US-born Women Research Articles

Abstract A096: Differences by nativity status in knowledge of and adherence to breast cancer screening guidelines: A Community Initiative Towards Improving Equity and Health Status (CITIES) study

Abstract Introduction: While immigrants initially demonstrate better health relative to those US-born, with longer length of US residency, immigrants tend to experience increased risk of many diseases – including breast cancer (BC) – compared to those US-born. However, immigrants are less likely to access preventive health services like BC screenings. Fortunately, research suggests that improved knowledge of BC screening guidelines can lead to increased guideline adherence. This project aimed to describe BC screening guideline knowledge and adherence among female Ohioans over 40 years old and to identify how these characteristics differed by nativity status. Methods: The Community Initiative Towards Improving Equity and Health Status (CITIES) project was a survey of Ohio residents focused on identifying factors contributing to cancer disparities. Wave 1 occurred in 2017-2018. Participants were asked about their knowledge of BC screening guidelines using the item, “At what age are most women supposed to start having mammograms?” The correct age was 40 years. Participants were also asked about their adherence to BC screening guidelines using the item, “How long ago has it been since you had your last mammogram?” Participants were up to date with screening if their last mammogram was within one year. Nativity status was foreign-born or US-born. Frequencies and percentages were used to describe knowledge of and adherence to BC screening guidelines. To identify how BC screening knowledge and adherence differed by nativity status, chi-square tests assessing differences in the frequencies of these factors for those foreign-born and US-born were used. Results: The study sample included 307 women over age 40: 18.6% were foreign-born, 32.2% were Black, non-Hispanic, and the mean age was 61.3 years (SD=7.1). The percentage of women with correct knowledge of BC screening guidelines was 52.4% (n=161). The percentage of women up to date with guidelines was 75.9% (n=233), of which 13.3% (n=31) were foreign- born. Overall, women with correct knowledge were more likely to be up to date with guidelines than were those with incorrect knowledge (43.0% vs. 32.9%; χ 2 p=0.01). This relationship was also observed among US-born women (47.2% vs. 33.6%; χ 2 p=0.04). However, foreign-born women with correct knowledge were no more likely to be up to date with guidelines than were foreign-born women with incorrect knowledge (24.6% vs. 29.8%; χ 2 p=0.42). Conclusions: Half of female Ohioans over age 40 had correct knowledge of BC screening guidelines and three- quarters were up to date with guidelines. More US-born than foreign-born women had correct knowledge of and were up to date with guidelines. A significant association existed between knowledge of BC screening guidelines and being up to date with guidelines among women overall and US-born women, but not among foreign-born women. Future research should identify strategies to improve knowledge of BC screening guidelines among foreign-born women, which may increase their BC screening uptake. Citation Format: Katarina M. Bischof, Mohamed I. Elsaid, Chloe M. Hery, Ryan D. Baltic, Cecilia R. DeGraffinreid, Chasity M. Washington, Electra D. Paskett. Differences by nativity status in knowledge of and adherence to breast cancer screening guidelines: A Community Initiative Towards Improving Equity and Health Status (CITIES) study [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A096.

Abstract C039: Nativity and breast cancer outcomes by breast cancer subtype in the ENCLAVE Study

Abstract Background: Associations of nativity and breast cancer (BC) mortality are mixed in studies using cancer registry data. We examined associations in diverse women with detailed individual-level data on BC treatment and subtype. Methods: The study population included 5,718 Asian (n=722, 71% foreign-born), Hispanic (n=631, 42% foreign-born), and non-Hispanic White (n=4,365, 9% foreign-born) women from the ENCLAVE Study diagnosed with invasive BC from 1996-2013 using pooled, harmonized data from two (of three) cohorts with data on BC subtype. Data on nativity, reproductive and behavioral factors were self-reported from questionnaires; data on disease severity, BC subtype (luminal A, luminal B, Her2 expressing, triple negative breast cancer), treatment, and mortality were obtained from cancer registries and electronic health records. Recurrences were identified by recurrence algorithms and medical record review. We fit Cox proportional hazards regression models to examine associations between self-reported nativity and recurrence, BC-specific mortality, and overall mortality. Covariates included age, sociodemographic factors, disease severity, and treatment, reproductive and behavioral factors. We also examined associations by race, ethnicity, and BC subtype. Results: Compared to US-born women, foreign-born women had lower total mortality (hazard ratio [HR]=0.75, 95% confidence interval [CI]: 0.64-0.89); lower risks were suggested for recurrence (HR=0.85, 95% CI: 0.68-1.06) and breast cancer-specific mortality (HR=0.87, 95% CI: 0.66-1.14). Stratified by BC subtype, foreign- (vs. US-) born women had a lower risk of overall mortality among those with luminal A (HR=0.72, 95% CI: 0.56-0.92) and luminal B (HR=0.66, 95% CI: 0.48-0.91) but not other subtypes. Among women with luminal B BC, these associations reached statistical significance for recurrence (HR=0.65, 95% CI: 0.45-0.94) and BC-specific mortality (HR=0.53, 95% CI: 0.33-0.84). We noted no associations in other BC subtypes though analyses of less common subtypes were underpowered. Associations did not differ by race or ethnicity. Conclusion: Foreign-born women with BC had lower risk of overall mortality than US-born women. Risks of recurrence and BC-specific mortality were lower in foreign-born vs. US-born women among those with the luminal B BC subtype. Associations were not explained by behavioral or reproductive factors. Citation Format: Candyce Kroenke, Rhonda Aoki, Stacey Alexeeff, Scarlett Gomez, Bette Caan, Brittany Morey, Jacqueline Torres, Larry Kushi. Nativity and breast cancer outcomes by breast cancer subtype in the ENCLAVE Study [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C039.

Mind the Gap: Sexual Orientation Wage Gaps for Non-White and Immigrant Minorities in the United States

ABSTRACT A growing body of literature has found that sexual orientation and gender impact labor market outcomes, including earnings. This literature generally finds that gay and bisexual men earn less than heterosexual men. Despite being the highest earners among women, lesbians earn less than heterosexual men, and bisexual women earn the least. Far less research has explored intersectional disadvantages/advantages of being a lesbian, gay, or bisexual (LGB) individual and belonging to other minority groups. Using data from the 2013 to 2018 US National Health Interview Survey, this paper explores whether being an LGB racial minority or LGB immigrant results in cumulative earning disadvantages/advantages. This study finds that regardless of race or immigrant status, gay men’s earnings did not statistically differ from white/US-born heterosexual men’s earnings. For white and US-born women, their earnings followed the same pattern, with lesbians earning the most, followed by heterosexual women, then bisexuals; however, for nonwhite women, bisexuals earned the most and lesbians earned the least. The results for immigrant sexual minorities were not statistically significant. These findings suggest that disadvantage/advantage is multilayered—sexual minorities who occupy multiple minority positions may experience different levels of disadvantage/advantage.

The Lived Experience of Postpartum Intergenerational Conflict of Vietnamese American Women with their Vietnamese Immigrant Parents: It's A Generational Thing!

US-born Vietnamese women who are in their childbearing years are more likely to identify with "western" perspectives when compared to their immigrant mothers who were born in Vietnam. Still, a gap in knowledge exists of their intergenerational differences. The purpose of this study was to explore and better understand Vietnamese American women's experiences of postpartum intergenerational conflict. van Manen's methodological approach (1997) was used. The purposive sample included 11 US-born Vietnamese women who experienced postpartum intergenerational conflict with their parents. Data were transcribed verbatim and analyzed using thematic analysis. The researcher transcended the themes through music. Songs and lyrics were arranged for guitar to bring the phenomenon to life. Four themes were identified: (1) "It's a Generational Thing!" (Một điều thế hệ): Leaning both ways; (2) "To rebel or not" (Nổi loạn hay không): Weighing the evidence of postpartum cultural practices; (3) "Stand My Ground" (Giữ vững lập trường của tôi): Keeping my newborn safe and healthy; and (4) "See Me" (Nhìn con): My mental health overshadowed by my mother's thoughts. This study revealed that the intergenerational conflict was influenced by the family's understanding over the division of infant care tasks, disagreements over cultural practices, and generational differences such as age, consistent with previous research. Tailored interventions for Vietnamese American women should consider the family as a whole. Nurses can assess proactively in prenatal care if there are cultural issues such as family hierarchy, gender, and history influencing one's choices or maternal autonomy.

34 Use of health services and cancer screening among immigrant cancer survivors with second primary cancer

OBJECTIVES/GOALS: Due to clinical advances, cancer survivors are living longer but have an increased risk of a second primary cancer (SPC). This cross-sectional study aims to examine SPC prevalence in immigrant women and compare healthcare use (HCU) and cancer screening in immigrants with SPC versus (1) immigrants with a single cancer and (2) US-born women with SPC. METHODS/STUDY POPULATION: The study population will include adult women with breast/gynecologic primary cancer (PC) from the 2005, 2008, 2010, 2013, and 2015 National Health Interview Survey. First-generation immigrant or US-born status will be defined by region of birth. SPC includes diagnosis with a second cancer type ≥1 year after the initial PC diagnosis. We will compare the prevalence of ≥1 SPC in immigrant and US-born women. To evaluate HCU and cancer screening differences, we will assess sociodemographic and socioeconomic factors, risk behaviors, length of US residence, and citizenship status with descriptive statistics. In regression analyses, we will compare number of provider visits and cancer screening rates in immigrant women with SPC versus immigrants with PC alone and US-born women with SPC after matching by age and PC type. RESULTS/ANTICIPATED RESULTS: Disparities in cancer diagnosis, quality of care, receipt of recommended treatment, and screening rates among immigrants in the US are well documented. Therefore, we hypothesize that immigrant cancer survivors will have similar or higher rates of SPC compared to women born in the US with variations based on health status. We further hypothesize that immigrants with SPC will report lower rates of HCU after diagnosis of their first cancer and cancer screening compared to US-born women. However, we expect that immigrants with SPC will report similar or higher rates of HCU and cancer screening compared to immigrant women with PC alone. DISCUSSION/SIGNIFICANCE: To our knowledge, this study will be the first to describe SPC among immigrant cancer survivors in the US. This research will inform interventions to improve cancer care delivery and ultimately reduce SPC in immigrants with cancer.

Abstract 798: Increasing breast cancer incidence across generation status in Mexican American women: The Multiethnic Cohort

Abstract Background: Breast cancer (BC) is the most commonly diagnosed cancer among Latino women in the US. Compared to foreign-born Latino women, US-born Latino women have a higher incidence of BC. While prior studies have suggested this difference in incidence may be explained by risk factors such as unhealthy lifestyle behaviors, reproductive history, and neighborhood socioeconomic status, it is unclear how the risk of BC has changed over generations among Latinos women. In this study, we investigated the association between generational status and BC incidence among Mexican American women within the Multiethnic Cohort (MEC). Methods: The study population included 15,303 self-reported Mexican Americans from the MEC. Generational status was categorized as: 1st generation (Mexico-born, n = 6,347), 2nd generation (US-born with one or two parents born in Mexico, n = 6,390), or 3rd generation (US-born with both parents born in the US, n = 2,566). Multivariable Cox models were used to calculate the hazard ratios (HR) and 95% confidence intervals (CI) of BC incidence by generational status. All models were adjusted for relevant risk factors including age, physical activity, smoking, alcohol intake, education, body mass index, diet, family history of BC, menopausal status, age at menarche, parity, mammography history, hormone use, neighborhood socioeconomic status, and Hispanic ethnic enclave. Results: During an average 21.5-year follow-up, 815 incident BC cases were identified. The age-adjusted incidence rate (per 100,000) of BC increased by generation (1st: 191.9; 2nd: 265.3; 3rd: 284.0). Third (70.4%) and 2nd (66.5%) generations had a larger proportion of localized disease at diagnosis compared to 1st generation women (59.7%). Compared to 1st generation Mexican Americans, 2nd (HR = 1.24; 95% CI: 1.03-1.49) and 3rd generation (HR = 1.28; 95% CI: 1.02-1.60) had elevated risks of BC (p-trend: 0.02) The positive association with generational status remained significant when restricting to women who reported mammogram use (HR 2nd vs. 1st = 1.27, 95% CI: 1.04-1.55; HR 3rd vs. 1st = 1.34, 95% CI: 1.06-1.70) (p-trend: 0.01). Conclusions: Our findings suggest that generational status among Mexican American women is associated with risk of BC, after adjusting for sociodemographic, lifestyle, neighborhood, and reproductive risk factors. Further studies are warranted to discover the potential factors that contribute to this increased risk and elucidate the underlying etiology. Citation Format: Xinman Zhang, Iona Cheng, Adelynn Paik, Brian Huang, Veronica Wendy Setiawan. Increasing breast cancer incidence across generation status in Mexican American women: The Multiethnic Cohort [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 798.

Differences in Smoking Behavior by Nativity, Race/Ethnicity, and Education among Women Diagnosed with Breast Cancer.

We evaluated smoking differences across nativity and race/ethnicity among women diagnosed with breast cancer. In our Northern Californian pooled population of 5,653 [670 Asian, 690 Hispanic, and 4,300 non-Hispanic White (White)] women diagnosed with breast cancer, we evaluated smoking differences across nativity, race/ethnicity, and acculturation and effect modification of nativity by race/ethnicity and education. Foreign-born women currently smoked less than US-born women [odds ratio (OR) = 0.46, 95% confidence limit (CL): 0.29-0.72]. Hispanic (OR = 0.50; 95% CL: 0.32-0.78) women currently smoked less than White women. Among those who ever smoked (n = 2,557), foreign-born women smoked 5.23 fewer pack-years (PY) than US-born women (95% CL: -2.75 to -7.70). Furthermore, Asian (-4.60, 95% CL: -0.81 to -8.39) and Hispanic (-6.79, 95% CL: -4.14 to -9.43) women smoked fewer PY than White women. Associations were generally suggestive of greater smoking with greater acculturation (immigration age, US years, survey language). Finally, associations for nativity differed by education but not race/ethnicity, with a higher likelihood of smoking in US-born women only among those with less than a bachelor's degree (OR = 2.84, 95% CL: 2.15-3.77; current smoking: P = 0.01, PY: P = 0.05). Asian and Hispanic (vs. White) and foreign-born (vs. US-born) breast cancer survivors reported fewer smoking behaviors. Smoking differences across nativity and education were driven by higher rates of smoking in US-born women with lower educational attainment. Smoking behavioral patterns were similar among breast cancer survivors and the general population, informing potential smoking interventions.

Assessing racial, ethnic, and nativity disparities in US cancer mortality using a new integrated platform.

Foreign-born populations in the United States have markedly increased, yet cancer trends remain unexplored. Survey-based Population-Adjusted Rate Calculator (SPARC) is a new tool for evaluating nativity differences in cancer mortality. Using SPARC, we calculated 3-year (2016-2018) age-adjusted mortality rates and rate ratios for common cancers by sex, age group, race and ethnicity, and nativity. Trends by nativity were examined for the first time for 2006-2018. Traditional cancer statistics draw populations from decennial censuses. However, nativity-stratified populations are from the American Community Surveys, thus involve sampling errors. To rectify this, SPARC employed bias-corrected estimators. Death counts came from the National Vital Statistics System. Age-adjusted mortality rates were higher among US-born populations across nearly all cancer types, with the largest US-born, foreign-born difference observed in lung cancer among Black women(rate ratio = 3.67, 95% confidence interval [CI] = 3.37 to 4.00). The well-documented White-Black differences in breast cancer mortality existed mainly among US-born women. For all cancers combined, descending trends were more accelerated for US-born compared with foreign-born individuals in all race and ethnicity groups with changes ranging from -2.6% per year in US-born Black men to stable (statistically nonsignificant) among foreign-born Black women. Pancreas and liver cancers were exceptions with increasing, stable, or decreasing trends depending on nativity and race and ethnicity. Notably, foreign-born Black men and foreign-born Hispanic men did not show a favorable decline in colorectal cancer mortality. Although all groups show beneficial cancer mortality trends, those with higher rates in 2006 have experienced sharper declines. Persistent disparities between US-born and foreign-born individuals, especially among Black people, necessitate further investigation.

Maternal and Perinatal Health Disparities Among Middle Eastern and North African Women and Children in the United States.

Few studies have evaluated the health of Middle Eastern and North African (MENA) women and children in the United States. Objectives were to determine the odds of well-visits, preventive behaviors during pregnancy, and low birthweight among foreign-born non-Hispanic MENA women and children compared to their US- and foreign-born non-Hispanic White counterparts after adjusting for covariates (hereafter, reported as MENA and White). We analyzed 2000-2018 National Health Interview Survey data (411,709 women, 311,961 children). Outcomes included well-woman visits (past 12 months); dentist visits (past 6 months) and current smoking among pregnant women; and low, moderately low, and very low birthweight among children. Covariates included age, family income, and health insurance for children. Education and marital status were also evaluated among women. Over half (53.4%) of foreign-born MENA women were of childbearing age (ages 18-45) compared to 47.7% US-born and 43.2% foreign-born White women. The odds of completing a well-women visit were 0.73 times lower (95% CI = 0.38-0.89) among foreign-born MENA women compared to US-born White women after adjusting for age, education, and marital status. There was no statistically significant difference in dental visits between groups. No foreign-born MENA pregnant women reported current smoking. Foreign-born MENA children had higher odds of low (OR = 1.65; 95% CI = 1.16-2.35) and moderately low birthweight (OR = 1.78; 95% CI = 1.19-2.66) compared to US-born White children in adjusted models. MENA women and children are classified as White by the federal government. Our results highlight that the health of foreign-born MENA women and children differ from their White counterparts.

The impact of nativity on uterine cancer survival in the public hospital system of Queens, New York

ObjectiveWe studied cis-women with uterine cancer presenting to the two Public Hospitals in Queens, New York from 2006 to 2015 to examine the relationship between nativity (birthplace) and survival. MethodsA retrospective review of tumor registries identified women diagnosed with uterine cancer between January 1, 2006, and December 31, 2015. Data from 259 women were available for this analysis. ResultsMost women were born outside the United States (US) (76% versus 24%). The majority of US-born women were black (68%). Seventy-seven women (30%) were born in Latin America, 76 in the Caribbean Islands (29%) and 44 in Asia/South Asia (17%). Most women presented with stage I/II disease (70%) and endometrioid/mucinous histology (68%) with no significant differences observed among nativity groups. Kaplan-Meier estimated survival curves stratified by birthplace demonstrated significant differences in survival distributions among the groups using the log-rank test (P < 0.0001). The most favorable survival curves were observed among all foreign-born women, whereas the least favorable survival was demonstrated in US-born women. Time to death was analyzed using the Cox proportional hazards model. Adjusting for age of diagnosis, insurance status, stage, and treatment modality, Latin American and Asia/South Asia birthplace was significantly associated with increased survival time. ConclusionAn immigrant health paradox was defined for foreign-born Latin American and Asian/South Asian women presenting to the two Public Hospitals of Queens, New York, as women born in these geographic regions were less likely to die at any given time compared to those born in the United States.

Structural racism, nativity and risk of adverse perinatal outcomes among Black women.

Black women in the United States (US) have the highest risk of preterm birth (PTB) and small for gestational age (SGA) births, compared to women of other racial groups. Among Black women, there are disparities by nativity whereby foreign-born women have a lower risk of PTB and SGA compared to US-born women. Differential exposure to racism may confer nativity-based differences in adverse perinatal outcomes between US- and foreign-born Black women. This remains unexplored among US- and African-born women in California. Evaluate the relationship between structural racism, nativity, PTB and SGA among US- and African-born Black women in California. We conducted a population-based study of singleton births to US- and African-born Black women in California from 2011 to 2017 (n = 131,424). We examined the risk of PTB and SGA by nativity and neighbourhoods with differing levels of structural racism, as measured by the Index of Concentration at the Extremes. We fit crude and age-adjusted Poisson regression models, estimated using generalized estimating equations, with risk ratios (RR) and 95% confidence intervals (CI) as the effect measure. The proportions of PTB and SGA were 9.7% and 14.5%, respectively, for US-born women, while 5.6% and 8.3% for African-born women. US-born women (n = 24,782; 20.8%) were more likely to live in neighbourhoods with high structural racism compared to African-born women (n = 1474; 11.6%). Structural racism was associated with an elevated risk of PTB (RR 1.19, 95% CI 1.12, 1.26) and SGA (RR 1.19, 95% CI 1.13, 1.25) for all Black women, however, there was heterogeneity by nativity, with US-born women experiencing a higher magnitude of effect than African-born women. Among Black women in California, exposure to structural racism and the impacts of structural racism on the risk of PTB and SGA varied by nativity.

Nativity and the risk of opioid use disorder among Hispanic/Latinx women in primary care in Los Angeles, CA

Background: While rates of opioid use disorder (OUD) are lower among women compared to men, nativity may have disproportionate impacts on OUD risk among Hispanic/Latinx women but remain understudied. Objective: To assess the association between country of birth and reported OUD risk among low-income Hispanic/Latinx women in primary care in Los Angeles, CA. Methods: This was a cross-sectional study of 1189 non-pregnant, Hispanic/Latinx women attending two federally qualified health centers in Los Angeles between March and July 2013. OUD risk was assessed using the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), and moderate-to-high risk was defined as ASSIST score ≥ 4. Results: Overall, 4.2% of women (n = 49) were at moderate-to-high risk for OUD. Risk for OUD was higher among US-born women compared to foreign-born women (6.7 vs. 1.7%; p < .01), those who reported 2+ chronic medical conditions (p < .01), and those who were at moderate-to-high risk for other substance use disorders (p < .01). In multivariable logistic regression analyses, being U.S.-born was independently associated with being at moderate-to-high risk for OUD among Hispanic/Latinx women as compared to those who were foreign-born (AOR = 2.8; 95% CI 1.2–6.8). Conclusion: Among low-income Hispanic/Latinx women presenting to primary care, one in twenty patients is at-risk for OUD. The odds of moderate-high risk of OUD were three times as high in US-born compared to foreign-born women, and higher among those with chronic medical conditions and those at risk of other substance use disorders. Gender-specific and culturally-tailored screening for OUD may inform overdose prevention interventions for US-born Hispanic/Latinx women.

Social Determinants of Health Among Pregnant Hispanic Women and Associated Psychological Outcomes.

There has been a concerning surge in maternal mortality among Hispanic women in recent years. Compromised mental health is present in nearly half of all maternal deaths, and risk factors include poor social support and depression. Among Hispanic women who were born in the USA versus those not born in the USA, we sought to describe and compare social determinants of health and maternal psychological outcomes. Hispanic pregnant women (n = 579) were recruited from two clinics in Tampa, FL, and completed various questionnaires related to social determinants of health, depression, stress, and social support. Descriptive statistics, t-tests, and chi-square analyses were used to compare relationships between maternal nativity and subsequent psychosocial outcomes. Pearson correlations were used to explore associations between variables. Hispanic pregnant women who were not born in the USA had lower incomes (χ2 = 5.68, p = 0.018, df = 1), were more likely to be unemployed (χ2 = 8.12, p = 0.004, df = 1), and were more likely to be married (χ2 = 4.79, p = 0.029, df = 1) when compared with those born in the USA. Those not born in the USA reported lower social support (t = 3.92, p<0.001), specifically the tangible (t = 4.18, p < 0.001) and emotional support subscales (t = 4.4, p<0.001). When compared with those born in the USA, foreign-born Hispanic women reported less stress (t = 3.23, p = 0.001) and depression (t = 3.3, p = 0.002). Pregnant Hispanic women not born in the USA are at increased risk for suboptimal social determinants of health, including less social support. US-born women were more stressed and depressed and had higher BMIs.

The distinct nature of U.S. based female immigrant entrepreneurs

ABSTRACT Despite contributing to host country economies, there is limited examination of self-employed female immigrants in the literature. While human, social, and financial capital are important for entrepreneurship in general, given immigrant women’s intersectional identities, the potential exists for these factors to affect them differently. This study uses US data obtained from Integrated Public Use Microdata Series (IPUMS) to empirically test the relationship of human, social, and financial capital on female immigrants’ self-employment and compares these relationships with US-born women and male immigrants. While the results are mixed, overall, the findings suggest that female immigrants’ odds of being self-employed, in relation to their levels of human, social, and financial capital, are influenced to a greater extent by their immigrant identity than their gender identity. Implications for future research and public policy are discussed.

Race/Ethnicity, Nativity, and Gender Disparities in Mental Health Trajectories from Mid- to Later-Life: A Life Course-Intersectional Approach.

Numerous studies have highlighted mental health disparities based on race/ethnicity, nativity, and gender across different life stages. However, few have investigated how the intersectionality of these factors influences mental health trajectories during midlife to late life. This study fills this gap by adopting a life course-intersectional approach, viewing mental health trajectories as dynamic processes shaped by the combined influences of race/ethnicity, nativity, and gender. It explores social, psychological, and physiological pathways contributing to these disparities. Using data from the Health and Retirement Study (2006-2018; N = 38,049 observations) and growth curve models, this study examines how intra-individual trends in depressive symptoms (measured as CES-D scale, 07) are influenced by the intersection of race/ethnicity, nativity, and gender. It also investigates the impact of objective and subjective social isolation and physical health on group disparities in mental health trajectories. The findings reveal that, during mid- to early late-life, most Black and Hispanic Americans experience higher levels of depressive symptoms compared to their White counterparts (disparities ranging from 0.184 to 0.463 for men and 0.117 to 0.439 for women). However, this disadvantage diminishes for US-born Hispanic men and US-born Black women (0.014-0.031 faster decrease rates compared to US-born White), while it intensifies for Hispanic immigrants (0.017-0.018 slower decrease rates compared to US-born White) in advanced ages. Mediation analysis demonstrates that both social isolation and physical health contribute to these disparities, with physical health explaining a larger portion, particularly in differences between immigrant Hispanic women and US-born Whites. This study underscores the importance of a life course-intersectional approach in understanding mental health disparities. It emphasizes the need for improved social welfare systems and community-level interventions targeting the specific challenges faced by older Hispanic immigrants, especially women who encounter multiple forms of oppression.

Fetal growth and pediatric cancer: A pan-cancer analysis in 7000 cases and 37 000 controls.

Birth weight is an established risk factor for some pediatric cancers but is dependent on gestational age and sex. Furthermore, it is unclear how associations may differ by infant sex, age at diagnosis, maternal race/ethnicity and maternal nativity status. We examined the association between size for gestation and a spectrum of pediatric cancers registered in the Texas Cancer Registry from 1995 to 2011. We analyzed up to 7547 cases and 37 735 controls. Analyses were conducted using logistic regression. Small-for-gestational age (SGA) and large-for-gestational age (LGA) were significantly associated with several tumors. SGA was associated with hepatic tumors (aOR = 1.76, 95% CI: 1.13, 2.74). Conversely, inverse associations were with Hodgkin lymphoma (aOR = 0.41, 95% CI: 0.19, 0.87) and soft tissue sarcomas (aOR = 0.65, 95% CI: 0.43, 0.97). LGA was associated with acute lymphoblastic leukemia (aOR = 1.37, 95% CI: 1.19, 1.57), Burkitt lymphoma (aOR = 1.90, 95% CI: 1.05, 3.45) and germ cell tumors (aOR = 1.55, 95% CI: 1.08, 2.23). Results did not differ when stratified by infant sex. The association with LGA and leukemia was strongest in those diagnosed 1 to 5 and 6 to 10 years. When stratified by maternal race/ethnicity, the association with LGA and neuroblastoma and renal tumors was strongest in children whose mother identified as non-Hispanic/Latina (H/L) Black. Among H/L women, children of Mexican-born women had a stronger association with LGA and leukemia, CNS tumors, neuroblastoma and renal tumors than children of US-born women (aOR range: 1.61-2.25 vs 1.12-1.27). Size for gestation is associated with several pediatric cancers. Associations may differ by age at diagnosis, maternal race/ethnicity and nativity.

Mexican-American Women’s Lifelong Residence in the United States Is Associated with an Increased Risk of Gastroschisis: A Population-Based Study

To determine whether nativity is associated with abdominal wall defects among births to Mexican-American women. Using a cross-sectional, population-based design, stratified and multivariable logistic regression analyses were performed on the 2014-2017 National Center for Health Statistics live-birth cohort dataset of infants of US-born (n=1 398 719) and foreign-born (n=1 221 411) Mexican-American women. The incidence of gastroschisis was greater among births to US-born compared with Mexico-born Mexican-American women: 36.7/100 000 vs 15.5/100 000, RR=2.4 (2.0, 2.9). US-born (compared with Mexico-born) Mexican-American mothers had a greater percentage of teens and cigarette smokers, P<.0001. In both subgroups, gastroschisis rates were greatest among teens and decreased with advancing maternal age. Adjusting for maternal age, parity, education, cigarette smoking, pre-pregnancy body mass index, prenatal care usage, and infant sex), OR of gastroschisis for US-born (compared with Mexico-born) Mexican-American women was 1.7 (95% CI 1.4-2.0). The population attributable risk of maternal birth in the US for gastroschisis equaled 43%. The incidence of omphalocele did not vary by maternal nativity. Mexican-American women's birth in the US vs Mexico is an independent risk factor for gastroschisis but not omphalocele. Moreover, a substantial proportion of gastroschisis lesions among Mexican-American infants is attributable to factors closely related to their mother's nativity.

What Do Your Neighbors Think About You? How Perceived Neighbor Attitudes Toward Latinos Influence Mental Health Among a Pregnant Latina Cohort

Latina women living in the USA experience disproportionately higher rates of psychological distress compared to their non-Latina White counterparts. Poor maternal mental health during pregnancy can contribute to intergenerational mental health disparities. Through this pathway, mothers’ experiences, environments, and exposures (henceforth “exposures”) during pregnancy become biologically embodied and can negatively affect the fetus and life-long developmental trajectories of her child. One of the exposures that can affect mother–offspring dyads is the neighborhood. With the goal of integrating anthropological and sociological theories to explain mental health disparities among pregnant Latina women, we explored how perceptions of neighbor attitudes may influence mental health during pregnancy. We analyzed self-reported responses from 239 pregnant Latina women in Southern California (131 foreign-born, 108 US-born) on their mental health and perceived attitudes of their neighbors using multiple linear regression models. Among foreign-born Latina women, living in neighborhoods with more favorable views of Latinos was associated with lower depression scores (pooled β = − .70, SE = .29, p = .019) and lower pregnancy-related anxiety scores (pooled β = − .11, SE = .05, p = .021), but greater state anxiety scores (pooled β = .09, SE = .04, p = .021). Among US-born women, there were no associations between neighbor attitudes and mental health. Overall, results suggest that social environments are correlated with mental health and that foreign-born and US-born Latinas have varied mental health experiences in the USA. Our findings highlight the importance of improving aspects of neighborhood cohesion as part of maternal–fetal care management.

Foreign-born status and risk of gestational diabetes mellitus by years of residence in the United States

To explore the association between acculturation among foreign-born (FB) women, gestational diabetes (GDM) and GDM-associated adverse birth outcomes, we conducted a retrospective cohort study of 34,696 singleton pregnancies from Houston, TX, between 2011 and 2022. FB women (n = 18,472) were categorized based on years of residence in US (0–5, 6–10, and > 10 years), while US-born women (n = 16,224) were the reference group. A modified Poisson regression model determined the association between acculturative level and GDM within the entire cohort and stratified by race/ethnicity. Compared to US-born women, FB women with 0–5 years [adjusted relative risk (RRadj.) 1.27, 95% confidence interval [CI] 1.14–1.42)], 6–10 years (RRadj. 1.89, 95%CI 1.68–2.11) and > 10 years in the US (RRadj. 1.85, 95%CI 1.69–2.03) had higher risk of GDM. Results were consistent for all racial/ethnic groups, although associations were not significant at 0–5 years. FB women had lower risk of other adverse pregnancy outcomes, except for preeclampsia with severe features at higher levels of acculturation. Results were similar among those with and without GDM. In conclusion, FB status increases risk of GDM among all racial/ethnic groups but is elevated with higher acculturation levels.

Experiences and Challenges of African American and Sub-Saharan African Immigrant Black Women in Completing Pap Screening: a Mixed Methods Study.

Understanding Black women's Papanicolaou (Pap) screening experiences can inform efforts to reduce cancer disparities. This study examined experiences among both US-born US Black women and Sub-Saharan African immigrant women. Using a convergent parallel mixed methods design, Black women born in the USA and in Sub-Saharan Africa age 21-65 years were recruited to participate in focus groups and complete a 25-item survey about patient-centered communication and perceived racial discrimination. Qualitative and quantitative data were integrated to provide a fuller understanding of results. Of the 37 participants, 14 were US-born and 23 were Sub-Saharan African-born Black women. The mean age was 40.0 ± 11.0, and 83.8% had received at least one Pap test. Five themes regarding factors that impact screening uptake emerged from the focus groups: (1) positive and negative experiences with providers; (2) provider communication and interaction; (3) individual barriers to screening uptake, (4) implicit bias, discrimination, and stereotypical views among providers, and (5)language barrier. Survey and focus group findings diverged on several points. While focus group themes captured both positive and negative experiences with provider communication, survey results indicated that most of both US-born and Sub-Saharan African-born women experienced positive patient-centered communication with health care providers. Additionally, during focus group sessions many participants described experiences of discrimination in health care settings, but less than a third reported this in the survey. Black women's health care experiences affect Pap screening uptake. Poor communication and perceived discrimination during health care encounters highlight areas for needed service improvement to reduce cervical cancer disparities.