%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 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