Migration and Contraception among Mexican Women: Assessing Selection, Disruption, and Adaptation.

Despite the sizeable impact of migration on childbearing, less is known about how it shapes contraceptive use undergirding fertility. We utilize binational survey data collected in 2006/7 by the Migration, Gender, and Health among Immigrant Latinos in Durham, NC study to assess how selection, disruption, and adaptation shape contraceptive use among Mexican migrant women. We address selectivity with respect to both socio-demographic and formative sexual initiation characteristics, comparing migrants to non-migrants in Mexico. We examine the disruptive effect of migration on contraception among migrant women sexually initiated in Mexico. Finally, we compare current methods between Mexican migrants and non-migrants to assess adaptation to U.S. contraceptive practices. We find migrant selectivity is less important than context in shaping immigrant women's contraceptive practices, though migrant women sexually initiated in the United States exhibit earlier and higher levels of contraceptive use than their migrant peers initiated in Mexico. Migration also disrupts contraceptive trajectories. Many migrants discontinue contraceptive use pre-migration in response to their husbands' solo migration. Partner separation also reduces contraceptive use immediately after migration. Finally, migrants show numerous signs of adaptation to the U.S. context, mainly via the adoption of oral contraception. The main obstacle for contraceptive use in Durham is lack of information about where to obtain it. Efforts to improve immigrants' reproductive health should recognize the deleterious effect of policies encouraging family separation. Healthcare must reach immigrant women soon after arrival, be attuned to pre-migration contraceptive practices, and recognize the unique vulnerabilities of women migrating at older ages.

Racial disparities in provider-patient communication of incidental medical findings.

Health disparities research often focuses on the social patterning of health outcomes. Increasingly, there has been an emphasis on understanding the mechanisms perpetuating disparities, even after issues of patient access to health services are addressed. The following study utilizes a novel dataset of electronic medical records (EMR), radiology records, and U.S. Census data to investigate the racial/ethnic patterning of provider-patient communication among patients diagnosed with incidental medical findings requiring follow-up. My results indicate that racial/ethnic disparities in follow-up adherence stem from initial disparities in provider-patient communication. These communication disparities persist even after accounting for multiple socioeconomic, health, and provider characteristics, indicating a bias in medicine, whereby providers are less likely to communicate information about incidental medical findings to patients of color relative to White patients. This paper has important clinical implications, as it sheds new light on why we might see low adherence to medical advice among patients of color. Findings also have social, political, and policy relevance, as they suggest an important mechanism through which health inequalities persist. To finally eliminate racial/ethnic health inequalities in the United States, racial bias and discrimination within medical and public health infrastructures must be eliminated.

"New White Ethnics" or "New Latinos"?: Hispanic/Latino Pan-Ethnicity and Ancestry Reporting among South American Immigrants to the United States.

This article explores the identification patterns of South American immigrants to the United States, as measured via Hispanic/Latino ethnicity and ancestry reporting on the US Census. Using data from the 2006-2010 and 2011-2015 American Community Survey, my analysis reveals four main findings. First, I show significant heterogeneity in identity patterns and in sociodemographic, immigration, and geographic characteristics between South American and Mexican immigrants in the United States. Second, I find that Southern Cone immigrants do not report Hispanic/Latino ethnicity and "birth-country" ancestry (ancestry that is concordant with birth country, such as Colombian or Chilean) to a greater extent than Andean immigrants, in favor of reporting more distal "ancestral-origin" ancestries (i.e., Spanish, Japanese, etc.). Third, I show that those immigrants who do report Hispanic/Latino ethnicity are more likely to report "birth-country" ancestry than "ancestral-origin" ancestry, net of other factors. Finally, my analysis demonstrates that Brazilian immigrants chart a different path of identification among South American immigrants and almost unanimously do not report Hispanic/Latino ethnicity while overwhelmingly reporting "Brazilian" ancestry. Taken together, variation in Hispanic/Latino ethnicity and ancestry reporting across South American immigrant groups has implications for their incorporation into US society, as well as for the degree to which these immigrants see themselves as racialized actors in the United States. Some South American immigrant groups (Southern Cone immigrants) appear to be incorporating as "New White ethnics," and others (Andean immigrants) appear to be incorporating as "New Latinos." Researchers of international migration should carefully consider these identification differences and their implications for the measurement and study of "Hispanic/Latino" immigrants and their descendants in the United States.

Police response to violence and conflict between parents and their minor children.

PURPOSE: This study examines the nature of all domestic violence incidents involving parents and their minor children to which police in Philadelphia responded during the 2013 calendar year. METHOD: We use a retrospective design to explore the nature and outcome of parent-child incidents to which police are summoned. Incidents that officers determined met the state statute definition of child abuse are not included. RESULTS: Of 54,456 domestic violence incidents in the city of Philadelphia in 2013, 2,361 involved a verbal incident or physical altercation between a minor child and at least one parent. Most reports (83.3%) identified the child as the offender and were for verbal incidents (89.6%), suggesting police were called to resolve conflict in the home. When a child was the offender, boys were the most common offenders and mothers the most common victims. When a parent was the offender, mothers were the most common offenders and daughters the most common victims. Parent-offender incidents were far fewer (16.7%) but more likely than child-offender incidents to involve physical violence (AOR=6.19) and to result in arrest (AOR=3.67). CONCLUSIONS: Parent-child incidents that are not child abuse constitute about 20% of all domestic violence incidents to which police are summoned. Parent-child incidents are an under-researched and perhaps under-served issue. We know of few resources beyond law enforcement for on-the-scene crisis intervention and, as such, officers appear to serve as mediators in these mostly verbal disagreements. The appropriateness and cost of such intervention merits investigation and discussion.

Racial/Ethnic Disparities in Follow-Up Adherence for Incidental Pulmonary Nodules: An Application of a Cascade-of-Care Framework.

PURPOSE: The aim of this study was to evaluate racial/ethnic disparities in follow-up adherence for incidental pulmonary nodules (IPNs) using a cascade-of-care framework, representing the multistage pathway from IPN diagnosis to timely follow-up adherence. METHODS: A cohort of 1,562 patients diagnosed with IPNs requiring follow-up in a tertiary health care system in 2016 were retrospectively identified. Racial/ethnic disparities in follow-up adherence were examined by developing a multistep cascade-of-care model (provider communication, follow-up examination ordering and scheduling, adherence) to identify where patients were most likely to fall off the path toward adherence. Racial/ethnic adherence disparities were measured using descriptive statistics and multivariate modeling, controlling for sociodemographic, communication, and health characteristics. RESULTS: Among 1,562 patients whose IPNs required follow-up, unadjusted results showed that nonwhite patients were less likely to meet each step on the cascade than White patients: for provider-patient IPN communication, 55% among Black patients and 80% among White patients; for follow-up ordering and scheduling, 42% and 41% among Black patients and 66% and 64% among White patients; and for timely adherence, 29% among Black patients and 54% among White patients. Adjusting for provider communication, sociodemographic, and health characteristics, Black patients had increased odds of never adhering to and delaying follow-up compared with White patients (odds ratios, 1.30 [95% confidence interval, 0.90-1.89] and 2.51 [95% confidence interval, 1.54-4.09], respectively). CONCLUSIONS: These findings demonstrate substantial racial/ethnic disparities in IPN follow-up adherence that persist after adjusting for multiple characteristics. The cascade of care demonstrates where on the adherence pathway patients are at risk for falling off, enabling specific targets for health policy and clinical interventions. Radiologists can play a key role in improving IPN follow-up via increased patient care involvement.

Nonfatal Gun Use in Intimate Partner Violence: A Systematic Review of the Literature.

Guns figure prominently in the homicide of women by an intimate partner. Less is known, however, about their nonfatal use against an intimate partner. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched eight electronic databases and identified 10 original research articles that reported the prevalence of the nonfatal use of firearms against an intimate partner. Results indicate that (1) there is relatively little research on the subject of intimate partners' nonfatal gun use against women. (2) The number of U.S. women alive today who have had an intimate partner use a gun against them is substantial: About 4.5 million have had an intimate partner threaten them with a gun and nearly 1 million have been shot or shot at by an intimate partner. Whether nonfatal gun use is limited to the extreme form of abuse (battering) or whether it occurs in the context of situational violence remains to be seen. Regardless, when it comes to the likely psychological impact, it may be a distinction without a difference; because guns can be lethal quickly and with relatively little effort, displaying or threatening with a gun can create a context known as coercive control, which facilitates chronic and escalating abuse. Implications for policy, practice, and research are discussed, all of which include expanding an implicit focus on homicide to include an intimate partner's nonfatal use of a gun.