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  • Immigrant Health is Interpersonal

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    By Amanda Venta, Ph.D.
    University of Houston
    Posted Sept. 9, 2024

    Photo of Dr. Amanda VentaWaves of Latinx immigration to the United States have changed in recent decades, and our scientific literature is only beginning to catch up. Regional violence and unrest in the Northern Triangle of Central America (i.e., El Salvador, Honduras, and Guatemala) have pushed families to seek asylum in the U.S. Simultaneously, we have seen growth in children traveling without a guardian (i.e., unaccompanied immigrant minors) from the same region.

    Health care professionals now find large numbers of Latinx immigrant youth and families in their waiting rooms, yet relatively little published research on their mental health experiences and clinical needs exist. Latinxs, in general, are underrepresented in published research. First generation-asylum-seekers from Central America, while characterizing recent waves of immigrants and rapidly increasing their demographic share in the U.S., have been practically invisible to the scientific literature until recently.

    It was during these shifts that I began working with the Office of Refugee Resettlement (ORR) to provide psychological services for unaccompanied immigrant minors. I received referrals for youth who were displaying psychological symptoms while living in ORR-approved facilities.

    Dr. Venta, wearing sunglasses, stands on an enclosed bridge with others looking through the metal grate at the U.S. border between Texas and MexicoDr. Venta and colleagues look out from the international bridge connecting McAllen, Texas and Reynosa, Mexico, where many migrants try to cross into the U.S., and many have lost their lives doing so. Credit: Mark Teiwes

    High-Stakes Health Consequences

    Across hundreds of cases, the prototypic experience is that of a 16- or 17-year-old boy from the Northern Triangle. We typically see a child who is left in his home country early in life by his father, who migrated to the U.S. to establish a foothold. Shortly thereafter, the child’s mother also migrates North in search of better opportunities or to flee growing regional danger. The child grows up with several different caregivers, coping in various ways with separation from his parents and surviving adversities associated with poverty, violence, and the absence of his primary caregivers.

    In late adolescence, the child decides to make the journey to the U.S. himself—sometimes with his parents’ blessing and sometimes without. Though escape from gang and cartel threats, poverty, and educational aspirations were often relevant, the emotionally salient motivation is almost always an interpersonal one—a view, idealized as it may be—that being reunited with mom or dad would solve the many problems this child has survived during the previous 10 to 12 years. As a clinical scientist with training in child and family psychology and attachment theory, I can no longer see immigration as a partisan, political issue; I see it as an interpersonal issue—a family issue with high-stakes health consequences.

    Over the last 10 years, the bulk of my research, including a three-year longitudinal study of recently immigrated Latinx youth and an ongoing, four-year longitudinal study of Latinx asylum-seeking adults, have reinforced this message: the health and well-being of immigrants depends upon their interpersonal ties.

    Trauma exposure is nearly universal in the child, adolescent, and adult Latinx asylum-seekers we have interviewed, and clinically significant symptoms of posttraumatic stress disorder (PTSD) are the norm, with 60% of our samples showing clinical elevations. This health disparity is jarring and deserving of clinical attention, but it is not the whole picture. Indeed, our work documents that interpersonal risks like family separation due to migration are prevalent and tied to interpersonal functioning and mental health in youth and young adulthood.

    More broadly, the interpersonal experience of failed belonging among young adult Latinx immigrants is a significant predictor of suicide-related thoughts and behaviors. Discrimination, in youth and adults, demonstrates significant relations to mental health problems. Our work repeatedly shows that these interpersonal risks are potently connected to immigrant health, even in the context of surviving trauma, migration, and settlement in a new country.

    Sticking Together, Making It Through, and Thriving

    Dr. Venta, crouched down to talk with a young girl at eye-level. The girl wears a blue plaid shirt, has a dark brown ponytail and holds up 4 fingersDr. Venta talks to a young girl at a migrant camp in Reynosa, Mexico. Credit: Mark Teiwes.

    At the same time, the immigrant context is full of evidence of resilience, and interpersonal factors play a significant role on this side of the coin as well. Our work with Latinx youth and young adults demonstrates that family relationships built on trust and communication are associated with reduced mental health problems and increased prosocial behavior and resilience. Even in families who experience separation, secure relationships can persist and continue to exert positive effects on mental health.

    Familismo, a Latinx cultural value emphasizing the primacy of the family, acts as a protective factor in our research on suicide-related thoughts and behaviors and underlies the provision of social support in immigrant families. Above and beyond the family context, young migrants’ perceived connections to school and peer relationships relate significantly to their mental health.

    Our work now includes clinical encounters with hundreds of immigrant minors and face-to-face and online data collection with thousands of Latinx children, adolescents, and adults. In many of these cases, the atrocities they have survived take center stage. Their experiences are unfathomable to many of us, and their suffering— leaving their children, losing their parents, and experiencing many forms of trauma—is palpable. And yet, they speak strongly of another story—one of resilience, of sticking together, of making it through, and of thriving under circumstances they never expected.

    Our research has coalesced on the notion that this resilience hinges on the interpersonal strengths and ties that Latinx immigrants carry with them along the journey. While some of these are tangible—like available caregivers with stable documentation status—most of them are felt—mental representations of caregivers as loving and reliable despite separation and perceptions of belonging at home, school, and in the U.S. that can withstand political realities about documentation status and immigration court.

    We can all learn from these examples.

    We thrive together.

    Amanda Venta, Ph.D., is a Latina bilingual associate professor at the University of Houston. Her research focuses on the development of psychopathology in youth, with expertise in how family relationships relate to risk and resilience. Over the last decade, she has worked clinically and centered her research on the experiences of immigrant youth and families from Central America with multiple awards from NIMHD (1R01MD016897-01A1 and R15MD014302-01). She serves on the editorial boards of Attachment and Human Development, Research on Child and Adolescent Psychopathology, the Journal of Clinical Child and Adolescent Psychology, and she is the associate editor of Behaviour Research and Therapy. Together, she has published 135+ scientific papers, chapters, and books.

    Disclaimer: NIMHD encourages the use of common terminology in collecting and reporting data, and this includes the standardization of racial and ethnic terms as identified in the revised OMB Statistical Policy Directive No. 15 for federal statistics and administrative reporting.

  • Moving From Willingness to Vaccination Uptake: Strategies for Promoting Health Through Vaccines

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    By Deborah E. Linares, Ph.D., M.A. and Vanessa Marshall, Ph.D.
    National Institute on Minority Health and Health Disparities (NIMHD)
    Posted March 7, 2024

    Moving from willingness (to take a vaccine) to vaccination uptake remains a public health challenge, because there are multiple factors driving vaccine hesitancy. Vaccine hesitancy occurs when there is a reluctance to receive a vaccine despite its availability. Developing strategies to build trust with people from racial and ethnic minority communities and the medical community are essential to effectively promoting health.

    NIMHD supports research in this area to eliminate health disparities and incorporate strategies to address:

    • Social determinants of health that create barriers to accessing vaccines.
    • Sustainable collaborations in communities disproportionately affected by illnesses.

    NIMHD continues to invest in community-engaged research among populations experiencing health disparities to promote wellness and protect health through vaccines. We held an NIH extramurally funded grantee meeting on COVID-19 vaccine uptake in 2022 where several insights were shared. In this blog post, we share these insights and a brief overview of how applying knowledge, steadfastness, and collaboration can help promote vaccine uptake. While we know some people are reluctant and may be unsure about being vaccinated, hopefully this blog will help to inform them.

    What are the benefits of vaccines?

    Vaccines provide multiple benefits for the prevention or reduction of disease, serious illness, or death while also protecting against disease transmission. The Centers for Disease Control and Prevention (CDC) recommends vaccinations across the lifespan for protection against many diseases.

    For example, influenza or the flu is an infection of the respiratory system that can cause serious complications for children ages 2 or younger, pregnant people, adults over age 65, and people with chronic health conditions. The flu causes more than 400,000 hospital stays and 50,000 deaths each year in the United States, with the highest rates among Black and African American and American Indian and Alaska Native (AI/AN) populations. Yet less than 43% of Latino and Hispanic, AI/AN, and Black and African American adults and less than 54% of Latino and Hispanic and Black and African American children receive the flu vaccine.

    U.S. Food and Drug Administration-approved vaccines are critical for reducing infection rates and slowing the spread of infectious diseases. Despite the CDC’s recommendations and the overwhelming benefits of vaccination, disparities exist in the acceptance and uptake of vaccines (e.g., COVID-19, flu, pneumococcal, hepatitis B, pertussis, measles, and human papilloma virus) among populations experiencing health disparities. These disparities also occur for many routine immunizations for all ages.

    What drives vaccine hesitancy?

    The COVID-19 pandemic showed us that vaccine hesitancy is complex; context specific; and changes across time, place, and type of vaccine, as well as in the timely completion of a vaccine series (i.e., receiving all vaccines within a series). It can also be influenced by factors such as complacency, convenience, and confidence.

    Pathways of vaccine hesitancy vary and are subject to change over time. For instance, parental vaccine hesitancy for childhood vaccines is growing within the United States for diseases such as measles, despite measles being declared eliminated in the United States in 2000 due to a prior robust vaccination program.

    Racial and ethnic minority populations may be more likely to experience skepticism about the trustworthiness of the source(s) of vaccination recommendations due to prior experiences of marginalization and mistreatment within the medical community. Cultural and religious factors may also influence vaccine uptake and low risk perceptions of disease.

    Other factors such as limited knowledge, limited information on vaccines, concerns about perceived safety, parental perceptions of vaccine safety, public uncertainty, low health literacy, considering immunization a low priority, and exposure to misinformation or disinformation via social media channels play a role in vaccine uptake.

    Getting protected: What you need to know

    Winter months are critical times for vaccines, especially COVID-19, flu, and respiratory syncytial virus (RSV). People may also be behind on other vaccines due to health care closures and accessibility issues during COVID-19. So how can we encourage the people around us to get vaccinated? Community-based organizations and health care providers can do the following:

    • Engage others in meaningful, authentic communication when you discuss vaccines.
    • Identify and address the needs, preferences, and concerns of a group in discussions about vaccines.
    • Provide targeted messaging that meets people where they are, in terms of their decision to vaccinate and the places where they receive care.
    • Give understandable communication that comes from a trusted source (e.g., health care provider or community leader).
    • Provide different modalities for messaging about vaccines (e.g., text message, face-to-face interactions, social media, videos).

    These strategies can be helpful to increase vaccine uptake within your community. In addition to getting vaccinated, please continue to use evidence-based mitigation strategies to reduce the risk of spreading infectious diseases, such as mask wearing and frequent hand washing. Persistence to these strategies and drawing on community-based collaborations can help promote health among populations experiencing health disparities.

    On-going NIMHD vaccine related funding opportunities and initiatives:

    Want to know more about how NIH is addressing vaccine hesitancy, uptake, and implementation among populations experiencing health disparities in the United States and its territories?

    To locate vaccines near you: www.vaccines.gov

    Deborah Linares, Ph.D., M.A., is a Health Scientist Administrator (Program Official) at NIMHD. She focuses on promoting research to understand behavioral and interpersonal factors contributing to resilience and susceptibility to adverse health conditions among disadvantaged and underserved populations. She provides expertise in conducting minority health and health disparities research in the areas of behavioral health, women’s health, child development, healthy aging, eHealth, and cancer control.

    Vanessa Marshall, Ph.D., is a Social Behavioral Scientist Administrator (Program Officer) in the Division of Community Health and Population Science at NIMHD. She manages and conducts research to advance public health prevention science. Her research focuses on improving health outcomes and promoting research to understand and address the multilevel determinants of factors that play a role in health disparities. She provides expertise in key research areas including minority health, health disparities, health services research, community engaged research, clinical trials, public health, quality improvement, implementation, dissemination and evaluation.