Immigrant Legal Status Disparities in Health Among First- and One-point-five-Generation Latinx Immigrants in California

Restrictive US immigration laws and law enforcement undermine immigrant health by generating fear and stress, disrupting families and communities, and eroding social and economic wellbeing. The inequality and stress created by immigration law and law enforcement may also generate disparities in health among immigrants with different legal statuses. However, existing research does not find consistent evidence of immigrant legal status disparities in health, possibly because it does not disaggregate immigrants by generation, defined by age at migration. Immigration and life course theory suggest that the health consequences of non-citizen status may be greater among 1.5-generation immigrants, who grew up in the same society that denies them formal membership, than among the 1st generation, who immigrated as adolescents or adults. In this study, we examine whether there are legal status disparities in health within and between the 1st generation and the 1.5 generation of 23,288 Latinx immigrant adults interviewed in the 2005–2017 waves of the California Health Interview Survey. We find evidence of legal status disparities in heart disease within the 1st generation and for high blood pressure and diabetes within the 1.5 generation. Non-citizens have higher rates of poor self-rated health and distress within both generations. Socioeconomic disadvantage and limited access to care largely account for the worse health of legally disadvantaged 1st- and 1.5-generation Latinx adults in California.

Using Population-Level Data to Assess Need for and Use of Long-Term Services and Supports in California

In response to aging and disability stakeholder advocacy in California, the state’s 2018-19 budget included support for the development of a study of Californians with needs for long-term services and supports (LTSS). Existing data on LTSS most typically represents those who already use specific programs or services. Yet many programs do not uniformly collect and report data, or have little capacity to share data across different delivery systems. In response to these gaps, we developed a 15-minute follow-on survey to the 2019-2020 California Health Interview Survey (CHIS), gathering statewide population-level data to assess LTSS needs and use by Californians 18 years of age and older. This paper reports on preliminary findings from the 2019 CHIS-LTSS survey conducted with a sample of 1097 respondents. Screening questions identified respondents reporting difficulties with concentrating, remembering, or making decisions (60%), performing basic daily activities such as dressing or bathing (26%), or getting out of the house to shop or to see the doctor (52%). Nearly half of respondents (45%) reported needing help with routine care needs while 16% needed help with personal care needs. Additional findings illustrate specific LTSS needs, service use, consequences of unmet needs, financial concerns, and consumer experiences. At a time when California policy makers, program planners, and advocates are engaged in implementing a 10-year Master Plan for Aging, these findings can be used to identify and address gaps in the types of services and supports that are essential to meet the LTSS needs of older adults and people with disabilities.

The Impact Of Oral Health On Psychological Distress Among Older Adults In California

In California, the population of adults ages 65 and older is projected to increase from 11% in 2010 to 19% in 2030. The aging of the population requires modifications in public health to ensure that people are not only living longer, but also healthier lives. Oral health is an important, but often overlooked factor that affects the overall health of older adults. Poor oral health increases the risk of physical comorbidities, decreases chewing performance, limits food choices, and exacerbates weight loss. Furthermore, poor oral health disrupts social health via decreases in verbal communication and facial expressions, such as smiling. This study examines the effects of oral health, assessed by tooth condition, on psychological distress among adults ages 65 and older in California. The study uses the 2019 California Health Interview Survey (CHIS), an annual survey of a representative sample of the state’s residential, noninstitutionalized population. Logistic regression models are used to determine the association between tooth condition on psychological distress controlling for gender, race, and elderly poverty index. Worsening tooth condition increases the odds of having psychological distress with lower odds among individuals 85+, and higher odds among women, and non-Hispanic whites compared to Hispanics. Public health programs and interventions are required in California to prevent and mitigate the impacts of poor oral health on psychological distress among the increasing and diverse older adult population.

Disparities in Financial Strain for Older Adults and People With Disabilities in California

This study examines disparities in the experience of financial strain among older adults and people with disabilities by age, gender, race/ethnicity, poverty, and disability type. People with disabilities refer to those who report cognitive impairment, difficulties performing activities of daily living (ADLs) and/or instrumental activities of daily living (IADLs). Financial strain includes challenges that participants incurred during the last 12 months in acquiring food, housing, health care, or income. This study uses the data from the 2019 California Long-Term Services and Supports (LTSS) survey that was merged with data from the omnibus California Health Interview Survey (CHIS) (N=1097). This is the most comprehensive population-level dataset to examine LTSS needs, unmet needs, and uses of LTSS in California. Initial findings show that 50% of participants report spending less on food, while 40% report cutting down on saving for retirement, receiving and borrowing money from others, and experiencing a decline in household income. More than 20% note that they could not make rent or mortgage payments, had debt due to medical bills, and had to spend less on prescription medications or medical care. We also find significant disparities in financial strain by age, gender, poverty, and disability type; however, no significant disparities by race/ethnicity. This study is among the first to examine disparities in various financial strain types for people who need LTSS in California. The findings have policy implications for the Master Plan for Aging (MPA), which serves as a blueprint to build environments that promote an age-friendly California.

Factors Associated With the Use of Telehealth in Middle-Aged and Older Adults During the COVID-19 Pandemic

The COVID-19 pandemic has promoted the adoption and use of telehealth, particularly in the early months of the pandemic. However, people with diverse characteristics may, or may not, be able to use telehealth, presenting digital divide in health care and potential health equity-related issues. This study aimed to assess the use of telehealth among middle-aged and older adults during COVID-19, and to explore factors associated with their telehealth utilization. We used publicly available data from the California Health Interview Survey collected during January 2019 and December 2020 (N=15, 279; mean age= 64.23±11.59; female: 52.7%). Approximately 11.0% of the sample used telehealth at least once. Bivariate and multivariate logistical regression analyses found that, compared with non-users, telehealth users were more likely to be having higher numbers of chronic conditions, with self-reported mental distress, living in urban areas, born in the US, with higher English proficiency, higher education, and having higher incomes. Age, race/ethnicity, and gender were not significantly correlated with telehealth usage. Logistic regression revealed that having mental distress (OR=1.48, 95% CI=1.29-1.71, p<0.01), more chronic conditions (OR=1.48, 95% CI=1.29-1.71, p<0.001) and living in an urban area (OR=1.93, 95% CI=1.36-2.74, p<0.001) were independently related to telehealth use. These findings suggest that telehealth, while being beneficial during the pandemic, might also introduce new challenges that exacerbate existing health inequity and disparities. Policy and community-based interventions are needed to promote the use of telehealth among middle-aged and older adults with diverse characteristics.

Informing California's Plan to Enhance HIV Screening in the Ending the HIV Epidemic Initiative

The CDC recommends that everyone have at least one HIV test in their lifetime. However, analyses of California Health Interview Survey data showed that in 2017 only half of Californians had ever received an HIV test. Non-Hispanic Black (64.8%) and Hispanic adults (54.7%) had higher lifetime testing rates than non-Hispanic White adults (48.8%). In multivariable analyses non-Hispanic African American adults had twice and Hispanic adults 1.2 times the odds of lifetime HIV testing as non-Hispanic White adults. The CDC recommends annual HIV testing for higher-risk individuals. Independent of race/ethnicity, heterosexual men with multiple sex partners had lower annual testing rates than other high-risk individuals. Annual testing was unrelated to education level and poverty, but was related to number of doctor visits. HIV screening rates among heterosexual men with multiple partners could be increased by targeting HIV screening to non-medical settings in California's eight Ending the HIV Epidemic counties.

Ethnic group differences in obesity in Asian Americans in California, 2013–2014

Background Obesity has been generally understudied in Asian Americans. It is important to identify subgroups of Asian Americans at high risk of obesity to help develop targeted interventions for those subgroups. This study aimed to examine the disparities in obesity among Asians (i.e., Chinese, Filipino, Japanese, Korean, and Vietnamese) living in California. Methods A sample of Adult Americans in California (n = 47,970) including Asian American adults (n = 3810) aged 18 years or older were obtained from the 2013–2014 California Health Interview Survey (the U.S. nation’s largest state cross-sectional health survey). Body mass index was calculated using self-reported height and weight. Weight status was determined using the WHO Asian BMI cut points in 4 categories: < 18.5 kg/m2 (underweight), 18.5–22.9 kg/m2 (normal weight), 23–27.5 kg/m2 (overweight), and ≥ 27.5 kg/m2 (obese). Multiple logistic regression analyses were used to estimate odds ratio (OR) and 95% confidence interval (CI) after adjustment for covariates. Results Overall, the prevalence of Asians was 23.3% for obesity and 40.0% for overweight. The obesity prevalence was higher in Asians who were males, aged 45–64 years old, had higher family income, were current smokers, never got married, had lower education level, had an insufficient level of physical activity, and had more frequent consumption of fast foods. After adjusting for other factors, compared to Whites, being Hispanics and Blacks were associated with higher odds of obesity (OR = 1.47, 95%CI = 1.31–1.65; OR = 2.04, 95%CI = 1.65–2.53, respectively); being Chinese, Korean, and Vietnamese were associated with lower odds of obesity (OR = 0.28, 95%CI = 0.18–0.45; OR = 0.14, 95%CI = 0.04–0.46; OR = 0.28, 95%CI = 0.14–0.58, respectively). Compared to Chinese, being Japanese and Filipino were associated with higher odds of obesity (OR = 2.75, 95%CI = 1.52–4.95; OR = 2.90, 95%CI = 1.87–4.49, respectively). Conclusions The prevalence of adult obesity was high among Asian Americans in California. Ethnic/racial disparities in obesity among Asian Americans in California were observed in 2013–2014. Compared to Whites, being Chinese, Korean, Vietnamese were associated with lower odds of obesity. Among Asians, compared to Chinese, being Japanese and being Filipino were associated with higher odds of obesity. These findings can help design better interventions to reduce racial and ethnic disparities in obesity, especially for Asian Americans.