%0 Journal Article %J Soc Sci Med %D 2012 %T Does an immigrant health paradox exist among Asian Americans? Associations of nativity and occupational class with self-rated health and mental disorders. %A John, Dolly A %A de Castro, A B %A Martin, Diane P %A Duran, Bonnie %A Takeuchi, David T %K Adult %K Asian Americans %K Confidence Intervals %K Emigrants and Immigrants %K Employment %K Female %K Health Status %K Humans %K Logistic Models %K Male %K Mental Disorders %K Odds Ratio %K Population Surveillance %K Self Report %K Sex Distribution %K United States %X

A robust socioeconomic gradient in health is well-documented, with higher socioeconomic status (SES) associated with better health across the SES spectrum. However, recent studies of U.S. racial/ethnic minorities and immigrants show complex SES-health patterns (e.g., flat gradients), with individuals of low SES having similar or better health than their richer, U.S.-born and more acculturated counterparts, a so-called "epidemiological paradox" or "immigrant health paradox". To examine whether this exists among Asian Americans, we investigate how nativity and occupational class (white-collar, blue-collar, service, unemployed) are associated with subjective health (self-rated physical health, self-rated mental health) and 12-month DSM-IV mental disorders (any mental disorder, anxiety, depression). We analyzed data from 1530 Asian respondents to the 2002-2003 National Latino and Asian American Study in the labor force using hierarchical multivariate logistic regression models controlling for confounders, subjective social status (SSS), material and psychosocial factors theorized to explain health inequalities. Compared to U.S.-born Asians, immigrants had worse socioeconomic profiles, and controlling for age and gender, increased odds for reporting fair/poor mental health and decreased odds for any DSM-IV mental disorder and anxiety. No strong occupational class-health gradients were found. The foreign-born health-protective effect persisted after controlling for SSS but became nonsignificant after controlling for material and psychosocial factors. Speaking fair/poor English was strongly associated with all outcomes. Material and psychosocial factors were associated with some outcomes--perceived financial need with subjective health, uninsurance with self-rated mental health and depression, social support, discrimination and acculturative stress with all or most DSM-IV outcomes. Our findings caution against using terms like "immigrant health paradox" which oversimplify complex patterns and mask negative outcomes among underserved sub-groups (e.g., speaking fair/poor English, experiencing acculturative stress). We discuss implications for better measurement of SES and health given the absence of a gradient and seemingly contradictory finding of nativity-related differences in self-rated health and DSM-IV mental disorders.

%B Soc Sci Med %V 75 %P 2085-98 %8 2012 Dec %G eng %N 12 %R 10.1016/j.socscimed.2012.01.035 %0 Journal Article %J Prog Community Health Partnersh %D 2012 %T Evaluating community-based participatory research to improve community-partnered science and community health. %A Hicks, Sarah %A Duran, Bonnie %A Wallerstein, Nina %A Avila, Magdalena %A Belone, Lorenda %A Lucero, Julie %A Magarati, Maya %A Mainer, Elana %A Martin, Diane %A Muhammad, Michael %A Oetzel, John %A Pearson, Cynthia %A Sahota, Puneet %A Simonds, Vanessa %A Sussman, Andrew %A Tafoya, Greg %A Hat, Emily White %K Community-Based Participatory Research %K Community-Institutional Relations %K Humans %K Indians, North American %K National Institutes of Health (U.S.) %K Public Health %K Research %K Trust %K United States %K Universities %X

BACKGROUND: Since 2007, the National Congress of American Indians (NCAI) Policy Research Center (PRC) has partnered with the Universities of New Mexico and Washington to study the science of community-based participatory research (CBPR). Our goal is to identify facilitators and barriers to effective community-academic partnerships in American Indian and other communities, which face health disparities.

OBJECTIVES: We have described herein the scientific design of our National Institutes of Health (NIH)-funded study (2009-2013) and lessons learned by having a strong community partner leading the research efforts.

METHODS: The research team is implementing a mixed-methods study involving a survey of principal investigators (PIs) and partners across the nation and in-depth case studies of CBPR projects.

RESULTS: We present preliminary findings on methods and measures for community-engaged research and eight lessons learned thus far regarding partnership evaluation, advisory councils, historical trust, research capacity development of community partner, advocacy, honoring each other, messaging, and funding.

CONCLUSIONS: Study methodologies and lessons learned can help community-academic research partnerships translate research in communities.

%B Prog Community Health Partnersh %V 6 %P 289-99 %8 2012 Fall %G eng %N 3 %R 10.1353/cpr.2012.0049 %0 Journal Article %J Health Educ Res %D 2012 %T Process and outcome constructs for evaluating community-based participatory research projects: a matrix of existing measures. %A Sandoval, Jennifer A %A Lucero, Julie %A Oetzel, John %A Avila, Magdalena %A Belone, Lorenda %A Mau, Marjorie %A Pearson, Cynthia %A Tafoya, Greg %A Duran, Bonnie %A Iglesias Rios, Lisbeth %A Wallerstein, Nina %K Community-Based Participatory Research %K Forecasting %K Group Processes %K Humans %K Models, Theoretical %K Outcome and Process Assessment (Health Care) %K Reproducibility of Results %K Research Design %X

Community-based participatory research (CBPR) has been widely used in public health research in the last decade as an approach to develop culturally centered interventions and collaborative research processes in which communities are directly involved in the construction and implementation of these interventions and in other application of findings. Little is known, however, about CBPR pathways of change and how these academic-community collaborations may contribute to successful outcomes. A new health CBPR conceptual model (Wallerstein N, Oetzel JG, Duran B et al. CBPR: What predicts outcomes? In: Minkler M, Wallerstein N (eds). Communication Based Participatory Research, 2nd edn. San Francisco, CA: John Wiley & Co., 2008) suggests that relationships between four components: context, group dynamics, the extent of community-centeredness in intervention and/or research design and the impact of these participatory processes on CBPR system change and health outcomes. This article seeks to identify instruments and measures in a comprehensive literature review that relates to these distinct components of the CBPR model and to present them in an organized and indexed format for researcher use. Specifically, 258 articles were identified in a review of CBPR (and related) literature from 2002 to 2008. Based on this review and from recommendations of a national advisory board, 46 CBPR instruments were identified and each was reviewed and coded using the CBPR logic model. The 46 instruments yielded 224 individual measures of characteristics in the CBPR model. While this study does not investigate the quality of the instruments, it does provide information about reliability and validity for specific measures. Group dynamics proved to have the largest number of identified measures, while context and CBPR system and health outcomes had the least. Consistent with other summaries of instruments, such as Granner and Sharpe's inventory (Granner ML, Sharpe PA. Evaluating community coalition characteristics and functioning: a summary of measurement tools. Health Educ Res 2004; 19: 514-32), validity and reliability information were often lacking, and one or both were only available for 65 of the 224 measures. This summary of measures provides a place to start for new and continuing partnerships seeking to evaluate their progress.

%B Health Educ Res %V 27 %P 680-90 %8 2012 Aug %G eng %N 4 %R 10.1093/her/cyr087 %0 Journal Article %J Public Health Rep %D 2010 %T Risk factors for HIV disease progression in a rural southwest American Indian population. %A Iralu, Jonathan %A Duran, Bonnie %A Pearson, Cynthia R %A Jiang, Yizhou %A Foley, Kevin %A Harrison, Melvin %K Alcoholism %K CD4 Lymphocyte Count %K Disease Progression %K Female %K HIV Infections %K Humans %K Indians, North American %K Male %K Medication Adherence %K Medicine, Traditional %K Prisoners %K Risk Factors %K Rural Population %K Southwestern United States %K Viral Load %X

OBJECTIVES: Risk factors for human immunodeficiency virus (HIV) disease progression among American Indians (AIs) have been poorly characterized. We assessed the impact of socioeconomic factors and use of traditional healing on HIV disease progression in a rural AI community.

METHODS: From January 2004 through December 2006, we interviewed 36 HIV-positive AIs regarding their socioeconomic status, incarceration, and use of traditional healing. We also collected chart-abstracted adherence and substance-abuse data. Through bivariate analysis, we compared these factors with the CD4-cell counts and log HIV-1 viral loads (VLs). Using a simple regression model, we assessed interactions between the significant associations and the outcome.

RESULTS: Participant characteristics included being male (58.3%), being transgender (13.9%), having ever been incarcerated (63.9%), having a household income of < $1,000/month (41.7%), being unemployed (61.1%), being diagnosed with alcohol abuse (50.0%), and using traditional medicine (27.8%) in the last 12 months. Higher VLs were associated with recent incarceration (p < 0.05), household income of < $1,000/month (p < 0.05), and provider-assessed alcohol abuse (p < 0.05). We found an interaction between incarceration and alcohol abuse, and alcohol abuse was the factor more strongly associated with higher VLs. A lower CD4 count was associated with recent incarceration (p < 0.05) and use of traditional medicine (p < 0.05).

CONCLUSIONS: Alcohol abuse is an important contributor to HIV disease progression, and participants with lower CD4 counts were more likely to use traditional medicine. HIV care among this rural AI population should focus on addressing alcohol abuse and other socioeconomic risk factors and promote collaboration between Western medical and Navajo traditional practitioners.

%B Public Health Rep %V 125 Suppl 4 %P 43-50 %8 2010 Jul-Aug %G eng