding Medicaid. Uninsured primary care patients utilizing a free clinic (N = 551) completed a self-administered survey in May and June 2015. Difficulty obtaining information, lack of instruction to apply, and cost, are major factors influencing intention not to apply for health insurance through the ACA. US born English speakers, non-US born English speakers, and Spanish speakers reported different kinds of perceived barriers to applying for health insurance through the ACA. Age is an important factor impacting individuals' intentions not to apply for health insurance through the ACA, as older patients in particular need assistance to obtain relevant information about the ACA and other resources. A number of unchangeable factors limit the free clinics' ability to promote enrollment of health insurance through the ACA. Yet free clinics could be able to provide some educational programs or the information of resources to patients. In particular, non-US born English speakers, Spanish speakers, and older adults need specific assistance to better understand health insurance options available to them.

Stress, Coping Strategies, and Depression--Uninsured Primary Care Patients.

OBJECTIVES: People of low socio-economic status (SES) are particularly at risk for developing stress-related conditions. The purpose of this study is to examine depression, stress, and coping strategies among uninsured primary care patients who live below the 150th percentile of the federal poverty level. Specifically, this study compares the experiences of impoverished US-born English speakers, non-US-born English speakers, and Spanish speakers. METHODS: Uninsured primary care patients utilizing a free clinic (N = 491) completed a self-administered survey using standardized measures of depression, perceived stress, and coping strategies in the spring of 2015. RESULTS: US-born English speakers reported higher levels of depression and perceived stress compared to non-US-born English speakers and Spanish speakers. US-born English speakers are more likely to use negative coping strategies than non-US-born English speakers and Spanish speakers. Perceived stress and negative coping strategies are significant predictors of depression. CONCLUSION: US-born English speakers, non-US-born English speakers, and Spanish speakers reported different coping strategies, and therefore, may have different needs for addressing depression. In particular, US-born English speakers need interventions for reducing substance use and negative psychological coping strategies.