Anti-immigrant rhetoric and political actions gained prominence and public support before, during, and after the 2016 presidential election. This anti-immigrant political environment threatens to increase health disparities among undocumented persons, immigrant groups, and people of color. I discuss the mechanisms by which anti-immigrant stigma exacerbates racial/ethnic health disparities through increasing multilevel discrimination and stress, deportation and detention, and policies that limit health resources. I argue that the anti-immigrant sociopolitical context is a social determinant of health that affects mostly communities of color, both immigrants and nonimmigrants. Public health has a moral obligation to consider how immigration policy is health policy and to be prepared to respond to worsening health disparities as a result of anti-immigrant racism.

Introduction

To understand how mixed-immigration status families-families with a mixture of people with and without documentation-in the United States (U.S.) fared during the COVID-19 pandemic. Specifically, this study highlights how health inequities were exacerbated during the height of the pandemic due to the implementation of anti-immigration policies such as Public Charge Rule, which stipulates that receiving public benefits is grounds for inadmissibility for immigrants seeking naturalization.

Methods

In-depth semistructured interviews were conducted over Zoom with 14 members of mixed-status families between February and April 2021. The interviews were audio recorded, transcribed, and analyzed using Atlas.ti. Using grounded theory, we assessed the level of awareness about Public Charge Rule and the health challenges these families faced during the COVID-19 pandemic.

Results

Themes that emerged included financial problems, job insecurity, housing insecurity, food insecurity, mental health problems, distrust of government and health officials, and a fear of Public Charge Rule. We present a framework for understanding health inequities for mixed-status families during the COVID-19 pandemic.

Discussion

Public Charge Rule caused fear and confusion for mixed-status families during the COVID-19 pandemic, resulting in individuals not receiving public benefits they urgently needed. This created heightened mental health problems due to job, housing, and food insecurity.

Health equity implications

We discuss how trust between mixed-status families and the government needs foundational rebuilding. In addition to streamlining the process for these families to apply for legal status, it is important to protect and support mixed-status families through programs and policies during public health emergencies.

Understanding how knowledge and attitudes about colorectal cancer (CRC) screening differs among Asian immigrants is important for informing targeted health interventions aimed at preventing and treating CRC in this diverse population. This study examines how Asian subgroup and acculturation are associated with CRC knowledge and attitudes among Chinese and Korean immigrants in the United States (U.S.). Data come from the baseline survey of a randomized controlled trial to increase CRC screening among Chinese and Korean American immigrants living in the Baltimore-Washington DC Metropolitan Area (n = 400). We use linear regression to examine how Asian subgroup, time in the U.S., English-speaking proficiency, and ethnic identity are associated with CRC knowledge and screening attitudes, accounting for demographic variables, socioeconomic status, and health insurance status. Results show that greater socioeconomic status was associated with higher CRC knowledge, and socioeconomic status explained more of the variance in CRC knowledge than acculturation factors. Additionally, attitudes varied by Asian subgroup, with Chinese reporting lower CRC screening salience, worry, response efficacy, and social influence compared to Koreans. Findings suggest that in-language interventions aimed at increasing CRC knowledge and capitalizing on attitudes about screening can help to bridge disparities in CRC screening by socioeconomic status and country of origin. We discuss implications for future interventions to increase CRC screening uptake among Chinese and Korean immigrants in the U.S.

Asian Americans are more likely to be unaware that they have hypertension compared to non-Hispanic white Americans, despite having higher risk of hypertension at lower body-mass indices. Furthermore, immigrants are more likely than their United States (U.S.)-born counterparts to have undiagnosed hypertension, placing them at greater risk of subsequent morbidity and mortality. This study examines the social determinants of undiagnosed hypertension among Asian American immigrants. Using a study of foreign-born Chinese and Korean Americans between the ages of 50-75 years-old recruited from physicians' clinics in the Baltimore-Washington DC Metropolitan Area (n = 355), we used blood pressure readings measured by trained staff members, self-reported diagnosis by a medical professional, and self-reported hypertension medication use to determine hypertension status-whether patients were non-hypertensive, had diagnosed hypertension, or had undiagnosed hypertension. Using multinomial logistic regression, we examined how demographic, socioeconomic, and immigration-related factors were associated with hypertension status. Results indicated that older age, male gender, Korean subgroup, and marital status were associated with having diagnosed hypertension compared to being non-hypertensive. Lack of health insurance was the strongest predictor of having undiagnosed hypertension compared to being non-hypertensive. Acculturation variables had no strong associations with hypertension status. We then explored correlates of health insurance status for Chinese and Korean American immigrants. Those without health insurance were more likely to have lower income and to be not currently employed. Our findings point to the importance of increasing health insurance access for Asian American immigrant groups to ensure that hypertension is not left undiagnosed and untreated.

Introduction

Disturbed sleep may be a factor that links stress with poor health, especially among groups experiencing high levels of stress caused by racial and ethnic minority and nativity status. The objective of this study was to describe the potential mediating role of sleep disturbance in the associations between various types of stress and self-rated health among Chinese and Korean Americans.

Methods

Our cross-sectional study consisted of 400 Chinese and Korean immigrants aged 50 to 75 years recruited from August 2018 through June 2020 from physicians' clinics in the Baltimore-Washington, DC, metropolitan area. We used the Patient Reported Outcomes Measurement Information System (PROMIS) short-form questionnaire to measure sleep disturbance. Linear regression analyses examined associations between 3 types of stress (acculturative stress, perceived stress, and distress) and self-rated health, accounting for demographic, socioeconomic, and health insurance factors. The Karlson-Holm-Breen method was used to estimate the total and direct effects of stresses on self-rated health and the indirect effects of stresses on health through sleep disturbance.

Results

Greater acculturative stress (β = 0.08; 95% CI, 0.01-0.14), perceived stress (β = 0.05; 95% CI, 0.03-0.08), and distress (β = 0.09; 95% CI, 0.05-0.13) were all associated with poorer self-rated health. Sleep disturbance was a partial mediator, with sleep disturbance accounting for 21.7%, 14.9%, and 18.7% of the associations between acculturative stress, perceived stress, and distress and self-rated health, respectively.

Conclusion

Because sleep disturbance partially mediates the associations between stress and poor self-rated health, future interventions and research may consider mitigating sleep disturbances and stress among racial and ethnic minority populations to address health disparities.

Introduction

Recently, the rates of utilization of alternative tobacco products have increased. Providing health information about tobacco products from trustworthy sources may help decrease the popularity of these products. Using a nationally representative study of adults, we fill the current gap in research on racial and ethnic disparities in utilization of alternative tobacco products as well as in trust of sources of health information about tobacco products.

Aims and methods

Data came from the Health Information National Trends Survey (N = 3738), which was collected in 2015. Logistic regression models were used to calculate odds of use of seven different tobacco product (eg, hookah, e-cigarettes, etc.), trust in seven different sources of e-cigarette health information (eg, family or friends, health care providers, etc.), and trust in six different sources of tobacco health information, adjusting for control variables.

Results

There were disparities in utilization of alternative tobacco products and in trust, in tobacco companies across racial and ethnic groups. Blacks and Asians were far more likely than whites to trust tobacco (adjusted odds ratios = 8.67 and 4.34) and e-cigarette companies (adjusted odds ratios = 6.97 and 3.13) with information about the health effects of e-cigarettes than whites.

Conclusions

The popularity of alternative tobacco products appears to be high and may offset recent observed decreases in cigarette use. Blacks and Asians appear to trust tobacco companies as sources of information when compared to whites.

Implications

Higher levels of trust in tobacco companies among Asians and blacks may translate to greater susceptibility to utilize tobacco products among these groups, thereby increasing disparities. There is a need for social marketing and education efforts focused on increasing awareness of adverse health effects of using alternative tobacco products as well as on the untrustworthiness of tobacco and e-cigarette companies, especially among racial and ethnic minorities.

Prior research contends that social support positively influences health by optimizing individuals' psychological processes such as appraisals, emotions, and sense of control-known as stress-buffering effects. This study tests this theoretical concept by examining whether the association between social support and health can be explained by the psychological processes of perceived stress and distress among Chinese and Korean American immigrants. Furthermore, we examine what predicts social support in this population, with a particular focus on factors related to immigration. Using a total sample of 400 Chinese and Korean American immigrants, we examine the association between social support and self-rated health (SRH), accounting for demographic factors, socioeconomic status, perceived stress, and perceived distress using multivariable logistic regression models. We conducted a mediation analysis using the Karlson, Holm, and Breen (KHB) method to determine whether perceived stress and distress partly explained the association between social support and SRH. Findings showed a strong total effect of higher social support on better SRH. Furthermore, mediation was detected, with perceived stress and distress explaining 42.98% of the total effect of social support on SRH. Multivariable linear regression models revealed that social support among Chinese and Korean American immigrants was associated with marital status, employment, ethnic identity, and acculturative stress. This study highlights the centrality of social support for Chinese and Korean American immigrants, which lowers perceived stress and distress, leading to better overall health. By confirming these stress-buffering effects, our findings suggest that bolstering social support among vulnerable Chinese and Korean American immigrant populations can have a positive effect on health by optimizing stress appraisals.

Qualitative work has found that Latino food pantry recipients share food and reciprocally provide social support to their food-insecure neighbors. These findings suggest that neighborhood cohesion (NC) may serve as an important community-level resource that Latinos utilize as a coping mechanism when food-insecure. High levels of NC may be a proxy for instrumental support outside the household and act as a buffer against the adverse health effects of food insecurity including type 2 diabetes (T2D), which is highly sensitive to food insecurity. The purpose of this study was to quantitatively test this theory by examining whether NC moderated the association between T2D and food security (FS) status among Latino adults nationwide. We used data from the 2013-2018 National Health Interview Survey (n = 23,478). We found that FS status was associated with T2D prevalence, with Latino adults having a higher odds of T2D if they had low FS or very low FS compared to their FS counterparts. We also found Latinos adults who reported high NC had a lower odds of T2D compared to those who reported low NC. However, we did not find there was significant interaction between FS status and NC on T2D. NC may instead be a precursor to FS status, rather than a buffer of food insecurity on T2D. Low NC may lead to less instrumental support and tangible benefits that determine FS. Additionally, perceived NC might not align with objective NC and T2D may be too distal of a health outcome to test the protective effect of NC.

We present interpretations of the idea that "epidemiologists count" in response to the current status of membership and diversity and inclusion efforts within the Society for Epidemiological Research (SER). We review whom epidemiologists count to describe the (mis)representation of SER membership and how categorizations of people reflect social constructions of identity and biases that exist in broader society. We argue that what epidemiologists count-how diversity and inclusion are operationalized-has real-world implications on institutional norms and how inclusive/non-inclusive environments are. Finally, we examine which epidemiologists count within the field and argue that inclusion can only be achieved when we address how resources and opportunities are distributed among epidemiologists. To improve diversity and inclusion within SER and beyond, we recommend that SER strengthen its commitment to diversity, inclusion, and equity by: 1) integrating this priority on all agendas; 2) enhancing efforts to improve self-awareness among members and accountability within the organization; 3) supporting the growth of a diversifying workforce in epidemiology; and 4) increasing the visibility of health disparities research and researchers in epidemiology.

Objective

This study examines associations between the risk of sleep apnea and abdominal obesity (assessed by waist-to-hip ratio (WHR)) and general obesity (assessed by body mass index (BMI)) in a sample of Chinese and Korean American immigrants.

Methods

The dataset included Chinese and Korean participants aged 50-75 who were recruited from primary care physicians' clinics from April 2018 to June 2020 in the Baltimore-Washington D.C. Metropolitan area (n = 394). Abdominal obesity was determined if WHR ≥ 0.9 in men and WHR ≥ 0.85 in women. General obesity was determined if BMI ≥ 30. The risk of sleep apnea was determined by using the Berlin questionnaire. Poisson regression models examined associations between sleep apnea risk and obesity. Models controlled for socio-demographic risk factors.

Results

Twelve percent of the study participants were classified as a high risk for sleep apnea, and 75% had abdominal obesity whereas 6.4% had general obesity. High risk of sleep apnea was positively associated with abdominal obesity (PR = 1.31, 95% CI: 1.17-1.47) and general obesity (PR = 2.19, 95% CI: 0.90-5.32), marginally significant at p < 0.1).

Conclusions

Chinese and Korean immigrants living in the USA who are at high risk of sleep apnea have higher abdominal obesity, even after accounting for sociodemographic characteristics. Abdominal obesity may be a better indicator than general obesity when examining the risk of sleep apnea among Asian Americans.

Information on clinical trial

Name: Screening To Prevent ColoRectal Cancer (STOP CRC) among At-Risk Asian American Primary Care Patients NCT Number: NCT03481296; Date of registration: March 29, 2018 URL: https://clinicaltrials.gov/ct2/show/NCT03481296?term=Sunmin+Lee&draw=2&rank=1.