Oral Health Policy and Research Capacity: Perspectives From Dental Schools in Africa.

INTRODUCTION AND AIMS: The prioritisation of oral health in all health policies in the WHO African region is gaining momentum. Dental schools in this region are key stakeholders in informing the development and subsequent downstream implementation and monitoring of these policies. The objectives of our study are to determine how dental schools contribute to oral health policies (OHPs) in this region, to identify the barriers to and facilitators for engaging with other local stakeholders, and to understand their capacity to respond to population and public health needs. METHODS: We developed a needs assessment survey, including quantitative and qualitative questions. The survey was developed electronically in Qualtrics and distributed by email in February 2023 to the deans or other designees at dental schools in the WHO African region. Data were analysed in SAS version 9.4 and ATLAS.ti. RESULTS: The capacity for dental schools to respond to population and public health needs varied. Most schools have postgraduate programs to train the next generation of researchers. However, these programs have limitations that may hinder the students from achieving the necessary skills and training. A majority (75%) of respondents were aware of the existence of national OHPs and encountered a myriad of challenges when engaging with them, including a lack of coordination with other stakeholders, resources, and oral health professionals, and the low priority given to oral health. Their strengths as technical experts and researchers was a common facilitator for engaging with OHPs. CONCLUSION: Dental schools in the region face common challenges and facilitators in engaging in the OHP process. There were several school-specific research and training capacities that enabled them to respond to population and public health needs. Overall, shared challenges and facilitators can inform stakeholder dialogues at a national and subnational level and help develop tailored solutions for enhancing the oral health policy pipeline.

Exploring the Association Between Detention Conditions, Detention-Related Abuse, and Mental Health Among Deported Mexican Migrants.

Migration, detention, and deportation are often rife with violence. This study sought to examine associations between pre-migration experiences, detention conditions, and mental health among Mexicans deported from the U.S. to Mexico between 2020 and 2021. Data from the Migrante Project (N=306, weighted N=14,841) were analyzed using descriptive statistics and unadjusted and adjusted multivariate regression models. The prevalence of a lifetime mental health diagnosis was 18.5%. Exposure to adverse conditions in detention (adjusted odds ratio [AOR]=17.56, p<.001) and having been detained in both immigration and non-immigration facilities (AOR=9.70, p=.042) were significantly associated with increased odds of experiencing abuse during migrants' most recent detention. Experiencing abuse during migrants' most recent detention was, in turn, associated with increased odds of a lifetime mental health diagnosis (AOR=4.72, p<.005). Targeted, trauma-informed mental health services are needed for deported Mexican migrants.

The next phases of the Migrante Project: Study protocol to expand an observatory of migrant health on the Mexico-U.S. border.

Background: Mexican migrants traveling across the Mexico-United States (U.S.) border region represent a large, highly mobile, and socially vulnerable subset of Mexican nationals. Population-level health data for this group is hard to obtain given their geographic dispersion, mobility, and largely unauthorized status in the U.S. Over the last 14 years, the Migrante Project has implemented a unique migration framework and novel methodological approach to generate population-level estimates of disease burden and healthcare access for migrants traversing the Mexico-U.S. border. This paper describes the rationale and history of the Migrante Project and the protocol for the next phases of the project. Methods/design: In the next phases, two probability, face-to-face surveys of Mexican migrant flows will be conducted at key crossing points in Tijuana, Ciudad Juarez, and Matamoros (N = 1,200 each). Both survey waves will obtain data on demographics, migration history, health status, health care access, COVID-19 history, and from biometric tests. In addition, the first survey will focus on non-communicable disease (NCD), while the second will dive deeper into mental health and substance use. The project will also pilot test the feasibility of a longitudinal dimension with 90 survey respondents that will be re-interviewed by phone 6 months after completing the face-to-face baseline survey. Discussion: Interview and biometric data from the Migrante project will help to characterize health care access and health status and identify variations in NCD-related outcomes, mental health, and substance use across migration phases. The results will also set the basis for a future longitudinal extension of this migrant health observatory. Analyses of previous Migrante data, paired with data from these upcoming phases, can shed light on the impact of health care and immigration policies on migrants' health and inform policy and programmatic responses to improve migrant health in sending, transit, and receiving communities.

Geographic dispersion and racial disparities in homeownership among Puerto Ricans.

The U.S. mainland Puerto Rican population has experienced dramatic growth and geographic dispersion in recent decades. Once overwhelmingly concentrated in the Northeast, especially New York City, Puerto Rican populations have grown dramatically in newer destinations such as Orlando, Florida. While the implications of dispersion for status attainment have received significant scholarly attention for Latinos as a whole, variation across national origin groups are less well understood. Owing to their unique racial and socioeconomic composition and historical settlement patterns, the impact of dispersion on dimensions such as homeownership could be particularly important for Puerto Ricans, since it implies a dramatic change in housing and economic context. This paper draws on U.S. Census data to examine the impact of metropolitan context, including a typology of destination types that reflects dispersion patterns, on Puerto Rican homeownership. A central objective is evaluating how location shapes racial inequality within the group, as well as the homeownership gaps between Puerto Ricans and non-Latino White, non-Latino Black, and other Latino Americans. Results show that metropolitan context, including housing conditions, residential segregation, and type of co-ethnic community, helps explain inequality among Puerto Ricans and relative to other groups. Thus, dispersion not only boosts Puerto Rican homeownership overall, it also contributes to narrowing inequality between Puerto Ricans and others, and racial inequality among Puerto Ricans.

COVID-19 testing, infection, and vaccination among deported Mexican migrants: Results from a survey on the Mexico-U.S. border.

Background: Migrants detained and held in immigration and other detention settings in the U.S. have faced increased risk of COVID-19 infection, but data on this population is scarce. This study sought to estimate rates of COVID-19 testing, infection, care seeking, and vaccination among Mexican migrants detained by U.S. immigration authorities and forcibly returned to Mexico. Methods: We conducted a cross-sectional probability survey of Mexican migrants deported from the U.S. to three Mexican border cities: Tijuana, Ciudad Juárez, and Matamoros (N = 306). Deported migrants were recruited at Mexican migration facilities after being processed and cleared for departure. A two-stage sampling strategy was used. Within each city, a selection of days and shifts were selected during the operating hours of these deportation facilities. The probability of selection was proportional to the volume of migrants deported on each day of the month and during each time period. During the selected survey shifts, migrants were consecutively approached, screened for eligibility, and invited to participate in the survey. Survey measures included self-reported history of COVID-19 testing, infection, care seeking, vaccination, intentions to vaccinate, and other prevention and risk factors. Weighted data were used to estimate population-level prevalence rates. Bivariate tests and adjusted logistic regression models were estimated to identify associations between these COVID-19 outcomes and demographic, migration, and contextual factors. Results: About 84.1% of migrants were tested for COVID-19, close to a third were estimated to have been infected, and, among them, 63% had sought care for COVID-19. An estimated 70.1% had been vaccinated against COVID-19 and, among those not yet vaccinated, 32.5% intended to get vaccinated. Close to half (44.3%) of respondents had experienced crowdedness while in detention in the U.S. Socio-demographic (e.g. age, education, English fluency) and migration-related (e.g. type of detention facility and time in detention) variables were significantly associated with COVID-19 testing, infection, care seeking, and vaccination history. Age, English fluency, and length of detention were positively associated with testing and vaccination history, whereas detention in an immigration center and length of time living in the U.S. were negatively related to testing, infection, and vaccination history. Survey city and survey quarter also showed adjusted associations with testing, infection, and vaccination history, reflecting potential variations in access to services across geographic regions and over time as the pandemic unfolded. Conclusion: These findings are evidence of increased risk of COVID-19 infection, insufficient access to testing and treatment, and missed opportunities for vaccination among Mexican migrants detained in and deported from the U.S. Deportee receiving stations can be leveraged to reduce disparities in testing and vaccination for deported migrants. In addition, decarceration of migrants and other measures informed by public health principles must be implemented to reduce COVID-19 risk and increase access to prevention, diagnostic, and treatment services among this underserved population.

Nativity differentials in first births in the United States: Patterns by race and ethnicity.

BACKGROUND: While recent decades have seen gradual convergence in ethno-racial disparities in completed fertility in the United States, differences in the age pattern of first births remain. The role of nativity has not been fully understood. OBJECTIVE: This paper examines how first births vary by nativity, and how this variation contributes to more significant racial and ethnic differentials. METHODS: Using data from the National Survey of Family Growth (1997-2017), we jointly estimate the correlates of the timing of first births and childlessness. We assess differences between immigrants and US-born and child-migrant women across ethno-racial groups. RESULTS: The unique first-birth patterns among foreign-born women have a notable impact on Hispanics, reducing differences from Whites in the average age at first birth and contributing to more significant differentials in childlessness. The impact of immigrant women on White and Black first births is more modest in scope. CONTRIBUTION: Our work shows the importance of nativity for ethnic/racial disparities in the timing and quantum of fertility in the United States. We demonstrate how the migrant population is more determinant for Hispanic fertility patterns than for Black or White. We conclude by elaborating on the implications of these results for future research as the immigrant population in the United States becomes ethnically and racially more diverse.

Continuities and Changes in the Processes of Mexican Migration and Return.

This article examines continuities and changes in the prevalence and determinants of first migration and return between Mexico and the United States. Results show a dramatic decline over time in the likelihood of migrants' making a first trip. The empirical design distinguishes processes affecting migrating cohorts from those emanating from period conditions, paying particular attention to changes in educational selectivity and the legal status of the flows. The definition of cohort and period corresponds roughly to changes in U.S. migration policy and the American economy. We find that the likelihood of return migration also declined in conjunction with period conditions that are related to border enforcement. The drop in the likelihood of return was particularly sharp for undocumented migrants, and over time return flows increasingly consist of documented migrants. The implications of these findings for immigration policy in the United States and for the incorporation of returnees in Mexico are discussed.

Migration and depression: A cross-national comparison of Mexicans in sending communities and Durham, NC.

RATIONALE: Latino immigrants have been shown to average better health and longevity than native whites, in spite of their relative socioeconomic disadvantage. However, mental health outcomes stand in stark contrast to this epidemiological "paradox," as factors such as depression are significantly higher for Latino immigrants than other groups. OBJECTIVE: We explore the link between migration and depressive feelings using a binational random survey of Mexicans in Durham, NC and sending communities in Mexico. METHOD: Explanations for the link between migration and depression, such as acculturative stress, lack of social support, and powerlessness and isolation, are analyzed by comparing results for protective vs. risk factors between residents of Mexico and Durham, and among immigrants themselves. Besides, selection hypothesis is explored using propensity matching scores. RESULTS: Results show little support for selection as an important source of migrant depression, and instead provide strong evidence that migration itself, and the disruption of social networks that it entails, is primarily responsible for the association. Family separation, in particular, is the strongest predictor of depressive feelings and accounts for a sizeable portion of the heightened depression among migrants. CONCLUSIONS: Understanding the subjective experiences of migration is necessary to better integrate newcomers into host societies.

Abortion Legalization and Childbearing in Mexico.

In 2007 abortion was legalized in the Federal District of Mexico, making it the largest jurisdiction in Latin America, outside of Cuba, to allow women to have abortions on request during the first trimester of pregnancy. While the implications of the law for women's health and maternal mortality have been investigated, its potential association with fertility behavior has yet to be assessed. We examine metropolitan-area differences in overall and parity-specific childbearing, as well as the age pattern of childbearing between 2000 and 2010 to identify the contribution of abortion legalization to fertility in Mexico. Our statistical specification applies difference-in-difference regression methods that control for concomitant changes in other socioeconomic predictors of fertility to assess the differential influence of the law across age groups. In addition, we account for prior fertility levels and change to better separate the effect of the law from preceding trends. Overall, the evidence suggests a systematic association between abortion legalization and fertility. The law appears to have contributed to lower fertility in Mexico City compared to other metropolitan areas and prior trends. The influence is mostly visible among women aged 20-34 in connection with the transition to first and second child, with limited impact on teenage fertility. There is some evidence that its effect might be diffusing to the Greater Mexico City Metropolitan area.

A tale of two contexts: U.S. migration and the labor force trajectories of Mexican women.

Even though women have long participated in Mexico-U.S. migration studies assessing the labor market implications of international mobility for women are rare. Especially lacking are studies that follow a life-course approach and compare employment trajectories across contexts and in connection with other transitions. Using life-history data collected in Mexico and the United States, we explore the impact of migration on women's employment, focusing on how the determinants of employment vary across contexts. We show that U.S. residence eliminates or even reverses the employment returns to education found in Mexico, and that the constraints imposed on women's work by marriage are actually stronger in the U.S. CONTEXT: We also explicitly connect migration to other life-course events, documenting how the impact of context varies not only by marital status but also by where women's unions were formed.

Perceived discrimination among Latino immigrants in new destinations: The case of Durham, NC.

This paper draws on original survey data to assess the prevalence of perceived discrimination among Latin American immigrants to Durham, NC, a "new immigrant destinations" in the Southeastern United States. Even though discrimination has a wide-ranging impact on social groups, from blocked opportunities, to adverse health outcomes, to highlighting and reifying inter-group boundaries, research among immigrant Latinos is rare, especially in new destinations. Our theoretical framework and empirical analysis expand social constructivist approaches that view ethnic discrimination as emerging from processes of competition and incorporation. We broaden prior discussions by investigating the specific social forces that give rise to perceived discrimination. In particular, we examine the extent to which perceptions of unequal treatment vary by gender, elaborating on the situational conditions than differentiate discrimination experiences for men and women. We also incorporate dimensions unique to the contemporary Latino immigrant experience, such as legal status, family migration dynamics, and transnationalism.

Migration, Social Organization, and the Sexual Partners of Mexican Men.

We build on recent developments in social organization theory to examine the sexual partnering of Mexican men in a new area of immigrant destination. We elaborate on two levels of contextual influence: 1) how differences in social capital between sending and receiving communities affect partner formation and 2) how neighborhood social cohesion influences immigrants' behavior. Data come from an original survey conducted in Durham, NC and migrant sending communities in Mexico. We show dramatic differences in sexual partnering between Mexico and the U.S. that are directly linked to lack of social networks and familial support. Neighborhood level social cohesion in part counteracts those effects. The role of social capital and neighborhoods, however, is highly gendered. The presence of women is a critical dimension of the social organization of immigrant communities and its effect extends beyond mere partner availability.

Hispanic fertility, immigration, and race in the twenty-first century.

In this paper we systematically describe the connection between immigration and fertility in light of the increasing nativist reaction to Hispanic groups. We follow a life-course perspective to directly link migration and fertility transitions. The analysis combines original qualitative and quantitative data collected in Durham/Chapel Hill, NC as well as national level information from the Current Population Survey. The qualitative data provides a person-centered approach to the connection between migration and fertility that we then extend in quantitative analyses. Results demonstrate that standard demographic measures that treat migration and fertility as separate processes considerably distort the childbearing experience of immigrant women, inflating fertility estimates for Hispanics as a whole. Once this connection is taken into consideration the fertility levels of Hispanic women are much lower than those reported with standard measures and the fertility-specific contribution of Hispanics to U.S. population growth is much reduced.

Forging Hispanic communities in new destinations: A case study of Durham, NC.

The Chicago School of urban sociology and its extension in the spatial assimilation model have provided the dominant framework for understanding the interplay between immigrant social and spatial mobility. However, the main tenets of the theory were derived from the experience of pre-war, centralized cities; scholars falling under the umbrella of the Los Angeles school have recently challenged the extent to which they are applicable to the contemporary urban form, which is characterized by sprawling, decentralized, and multi-nucleated development. Indeed, new immigrant destinations, such as those scattered throughout the American Southeast, are both decentralized and lack prior experience with large scale immigration. Informed by this debate this paper traces the formation and early evolution of Hispanic neighborhoods in Durham, NC, a new immigrant destination. Using qualitative data we construct a social history of immigrant neighborhoods and apply survey and census information to examine the spatial pattern of neighborhood succession. We also model the sorting of immigrants across neighborhoods according to personal characteristics. Despite the many differences in urban form and experience with immigration, the main processes forging the early development of Hispanic neighborhoods in Durham are remarkably consistent with the spatial expectations from the Chicago School, though the sorting of immigrants across neighborhoods is more closely connected to family dynamics and political economy considerations than purely human capital attributes.

Hispanic Familism Reconsidered: Ethnic Differences in the Perceived Value of Children and Fertility Intentions.

Familism has been described as a cultural trait that might explain why the fertility of Hispanic women remains higher than non-Hispanic White women. Still, few studies have analyzed group differences in childbearing attitudes. This paper focuses on two dimensions of childbearing orientation: social value of children and fertility intentions. Using the National Survey of Family Growth we find limited support for the idea that familism undergirds differentials in fertility between native-born Hispanics and Whites. However, for foreign-born Hispanics, there are some differences in the perceived value of children compared with Whites, and these differences could contribute to fertility differentials.

How high is Hispanic/Mexican fertility in the united states? Immigration and tempo considerations.

In this article, I demonstrate that the apparently much higher fertility of Hispanic/Mexican women in the United States is almost exclusively the product of period estimates obtained for immigrant women and that period measures of immigrant fertility suffer from three serious sources of bias that together significantly overstate fertility levels: difficulties in estimating the size of immigrant groups; the tendency for migration to occur at a particular stage in life; and, most importantly, the tendency for women to have a birth soon after migration. When these sources of bias are taken into consideration, the fertility of native Hispanic/Mexican women is very close to replacement level. In addition, the completed fertility of immigrant women in the United States is dramatically lower than the level obtained from period calculations. Findings are consistent with classical theories of immigrant assimilation but are a striking departure from the patterns found in previous studies and published statistics. The main implication is that without a significant change in immigration levels, current projections based on the premise of high Hispanic fertility are likely to considerably exaggerate Hispanic population growth, its impact on the ethno-racial profile of the country, and its potential to counteract population aging.

Migration and Sexuality: A Comparison of Mexicans in Sending and Receiving Communities.

The reconstruction of sexuality after migration is a central dimension of immigrant health and an integral part of the process of adaptation and incorporation. Despite its significance there is little quantitative information measuring the changes in sexual behavior accompanying migration. This paper contributes to the literature connecting immigrant adaptation and health risks by comparing sexual practices and attitudes among Mexicans in Durham, NC and Mexican sending communities. Consistent with a social constructivist approach to sexuality we show that compared to non-migrants, Mexicans residing in the U.S. exhibit heightened exposure to risk, including casual and, among men, commercial partners. The enhanced risks associated with migration vary systematically by gender and marital status and are accompanied by variation in attitudes towards sexuality, with the U.S. context associated with higher tolerance for infidelity and biological explanations of sexuality. We discuss the implications for immigrant adaptation and health policies in the U.S. and abroad.

Community attachment, neighborhood context, and sex worker use among Hispanic migrants in Durham, North Carolina, USA.

We build on social disorganization theory to formulate and test a hierarchical model of sex worker use among male Hispanic immigrants in the Durham, North Carolina area. The study considers both individual and neighborhood level dimensions of community organization as central factors affecting immigrants' exposure to sexual risks. At the individual level, we find support for the systemic model of community attachment, as time in the U.S. affects sex worker use, although the pattern is non-linear. At the neighborhood level we find that structural social disorganization, external social disorganization (or broken windows), and collective efficacy all correlate with sex worker use in the expected direction. In addition, we extend power-control theory to the community level to show that neighborhood gender imbalances are a central dimension of migrant men's heightened sex worker use, a factor not systematically considered in research on neighborhoods and health. When taken together, collective efficacy and gender imbalances stand out as central mediators between other dimensions of social disorder and sex worker use. Overall, we stress the importance of considering the neighborhood context of reception as an added dimension for understanding and improving immigrant health.

Intergenerational fertility among Hispanic women: new evidence of immigrant assimilation.

In recent decades, rapid growth of the U.S. Hispanic population has raised concerns about immigrant adaptation, including fertility. Empirical research suggests that Hispanics, especially Mexicans, might not be following the historical European pattern of rapid intergenerational fertility decline (and convergence toward native levels). If confirmed, continued high Hispanic fertility could indicate a broader lack of assimilation into mainstream American society. In this paper, we reexamine the issue of Hispanic and Mexican fertility using an approach that combines biological and immigrant generations to more closely approximate a comparison of immigrant women with those of their daughters' and granddaughters' generation. Contrary to cross-sectional results, our new analyses show that Hispanic and Mexican fertility is converging with that of whites, and that it is similarly responsive to period conditions and to women's level of education. In addition, we employ a mathematical simulation to illustrate the conditions under which cross-sectional analyses can produce misleading results. Finally, we discuss the import of the fertility convergence we document for debates about immigrant assimilation.

Religious attendance and mortality: implications for the black-white mortality crossover.

This study investigates the relationships among religious attendance, mortality, and the black-white mortality crossover. We build on prior research by examining the link between attendance and mortality while testing whether religious involvement captures an important source of population heterogeneity that contributes to a crossover Using data from the Established Populations for Epidemiologic Studies of the Elderly, we find a strong negative association between attendance and mortality. Our results also show evidence of a racial crossover in mortality rates for both men and women. When religious attendance is modeled in terms of differential frailty, clear gender differences emerge. For women, the effect of attendance is race- and age-dependent, modifying the age at crossover by 10 years. For men, however; the effect of attendance is not related to race and does not alter the crossover pattern. When other health risks are modeled in terms of differential frailty, wefind neither race nor age-related effects. Overall, the results highlight the importance of considering religious attendance when examining racial and gender differences in age-specific mortality rates.