Outcomes In Early Adulthood Research Articles

Depression in childhood to early adulthood and respiratory health in early adulthood.

Both depression and respiratory disease are common today in young populations. However, little is known about the relationship between them. This study aims to explore the association between depression in childhood to early adulthood and respiratory health outcomes in early adulthood, and the potential underlying mechanisms. A prospective study was conducted based on the Swedish BAMSE (Barn, Allergi, Miljö, Stockholm, Epidemiologi [Children, Allergy, Milieu, Stockholm, Epidemiology]) birth cohort (n = 4089). We identified clinically diagnosed depression through the dispensation of antidepressants, using national register data confirmed by self-reported diagnosis. At the 24-year follow-up, respiratory health was assessed via questionnaires and clinical evaluation. Metabolic and inflammatory profiles were analysed to explore potential mechanisms. Among the 2994 participants who provided study data, 403 (13.5%) had depression at any time point from around age 10 to 25 years. Depression was associated with higher risks of any chronic bronchitis symptoms (odds ratio = 1.58, 95% CI 1.21-2.06) and respiratory symptoms (odds ratio = 1.41, 95% CI 1.11-1.80) in early adulthood, independent of body mass index (BMI) and smoking status. Compared to individuals without depression, those with depression had a higher fat mass index (FMI (β = 0.48, 95% CI 0.22-0.74)) and increased blood levels of fibroblast growth factor 21 and Interleukin-6 in early adulthood. These markers together with FMI were found to partly mediate the association between depression and respiratory symptoms (total mediation proportion: 19.8 and 15.4%, respectively, P < 0.01). Depression in childhood to early adulthood was associated with an increased risk of respiratory ill-health in early adulthood, independently of smoking. Metabolic and inflammatory dysregulations may underlie this link.

Impact of body mass index on aortic valve stenosis and its clinical outcomes in early adulthood: a long-term study of young men

Abstract Aims Studies investigating associations between body mass index (BMI), incidence of aortic valve stenosis (AVS), and clinical outcomes in AVS patients are scarce. Purpose To investigate the relationship between BMI in youth and subsequent diagnosis of AVS. A secondary aim was to determine the role of obesity in clinical outcomes in individuals diagnosed with AVS. Methods This was a nationwide, register-based cohort study of 1 701 390 men (mean age, 18.3 ±0.8 years) enrolled in compulsory conscription for military service in Sweden from 1969 through 2005. Anthropometrics, blood pressure, fitness, muscle strength and IQ were recorded at baseline. AVS cases and cardiovascular outcomes were identified according to the International Classification of Diseases (ICD)-10 registered in the National patient register and Cause of Death Register through the Swedish 12-digit personal identification number. BMI (kg/m2) was categorized as &amp;lt;18.5, 18.5–&amp;lt;20, 20–&amp;lt;22.5, 22.5–&amp;lt;25, 25–&amp;lt;27.5, 27.5 &amp;lt;30, 30–&amp;lt;35, and 35–&amp;lt;50 kg/m2. Cox proportional hazard models were used to estimate the association between adolescent BMI and future hospitalization for AVS while adjusting for potential confounders. The BMI reference was set as 20–&amp;lt;22.5. Those who developed AVS formed a subcohort that was followed until a first clinical cardiovascular outcome of death, cardiovascular mortality, Heart failure, Atrial fibrillation, myocardial infarction, or ischaemic stroke. Results During a median follow-up of 32 years (IQR, 24-41 years), 5766 cases (mean age 54.7±9.4 years) of AVS were diagnosed. After adjustment, underweight subjects with a BMI of &amp;lt;18.5 kg/m2, compared to those with a low-normal BMI (20.0–&amp;lt;22.5 kg/m2) showed lower risk (HR 0.70; 95% CI 0.61–0.80) of AVS. The multivariable-adjusted HR for AVS increased from HR 1.28; 95% CI 1.17–1.39 for BMI 22.5–&amp;lt;25 kg/m2 to HR 1.91; 95% CI 1.12–3.25 for those with BMI 35–50 kg/m2. Further on, individuals diagnosed with AVS were followed for a median of ~5.5 years. The multivariable-adjusted HR for all-cause mortality, cardiovascular mortality, and heart failure for obese (BMI 30–50 kg/m2), compared to BMI &amp;lt;20.0 kg/m2 in men diagnosed with AVS, were 4.69 (95% CI 2.61–8.44), 4.09 (95% CI 1.72–9.73), and 2.76 (95% CI, 1.36–5.60), respectively. Conclusions Elevated BMI in youth, even within the normal range, is associated with increased risk of developing AVS, while subnormal BMI was protective. Excess weight in youth diagnosed with AVS is associated with higher risk of subsequent clinical outcomes. These findings are novel, generating new questions as to potential mechanisms and implying more vigilant monitoring of patients with AVS and a history of obesity in youth.Figure 1Figure 2

The Impact of Positive and Adverse Experiences in Adolescence on Health and Wellbeing Outcomes in Early Adulthood.

This study evaluated the associations between positive and adverse experiences and environments in adolescence and health, education and employment outcomes in early adulthood. Data were extracted from the Longitudinal Studies of Australian Youth cohort that commenced in 2003. The items were conceptually mapped to Positive and Adverse Youth Experiences and environments (PYEs and AYEs) at 15, 16 and 17 years old and outcomes at 25 years old. The associations between PYEs, AYEs and general health, mental health, education and employment were examined, including testing whether PYEs mitigated the association between AYEs and outcomes. A higher number of AYEs was associated with poorer health, education, and employment outcomes. Conversely, a higher number of PYEs was correlated with positive outcomes. The participants with higher PYEs had significantly greater odds of better general and mental health outcomes, even after accounting for AYEs. This relationship was not observed for employment or education outcomes. Adolescence and the transition to adulthood are critical developmental stages. Reducing adverse experiences and environments and increasing positive ones during adolescence could enhance adult wellbeing.

Trajectories of Inflammation in Youth and Risk of Mental and Cardiometabolic Disorders in Adulthood

Research suggests that low-grade, nonresolving inflammation may predate adult mental and physical illness. However, evidence to date is largely cross-sectional or focuses on single disorder outcomes. To examine trajectories of inflammation as measured by C-reactive protein (CRP) levels in a large sample of children and adolescents, and to explore associations between different identified trajectories and mental and related cardiometabolic health outcomes in early adulthood. In a longitudinal cohort study using data from the large UK-based Avon Longitudinal Study of Parents and Children (ALSPAC), latent class growth analysis (LCGA) was used to explore different trajectories of inflammation, with logistic regression exploring association with mental and physical health outcomes. Participants with measurable CRP data and associated mental and cardiometabolic health outcomes recorded were included in the analysis. Data analysis was performed from May 1, 2023, to March 30, 2024. Inflammation was assessed via CRP levels at ages 9, 15, and 17 years. LCGA was used to identify different trajectories of inflammation. Outcomes assessed at age 24 years included psychotic disorders, depressive disorders, anxiety disorders, hypomania, and, as a measure of insulin resistance, Homeostasis Model Assessment (HOMA2) score. A total of 6556 participants (3303 [50.4%] female) were included. Three classes of inflammation were identified: persistently low CRP levels (reference class, n = 6109); persistently raised CRP levels, peaking at age 9 years (early peak, n = 197); and persistently raised CRP levels, peaking at age 17 years (late peak, n = 250). Participants in the early peak group were associated with a higher risk of psychotic disorder (odds ratio [OR], 4.60; 95% CI, 1.81-11.70; P = .008), a higher risk of severe depression (OR, 4.37; 95% CI, 1.64-11.63; P = .02), and higher HOMA2 scores (β = 0.05; 95% CI, 0.01-0.62, P = .04) compared with participants with persistently low CRP. The late peak group was not associated with any outcomes at age 24 years. Low-grade systemic inflammation peaking in midchildhood was associated with specific mental and cardiometabolic disorders in young adulthood. These findings suggest that low-grade persistent inflammation in early life may be an important shared common factor for mental-physical comorbidity and so could be relevant to future efforts of patient stratification and risk profiling.

Music@Home–Retrospective: A new measure to retrospectively assess childhood home musical environments

Early home musical environments can significantly impact sensory, cognitive, and socioemotional development. While longitudinal studies may be resource-intensive, retrospective reports are a relatively quick and inexpensive way to examine associations between early home musical environments and adult outcomes. We present the Music@Home–Retrospective scale, derived partly from the Music@Home–Preschool scale (Politimou et al., 2018), to retrospectively assess the childhood home musical environment. In two studies (total n = 578), we conducted an exploratory factor analysis (Study 1) and confirmatory factor analysis (Study 2) on items, including many adapted from the Music@Home–Preschool scale. This revealed a 20-item solution with five subscales. Items retained for three subscales (Caregiver Beliefs, Caregiver Initiation of Singing, Child Engagement with Music) load identically to three in the Music@Home-–Preschool Scale. We also identified two additional dimensions of the childhood home musical environment. The Attitude Toward Childhood Home Musical Environment subscale captures participants’ current adult attitudes toward their childhood home musical environment, and the Social Listening Contexts subscale indexes the degree to which participants listened to music at home with others (i.e., friends, siblings, and caregivers). Music@Home–Retrospective scores were related to adult self-reports of musicality, performance on a melodic perception task, and self-reports of well-being, demonstrating utility in measuring the early home music environment as captured through this scale. The Music@Home–Retrospective scale is freely available to enable future investigations exploring how the early home musical environment relates to adult cognition, affect, and behavior.

Beyond the mind: Understanding the influence of mental health on youth NEET status in Europe-A systematic literature review.

In the fields of labor market and education research, there is a vast interest in mental health factors affecting unsuccessful school-to-work transitions, dropout from school and labor market disconnections for young people. Young people who are not in employment, education or training are conceived of as NEET. To get an overview we conducted a systematic review of the present literature on the influence of mental health on the likelihood of becoming NEET in Europe. A Systematic literature search was conducted in four databases on February 21, 2023, with an update on January 15, 2024. 33,314 articles were screened whereas 41 studies involving 8,914,123 individuals were included. Poor mental health such as attention deficit hyperactive disorder, autism, depression, borderline, and psychosis during childhood and adolescence is strongly associated with becoming NEET. Mental health issues, whether mild or severe, heighten significant the risk of adverse education and employment outcomes in early adulthood, extending to young individuals with personality disorders, borderline personality disorder, and psychoses. These observations inform early intervention strategies for children and young people grappling with mental health challenges. Timely treatment is essential. Future research should focus on the gap in research like specific disorders such as eating disorders and anxiety.

Understanding how young people transitioning from out-of-home care acquire and develop independent living skills and knowledge: A systematic review of longitudinal studies.

Young people leaving state care often experience hardship in many areas of their life. At a population level, their outcomes in early adulthood are poorer compared to general populations. Effective preparation for leaving care and post-care support systems is vital to improving outcomes. Individual and systemic support for young people to acquire Independent Living Skills (ILS) in the following eight ILS domains have been identified: Financial Management, Knowledge of Accessing Available Supports, Managing Housing, Education Planning, Job Seeking, Health Risk Management, Domestic and Self-help Task, and Managing Relationships. This systematic review aims to identify, summarise, and appraise longitudinal studies that address ILS across these ILS domains to understand better how outcomes could be improved. Seven databases (CINAHL, Embase, ProQuest, PsychINFO, PubMed, Scopus, and Web of Science) were searched on 20th July 2023. In total, twenty-seven studies published between 1994 and 2022 from various countries met the eligibility criteria. The included studies reported on 2-4 waves and adopted different methodological approaches. Study quality was scored using Qualsyst. Study characteristics and details of the interventions are presented in tables. Studies cover overlapping ILS domains, which are mapped in a matrix. Results revealed that nearly three-quarters (74% or 20 out of 27) of studies explored four or fewer of the eight ILS domains. The most frequent ILS domain covered was 'Knowledge of Accessing Available Supports' (19/27 studies). The main conclusion considers the concept of independence as a misnomer, with ILS covering multiple, intersecting, and interdependent domains, which ultimately help and hinder one another. Further research is required to adopt a more comprehensive approach encompassing all the domains to better inform policy, programs, and practice. A limitation is that a meta-analysis was not conducted for this review. This study registered a 'Protocol' with OSF Registries (DOI: 10.17605/OSF.IO/MJ3ZX) on June 5th, 2022.

Long-Term Advantages of Adolescent Optimism: Nonlinear Associations With Adult Outcomes and its Protective Role in Buffering Socioeconomic Risk

This study examined whether optimism in early adolescence predicts occupational and psychosocial outcomes in early adulthood and explored the functional form of this relation. We also investigated whether these associations continue to hold after accounting for concomitant factors and whether optimism acts as a protective factor that helps early adolescents deal with socioeconomic adversity. We followed a large sample of German seventh graders ( N = 1596; 63.8% females; baseline M age = 12.9) at two measurement points over a period of 18 years and estimated latent regression models. Optimism in early adolescence predicted several adult outcomes, including occupational prestige, social integration, psychosocial symptoms, and depression. Analyses with social integration, depression, and life satisfaction revealed a nonlinear association: Optimism promoted life outcomes, but this positive association reached a plateau in above-average ranges of optimism and a minimum value in below-average optimism ranges. Moreover, optimism in early adolescence buffered the negative effects of low parental socioeconomic status on occupational prestige, job satisfaction, and psychosomatic symptoms in adulthood. The findings offer increased knowledge about the long-term significance of optimism and underscore the necessity of considering these effects from a more comprehensive and interactional point of view.

Longitudinal Trajectories of Plasma Polyunsaturated Fatty Acids and Associations With Psychosis-Spectrum Outcomes in Early Adulthood

Longitudinal Trajectories of Plasma Polyunsaturated Fatty Acids and Associations With Psychosis-Spectrum Outcomes in Early Adulthood

Longitudinal Trajectories of Plasma Polyunsaturated Fatty Acids and Associations With Psychosis Spectrum Outcomes in Early Adulthood

BackgroundEvidence supports associations between polyunsaturated fatty acids such as docosahexaenoic acid (DHA) and psychosis. However, polyunsaturated fatty acid trajectories in the general population have not been characterized, and associations with psychosis spectrum outcomes in early adulthood are unknown. MethodsPlasma omega-6 to omega-3 ratio and DHA (expressed as percentage of total fatty acids) were measured by nuclear magnetic spectroscopy at 7, 15, 17, and 24 years of age in participants of ALSPAC (Avon Longitudinal Study of Parents and Children). Curvilinear growth mixture modeling evaluated body mass index–adjusted trajectories of both measures. Outcomes were assessed at 24 years. Psychotic experiences (PEs), at-risk mental state status, psychotic disorder, and number of PEs were assessed using the Psychosis-Like Symptoms interview (n = 3635; 2247 [61.8%] female). Negative symptoms score was measured using the Community Assessment of Psychic Experiences (n = 3484; 2161 [62.0%] female). Associations were adjusted for sex, ethnicity, parental social class, and cumulative smoking and alcohol use. ResultsRelative to stable average, the persistently high omega-6 to omega-3 ratio trajectory was associated with increased odds of PEs and psychotic disorder, but attenuated on adjustment for covariates (PEs adjusted odds ratio [aOR] = 1.63, 95% CI = 0.92-2.89; psychotic disorder aOR = 1.69, 95% CI = 0.71-4.07). This was also the case for persistently low DHA (PEs aOR = 1.42, 95% CI = 0.84-2.37; psychotic disorder aOR = 1.14, 95% CI = 0.49-2.67). Following adjustment, persistently high omega-6 to omega-3 ratio was associated with increased number of PEs (β = 0.41, 95% CI = 0.05-0.78) and negative symptoms score (β = 0.43, 95% CI = 0.14-0.72), as was persistently low DHA (number of PEs β = 0.45, 95% CI = 0.14-0.76; negative symptoms β = 0.35, 95% CI = 0.12-0.58). ConclusionsOptimization of polyunsaturated fatty acid status during development warrants further investigation in relation to psychotic symptoms in early adulthood.

Preparedness for adulthood among young adults with histories of out-of-home care

Young adults with histories of out-of-home care (OOHC) have poor early adult outcomes. Transitioning to adulthood takes preparation, coupled with support and resources. Few studies have examined these young adults’ perceptions of what helped them prepare for adulthood and how prepared they perceived they were to make the developmental transition to adulthood. This convergent mixed methods study builds knowledge surrounding preparedness among a sample of young adults with histories in OOHC ( N = 204). The study progressed in three phases. First, quantitative measures of preparedness were examined related to five critical areas of young adulthood: (1) employment, (2) education/training, (3) health care, (4) housing and (5) managing money. Results indicated that youth felt more prepared to manage their money and pursue employment than they felt prepared in the other areas. The second phase focused on qualitative interview data. Participants were asked, “What has been the most helpful thing in preparing you to live as an adult?” Open-ended responses were audiotaped, listened to by analysts, transcribed, and de-identified. Qualitative analysis followed a series of steps, centering constant comparison. Six themes (with sub-themes) emerged from the analysis of the data, namely (1) Forced independence; (2) The instructive role of mistakes; (3) Programs and services; (4) Family support; (5) Structure; and (6) Role models. Finally, analysts compared results of the quantitative and qualitative data and noted the data were convergent in suggesting that young adults feel somewhat more prepared around employment, managing money, and finances, in comparison to other areas. Implications are discussed.

Adverse childhood experiences and crime outcomes in early adulthood: A multi-method approach in a Brazilian birth cohort

This study aimed to investigate alternative approaches to a cumulative risk score in the relationship between adverse childhood experiences (ACEs) and crime. Using data from the 1993 Pelotas (Brazil) Birth Cohort (n = 3236), we measured 12 ACEs up to 15 years, and past-year violent and non-violent crime at 22 years. We used four analytical approaches: single adversities, cumulative risk, latent class analysis, and network analysis. When examined individually, physical abuse, emotional abuse, and domestic violence were associated with both crime outcomes, whereas maternal mental illness and discrimination were associated with violent crime only, and parental divorce and poverty with non-violent crime only. There was a cumulative effect of ACEs on crime. The class with child maltreatment and household challenges was associated with both crime outcomes; exposure to household challenges and social risks was associated with violent crime only. In network models, crime showed conditional associations with physical abuse, maternal mental illness, and parental divorce. Although cumulative ACEs did associate with crime, some individual and combinations of ACEs showed particularly strong and robust effects, which were not captured by the cumulative score. Many ACEs are closely connected and/or cluster together, and the usefulness of the ACE score needs to be further evaluated.

Scarred for Life? Early-Life Experience of the Post-Reunification Economic Crisis in East Germany and Physical and Mental Health Outcomes in Early Adulthood

Existing research suggests adverse short-term health effects of economic crises during early life, yet, the long-term health effects for children and adolescents exposed to economic crises are still understudied. We investigated the early-adult health implications of experiencing the post-reunification economic crisis in East Germany in the early 1990s during infancy, childhood and adolescence. Using data from the German Socio-Economic Panel (SOEP) and its linkage with German pension records (SOEP-RV), we applied entropy balancing and conditional quantile regression to assess the relationship between the experience of the economic crisis during early life (ages 0-17) and physical and mental health effects (SF-12 summary scores) in N = 2,337 young adults (aged 17-30) from East and West Germany. Our results indicate mainly no significant physical health effects, yet, significant adverse mental health effects for respondents exposed to the economic crisis in East Germany, especially in young women of average and better mental health. Parental unemployment was an additional risk factor for young women’s mental health. Thus, we suggest women who experienced economic crises during early life are at increased risk of adverse mental health effects already early in their adulthood. Support for families in times of economic crisis and early prevention for infants, children and adolescents exposed to economic adversities is warranted.

Youth education decisions and occupational misalignment and mismatch: evidence from a representative cohort study of Australian youth

ABSTRACT In theory, misalignment of education and career aspirations in high school is a crucial determinant of post-school education and career mismatch. However, existing scholarship investigates the social influence and rational choice determinants of misalignment and mismatch separately. This study examines how misalignment at 15 years of age correlates with career mismatch in young adulthood (25 years). Using data from Y09 cohort in the Longitudinal Surveys of Australian Youth (LSAY), it analyses the education and career aspirations of 7,871 15-year-olds and the education and career outcomes of 2,697 of the same cohort after ten years. Consistent with both social class influences and rational choice factors, the results show that young people who were female, misaligned at school, in vocational pathways, were in relatively poor health and wealth when growing up and had a father with lower levels of education were more likely to be mismatched. Notably, misalignment of career and educational aspirations at age 15 was the strongest indicator of employment outcomes in early adulthood at age 25. The findings urge a rethinking of national and state investment in careers education, especially in addressing disadvantages faced by equity groups and within occupations served by vocational education.

Weaving culture with consequence: Immigrant status and child maltreatment outcomes in early adulthood

BackgroundChild maltreatment is associated with a host of negative consequences over the life course, the most concerning of which is violence. Nevertheless, many abused and neglected youth do not grow up and commit violence. Meanwhile, research consistently finds an immigrant paradox, where foreign-born nativity is protective against a range of negative life outcomes. It may be that immigrants to the U.S. are more resilient to child maltreatment and less likely to engage in violence later in life. ObjectiveThis study contributes to the literature on victimization and the immigrant paradox by determining whether the effect of child maltreatment on later violence varies between immigrants and non-immigrants. Participants and settingThe present study uses a subsample of 964 foreign- and 12,808 native-born persons from Waves I and III of the National Longitudinal Study of Adolescent to Adult Health. MethodsLogistic regression models are specified and interaction terms are used to determine moderating effects of immigrant status on the link between child maltreatment and later violence. ResultsFindings indicate that child maltreatment significantly increased the odds of violent behavior in early adulthood by nearly 64 %, and this result was not moderated by immigrant status. Supplemental analyses continued to show generality in maltreatment effects. ConclusionsThe idea that child maltreatment is less harmful among foreign-born persons, or that they are able to “bounce back” from this form of victimization due to their unique multicultural assets, is not evidenced here. Key policy implications include a need for culturally competent victim services.

Can a nation-wide e-cohort of ADHD and ASD in childhood be established using Welsh routinely available datasets?

ObjectivesWe investigated the feasibility and validity of establishing a nationwide e-cohort of individuals with a diagnosis of attention deficit hyperactivity disorder (ADHD) and/or autism spectrum disorder (ASD) for future longitudinal...

Do Conditional Cash Transfers Improve Economic Outcomes in the Next Generation? Evidence from Mexico

Abstract Conditional cash transfer programmes have spread to over 60 countries in the past two decades, but little is known about their long-term effects. We estimate the lasting impact of childhood exposure to the Mexico’s flagship programme Progresa by leveraging the age structure of benefits and geographic variation in early programme penetration nationwide. Childhood exposure improves women’s outcomes in early adulthood with increases in educational attainment, geographic mobility, labour market performance and household living standards. For men, effects are smaller and more difficult to distinguish from spatial convergence.

Foster care, kinship care, and the transition to adulthood: Do child welfare system processes explain differences in outcomes?

Despite longstanding policy preferences favoring kinship care placements over non-relative family foster care placements, research findings on the benefits of kinship care vary by measurement, assessed outcome, follow-up period, and other study design elements. We examined early adulthood outcomes—incarceration and teen parenthood—among WI youth who entered foster care in early-to-middle childhood (ages 5–10). Results suggest that initial placement in kin or nonrelative kinship care was not significantly related to imprisonment or teenage parenthood directly; however, first placement in kinship care is associated with fewer moves, longer duration in care, and a higher probability of a new maltreatment investigation, which in turn is related to long-term outcomes. Further, a new maltreatment investigation was an important mediator and was significantly associated with a higher probability of incarceration and teenage parenthood. This study provides mechanisms on the ways in which first placement setting influences incarceration and teenage parenthood. Findings provide important policy and practice implications on how children’s experiences in foster care, based on their initial placement type, can lead to maladaptive outcomes.

Relationships That Persist and Protect: The Role of Enduring Relationships on Early-Adult Outcomes among Youth Transitioning Out of Foster Care

Relationships That Persist and Protect: The Role of Enduring Relationships on Early-Adult Outcomes among Youth Transitioning Out of Foster Care

Supportive relationships in childhood: Does it have a long Reach into health and depression outcomes for immigrants from Latin America?

This study examines how social support during childhood and adolescence is associated with self-rated good health and the incidence of depression among Latin American immigrants in the U.S. We focus on those who immigrated under age 18 (childhood arrivals) to understand the interplay between early social support and adult health outcomes. Data are from the 2012–2013 iteration of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III), which included a sample of 3441 immigrant respondents born in Latin America. Multivariable binomial logistic regression analyses indicated that childhood and interpersonal support in adulthood were negatively associated with lifetime major depressive disorder (LMDD) episodes. These associations differed between childhood arrival and adult arrival immigration samples. Findings from this study highlight the role that social support in critical developmental periods has on immigrant health and depression outcomes. Continued and more nuanced investigations are warranted to examine social resources across lifespans and their roles in mitigating adverse health outcomes among immigrants from Latin America.