This landmark report describes patterns and trends associated with Latin American, in particular, Mexican migration to the United States. Authored by Center associate director, Steven P. Wallace, PhD, and others, the report focuses on immigrants' health insurance coverage, common illnesses, and access to and utilization of health services. This report also includes a number of considerations that point out challenges and opportunities in the field of binational public policy. The production of this report was made possible through the binational collaboration of the National Population Council of Mexico (CONAPO), the Secretary of Health of Mexico, and the University of California.

Chronic diseases are the leading causes of death in California and have become among the most common, costly, and often preventable of all health problems. Chronic Conditions of Californians reports that in 2003, 11.5 million California adults over age 18 were living with one or more chronic conditions including heart disease, hypertension, diabetes, asthma, or fair/poor health status. In addition, 1.9 million children ages 1-17 were living with asthma or fair/poor health status.

This report presents data on each chronic condition as well as on summary indicators for California counties and Los Angeles County SPAs. It also presents the socioeconomic and demographic profiles of those with chronic conditions, and the actual access problems and potential barriers to obtaining health care of all persons in those areas. A summary index of chronic conditions and these access indicators suggest areas in the state with the greatest overall burden from chronic conditions on local health systems. Overall, the Colusa/Glenn/Tehama county group, Kern County, Madera County, and Merced County had the worst chronic illness related summary indicators.

Supplemental exhibits offer confidence intervals for all data found in the report, a map of the chronic conditions index among children ages 1-17 living with asthma or fair/poor health status, additional regional data on limited English proficiency and uninsured rates per chronic condition among adults, uninsured rates among children with asthma, and selected population characteristics among adults and children.

This data is a useful tool for health planners and policy makers with which to target public health interventions and plan health service provision.

This dissertation explores the relationship between personal and spousal migration to the United States and later-life health for older Mexican adults living in Mexico in the context of other social determinants of health across the life-course determinants. I use the 2001 baseline wave of the Mexican Health and Aging Survey, a nationally representative sample of Mexican adults 50 years and older (born before 1951). I test the relationship between U.S. migration experience and later-life depression, diabetes, and hypertension for older Mexican men, and between spousal migration to the U.S. and later-life depression, diabetes, and hypertension for older Mexican women. I also examine the degree to which personal or spousal migration to the U.S. might mediate or moderate the relationship between early-life socio-economic status and health conditions, and later-life health outcomes. My results suggest that there is no significant main effect of U.S. migration experience on later-life health for older Mexican men, although return U.S. migrant men who report lower socio-economic standing later in life appear to have elevated risk of depression and diabetes. On the other hand, older Mexican women whose spouses migrated to the U.S. have significantly increased odds of later-life diabetes and hypertension if those women are no longer in a union by the time of the survey. The adverse effects of spousal migration to the U.S. are exacerbated by women's domestic labor outside the home and lack of decision-making power relative to their spouses, but buffered by their own migration experience. Finally, although greater socio-economic disadvantage in childhood predicts both U.S. migration (personal and spousal), and increased odds of later-life depression, diabetes, and hypertension, there is no evidence that US migration experience explains this life-course trajectory of socio-economic status and health. There is also limited evidence that a U.S. migration experience alters the relationship between childhood conditions and later-life health. Overall, for this group of older Mexican adults, the adverse effects of past U.S. migration experience are only observed for women whose spouses migrated to the U.S. and who are no longer in a union, which contributes to theories of the gendered geographies of power, or the ways in which migration may have different effects for men and women - in this case women who primarily stayed behind in Mexico. On the other hand, contrary to theories of migration stress, having a U.S. migration history does not appear to have a substantial effect on the health of return Mexican migrant men.

Background and Significance: Acculturation is commonly used in public health studies to examine and explain differences in health behaviors and outcomes between racial and ethnic groups. Despite limitations, language preference, length of residence in the U.S., and nativity are typically used as indicators of acculturation. The purpose of this dissertation research was to explore the transition processes of recent Filipino immigrants via grounded theory and qualitative data collection methods to gain a better understanding of their pre and post migration experiences for future use in culture and health initiatives. Age at migration was a central point of comparison, with the underlying use of a life course perspective.

Methods: Semi-structured interviews were conducted with 24 Filipino immigrants who migrated 15 years ago or less. Data were collected on reasons for migration, expectations, post-migration experiences and perceptions, Filipino-influenced behaviors and beliefs, American cultural norms, contact with mainstream institutions, and several health-related domains.

Findings: Immigrants described several factors related to ease of transitions, including prior knowledge of the U.S. and language skills as well as experiencing culture shock. These factors, in addition to reasons for migration, influenced the type and degree of exposure to mainstream institutions that resulted in further acclimation to the U.S. culture. Those that had higher levels of exposure to and encounters with institutions had more knowledge of American ways of life and appeared more integrated in the mainstream society. Further, while language, time since migration, and age at migration had secondary effects on post-migration experiences, they did not directly influence interviewee's integration to U.S. society. Immigrants' cultural values and beliefs were not replaced by those of the mainstream as is typically assumed via frameworks of acculturation. Further, the core cultural values that interviewees described like the importance of family and respect did not appear to diminish with increasing time since migration. Yet retaining these values also did not tend to hinder people's ability to acclimate to life in the U.S.

Conclusion: Traditional acculturation theories and models that are commonly used in public health are not useful for understanding the migration experiences or cultural changes of Filipino immigrants. More effective frameworks would identify transition domains like language, knowledge, and skills and then examine changes to them. They would also focus on immigrants' contact with mainstream institutions and their ability at navigating through the new society. The Filipinos in this sample did not describe processes of being "more American" but rather the gaining of knowledge and skills needed to navigate the U.S. Public health efforts tailored to Filipino immigrants may be more effective if they incorporate knowledge on migration experiences, the notion of retaining core values and adopting traits needed to integrate to society, and specific values that have been identified to influence attitudes and behavior.

Background

Objectives

Results

Conclusion

Introduction

Methods

Results

Conclusion

This dissertation examines how the daily life of low-income Latinos in California’s Central Valley influences their family food decisions. The ever-increasing obesity prevalence among this population warrants research on the factors that shape food decisions in this population. Twenty-one families were recruited in collaboration with the ”Reed” Charter School, an elementary charter school committed to healthy eating. The families were followed over the course of two years.

Multiple open-ended interviews were conducted and recorded with 21 mothers and with six fathers; participant observation was conducted in 10 family homes. Participant observation was also conducted at the school and in the community during cooking classes for parents and children, during faculty development and training meetings, at parent forums, during parent teacher conferences, parent group meetings, through the wellness committee at the charter school, in the cafeteria during preparation and lunch times, at the main grocery store, at eight other food outlets including two of the carnicerias (butcher shops), at the local library, and at the local Department of Motor Vehicles. Two focus groups were also conducted to collect data. The findings of these data illustrate how the home, school and work, and the community nutrition environments interact to influence family food decisions.

As has been found in other studies, mealtimes are an important contextual factor influencing food consumption, preparation and eating behaviors. In this study I examine in depth mealtimes among Latino families living in Reed, a small town in California’s Central Valley. The guiding approaches identified in this study provide a new typology of how Latino families organize their family meals. In the home, families were found to have a distinct set of organizing principles (“guiding approaches”) for mealtimes. These included health, traditional, developmental, and path of least resistance. The guiding approaches are influenced by factors in the home including work schedules, food preferences, and the food context in schools, work, and the community.

In Reed, the most accessible food choices for children and people with limited time are cheap, calorically dense, and possess low nutritional value. Ironically, a large proportion of the nation’s produce and fruit is cultivated and harvested in the region, yet the food that is most omnipresent for residents to consume is heavily processed or calorically dense with low nutritional value. At Reed Charter School, children consume school-made lunches that emphasize fresh fruits and vegetables. Most children in Reed, however, attend schools that provide a traditional school lunch that more closely resembles fast food.

Additionally, many families have at least one member who works in a blue-collar job that keeps them away from mealtimes. Health promotion is lacking in the workplace—even though there were a few cases where healthful eating is supported and promoted. Reed Charter School, for example, promotes health among its students and employees. The health promoting effects of Reed Charter School transfer to the home environment and highlight the power of health promotion in low-income communities with limited access to healthful food options. Implications for theory, practice, and research are also provided in the study.

The federal poverty guideline, used to determine income eligibility for many public programs, covers less than half of the basic costs experienced by adults age 65 and older in the state. This report shows how the new Elder Economic Security Standard index (Elder Index) for California provides an empirically-based measure that more accurately reflects county-level costs faced by older adults in the state. In 2007, the federal poverty guideline for a single, elderly person was an annual income of $10,210, and for an older couple, $13,690. But according to the report's calculations, broken down by each California county, a basic annual cost of living for a retired older adult, in good health and living in rental housing, averages $21,011, reaching a high of $27,550 in San Mateo County. The supplemental materials include the Elder Index for each California county together with information on the health care, housing, food, transportation, and miscellanous costs that comprise the Elder Index. The Elder Index is part of a statewide initiative to raise awareness, and to promote policy and programs, that assures income adequacy for all of the state's older adults. The statewide initiative is led by the Insight Center for Community Economic Economic Development, which is part of a national project headed by Wider Opportunities for Women.