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Undocumented Immigration Status and Diabetes Care Among Mexican Immigrants In Two Immigration “Sanctuary” Areas

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Abstract

The objective of this study is to investigate the relationship between immigration status and the patient experience of health care, diabetes self-management, and clinical outcomes among Mexican immigrants with diabetes receiving health care in two immigration sanctuary cities. We used data from the Immigration, Culture and Health Care study, a cross-sectional survey and medical record study of low-income patients with diabetes recruited from public hospitals and community clinics in the San Francisco Bay Area and Chicago. Undocumented Mexican, documented Mexican immigrants, and US-born Mexican–Americans’ health care experiences, diabetes self-management, and clinical outcomes were compared using multivariate linear and logistic regressions. We found no significant differences in reports of physician communication, or in measures of diabetes management between undocumented and documented immigrants. All three groups had similar clinical outcomes in glycemic, systolic blood pressure, and lipid control. These results indicate that, at least in some settings, undocumented Mexican immigrants with diabetes can achieve similar clinical outcomes and report similar health care experiences as documented immigrants and US-born Mexican–Americans.

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References

  1. Taylor P, Lopez MH, Martinez JH, Velasco G. When labels don’t fit: hispanics and their views of identity. Washington: Pew Hispanic Center; 2012.

    Google Scholar 

  2. Passel J. Unauthorized migrants: numbers and characteristics. Washington: Pew Hispanic Center; 2005.

    Google Scholar 

  3. Nandi A, Galea S, Lopez G, Nandi V, Strongarone S, Ompad DC. Access to and use of health services among undocumented mexican immigrants in a us urban area. Am J Public Health. 2008;98:2011–20.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Annual estimates of the resident population by sex, Race, and Hispanic Origin for the United States. US Census Bureau; 2009. Accessed 5 July 2010 http://www.census.gov?_jpc/www/usinterimproj.

  5. American community survey. US Census Bureau; 2006. Accessed 5 July 2010 http://factfinder.census.gov/servlet/DatasetMainPageServlet?_program=ACS&_Submenuld=&_lang=en&_ts.

  6. Passel J. Growing share of immigrants choosing naturalization. Washington: Pew Hispanic Center; 2007.

    Google Scholar 

  7. Goldman D, Smith JP, Sood N. Legal status and health insurance among immigrants. Health Aff. 2005;24:1640–53.

    Article  Google Scholar 

  8. Ku L, Matani S. Left out: immigrants’ access to health care and insurance. Health Aff. 2001;20:247–56.

    Article  CAS  Google Scholar 

  9. Chavez L, Cornelius W, Jones OW. Mexican immigrants and the utilization of US health services: the case of San Diego. Soc Sci Med. 1985;21:93–102.

    Article  CAS  PubMed  Google Scholar 

  10. Berk ML, Schur CL, Chavez LR, Frankel M. Health care use among undocumented latino immigrants. Health Aff. 2000;19:51–64.

    Article  CAS  Google Scholar 

  11. Fuentes-Afflick E, Hessol N. Immigration status and use of health services among Latina women in the San Francisco bay area. J Women’s Health. 2009;18:1275–80.

    Article  Google Scholar 

  12. Hubbell FA, Waitzkin H, Mishra SI, Dombrink J, Chavez LR. Access to medical care for documented and undocumented Latinos in a Southern California County. West J Med. 1991;154:414–7.

    CAS  PubMed Central  PubMed  Google Scholar 

  13. Ortega AN, Fang H, Perez VH, Rizzo JA, Carter-Pokras O, Wallace SP, Gelberg L. Health care access, use of services, and experiences among undocumented Mexicans and other Latinos. Arch Intern Med. 2007;167:2354–60.

    Article  PubMed  Google Scholar 

  14. Marshall KJ, Urrutia-Rojas X, Mas FS, Coggin C. Health status and access to health care of documented and undocumented immigrant Latino women. Health Care Women Int. 2005;26:916–36.

    Article  PubMed  Google Scholar 

  15. DeVoe JE, Wallace LS, Pandhi N, Solotaroff R, Fryer GE Jr. Comprehending care in a medical home: a usual source of care and patient perceptions about healthcare communication. J Am Board Fam Med. 2008;21:441–50.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Cavazos-Rehg P, Zayas L, Spitznagel E. Legal status, emotional well-being and subjective health status of Latino immigrants. J Natl Med Assoc. 2007;99:1126–31.

    PubMed Central  PubMed  Google Scholar 

  17. Hunt KJ, Williams K, Resendez RG, Hazuda HP, Haffner SM, Stern MP. All-cause and cardiovascular mortality among diabetic patients in the San Antonio heart study. Diabetes Care. 2002;25:1557–63.

    Article  PubMed  Google Scholar 

  18. Hunt KJ, Gonzalez ME, Lopez R, Haffner SM, Stern MP, Gonzalez-Villalpando C. Diabetes is more lethal in Mexicans and mexican-Americans compared to non-hispanic whites. Ann Epidemiol. 2011;21:899–906.

    Article  PubMed Central  PubMed  Google Scholar 

  19. National Diabetes Fact Sheet: (2005) General information and national estimates on diabetes in the United States. Atlanta, GA: US Department of Health and Human Services, Center for Disease Control and Prevention 2005.

  20. Livingston G, Minushkin S, Cohn D. Hispanics and health care in the United States: access, information and knowledge. Washington: Pew Hispanic Center and Robert Wood Johnson Foundation; 2008.

    Google Scholar 

  21. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27:1047–53.

    Article  PubMed  Google Scholar 

  22. Berk ML, Schur CL. The effect of fear on access to care among undocumented latino immigrants. J Immigr Health. 2001;3:151–6.

    Article  CAS  PubMed  Google Scholar 

  23. Villazor R. ‘Sanctuary cities’ and local citizenship. Fordham Urban Law J. 2010;37:573–98.

    Google Scholar 

  24. Marrow H: The Power of Local Autonomy: Expanding Health Care to Unauthorized Immigrants in San Francisco. Ethnic and Racial Studies 2011; 1-16.

  25. Seligman H, Stern RJ, Fernandez A, Jacobs E, Neilands T, Maldonado RW, Carle A, Quan J: Advances in Measuring Culturally Compentent Care: A Confirmatory Factor Analysis of CAHPS-CC in a Safety-Net Population. Unpublished manuscript 2010.

  26. Zweifler J, Hughes S, Lopez RA. Controlling for race/ethnicity: a comparison of California commercial health plans CAHPS scores to NCBD benchmarks. Int J Equity Health. 2010;9:1–9.

    Article  Google Scholar 

  27. Toobert D, Hampson S, Glasgow R. The summary of diabetes self-care activities measure: results from 7 studies and a revised scale. Diabetes Care. 2000;23:943–50.

    Article  CAS  PubMed  Google Scholar 

  28. Passel J. The size and characteristics of the unauthorized migrant population in the US. Washington: Pew Hispanic Center; 2006.

    Google Scholar 

  29. Brown SA, Becker HA, Garcia AA, Barton SA, Hanis CL. Measuring health beliefs in spanish-speaking Mexican Americans with type 2 diabetes: adapting an existing instrument. Res Nurs Health. 2002;25:145–58.

    Article  PubMed  Google Scholar 

  30. Brown SA, Blozis SA, Kouzekanani K, Garcia AA, Winchell M, Hanis CL. Health beliefs of Mexican Americans with type 2 diabetes: the Starr county border health initiative. The Diabetes Educator. 2007;33:300–8.

    Article  PubMed  Google Scholar 

  31. Viruell-Fuentes EA, Schulz AJ. Toward a dynamic conceptualization of social ties and context: implications for understanding immigrant and Latino health. Am J Public Health. 2009;99:2167–75.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Stanford Patient Education Research Center: Diabetes Self-Efficacy Scale. Palo Alto: Stanford University. http://patienteducation.stanford.edu/research/sediabetes.html.

  33. Williams KE, Bond MJ. The roles of self-efficacy, outcome expectancies and social support in the self-care behaviours of diabetics. Psychology, Health & Medicine. 2002;7:127–41.

    Article  Google Scholar 

  34. Morisky D, Green L, Levine D. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24:67–74.

    Article  CAS  PubMed  Google Scholar 

  35. Lee Y, Lin J. The effects of trust in physician on self-efficacy, adherence and diabetes outcomes. Soc Sci Med. 2009;68:1060–8.

    Article  PubMed  Google Scholar 

  36. American Diabetes Association. Standards of medical care for patients with diabetes mellitus. Diabetes Care. 2003;26:S33–50.

    Article  Google Scholar 

  37. Nord M, Andrews M, Carlson S: Household Food Security in the United States, 2008. United States Department of Agriculture (Economic Research Service); 2009.

  38. Seligman HK, Jacobs EA, Lopez A, Tschann J, Fernandez A. Food insecurity and glycemic control among low-income patients with type 2 diabetes. Diabetes Care. 2012;35:233–8.

    Article  PubMed Central  PubMed  Google Scholar 

  39. Bickel G, Nord M, Price C: Guide to measuring household food security. United States Department of Agriculture (Food and Nutrition Service); Alexandria, VA: 2000.

  40. Seligman HK, Jacobs EA, Lopez A, Sarkar U, Tschann J, Fernandez A. Food Insecurity and hypoglycemia among safety net patients with diabetes. Arch Intern Med. 2011;171:1204–6.

    Article  PubMed  Google Scholar 

  41. Cuéllar I, Arnold B, Maldonado R. Acculturation rating scale for Mexican Americans-II: a revision of the original ARSMA scale. Hisp J Behav Sci. 1995;17:275–304.

    Article  Google Scholar 

  42. City & County of San Francisco: Sanctuary Ordinance. 2000. Accessed 6 February 2012 http://sfgsa.org/index.aspx?page=1067.

  43. Ohio Jobs and Justice Political Action Committee: Sanctuary Cities USA. 2012. Accessed 6 February 2012 http://ojjpac.org/sanctuary.asp.

  44. Fernandez A, Schillinger D, Warton EM, Adler N, Moffet HH, Schenker Y, Salgado MV, Ahmed A, Karter AJ. Language barriers, physician-patient language concordance, and glycemic control among insured Latinos with diabetes: the diabetes study of Northern California (DISTANCE). J Gen Intern Med. 2010;26:170–6.

    Article  PubMed Central  PubMed  Google Scholar 

  45. Blendon RJ, Buhr T, Cassidy EF, Perez DJ, Hunt KA, Fleischfresser C, Benson JM, Hermann MJ. Disparities in health: perspectives of a multi-ethnic, Multi-Racial America. Health Aff. 2007;26:1437–47.

    Article  Google Scholar 

  46. Sixma HJ, Kerssens JJ, Campen CV, Peters L. Quality of care from the patient’s perspective: from theoretical concept to a new measuring instrument. Health Expect. 1998;1:82–95.

    Article  PubMed  Google Scholar 

  47. Harmsen JA, Bernsen RM, Brujinzeels MA, Meeuwesen L. Patient’s evaluation of quality of care in general practice: what are the cultural and linguistic barriers. Patient Educ Couns. 2008;72:155–62.

    Article  CAS  PubMed  Google Scholar 

  48. Rodríguez M, Bustamante A, Ang A. Perceived quality of care, receipt of preventive care, and usual source of health care among undocumented and other Latinos. J Gen Intern Med. 2009;24:S508–13.

    Article  Google Scholar 

  49. Passel Jeffrey, Cohn D’Vera. A portrait of unathorized immigrants in the United States. Washington, DC: Pew Hispanic Center; 2009.

    Google Scholar 

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Acknowledgments

This research was funded by the Russell Sage Foundation, Arnold P. Gold Foundation, UCSF School of Medicine Dean’s Summer Research Fellowship, and the UC Berkeley-UCSF Joint Medical Program Helen Schoeneman Research Fellowship. We acknowledge Dr. Karen Sokal-Gutierrez and Dr. Sylvia Guendelman of the UC Berkeley School of Public Health for their valuable comments. We are grateful for the patients and staff of participating clinics.

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Correspondence to Alicia Fernández.

Additional information

We recognize that some Mexican immigrants, regardless of immigration status, consider themselves Mexican–American and others do not. For sake of clarity we will use the terms documented and undocumented immigrants to refer to this heterogeneous group [1].

Appendix

Appendix

Details on the different measures discussed in the methods section.

CAHPS-Cultural Competency

The CAHPS-CC has seven subdomains: positive doctor communication, negative doctor communication, health promotion, alternative medicine, shared decision-making, equitable treatment, and trust. Internal consistency for the Immigration, Culture and Health Care (ICHC) study population was determined by Cronbach alpha (0.82 for positive communication, 0.77 for trust, 0.72 for preventive care counseling). Negative communication and equitable treatment were not included in this study due to their low Cronbach alpha in the Spanish-speaking population. Shared decision-making and alternative medicine are also excluded due to their overall low Cronbach alpha. Due to highly skewed distributions and as a proof of concept, scores for the two domains included in the study were dichotomized into two categories [26]: the upper 25 % (optimal) and the lower 75 % (suboptimal). Scores for each of the CAHPS-CC subscales range from 0 to 100.

Diabetes Self-Management

(1) Diabetes self-care is measured through a brief version of the Summary of Diabetes Self-Care Activities (SDSCA) scale [27]. It is a self-report questionnaire that measures levels of self-management across different components of the diabetes regimen: general diet (2 items), specific diet (2 items), exercise (2 items), blood-glucose testing (2 items), foot care (2 items), and smoking (not included in the ICHC Study survey). Due to issues of recall, we decided to use only the item of each measure that asked about behaviors within the immediate past week. For the foot care measure, we only used the item that asked about checking feet and not inspecting the inside of shoes. Responses range from 0 to 7 (days a week) with higher scores indicating better diabetes self-management. (2) Diabetes self-care barriers/supports were measured using a diabetes-related health belief instrument translated for use with Spanish-speaking Mexican Americans [29]. It is a 25-item health belief instrument from Starr County, Texas consisting of five subscales: Social support for diet, Impact of job on therapy, Benefits of therapy, Control of effect of diabetes, and Total barriers to diet and taking medications. Responses were given in a Likert-scale format, ranging 1 (strongly disagree) to 5 (strongly agree). The higher the score on an item, the stronger the belief. (3) Diabetes self-efficacy was measured through an 8-item scale originally developed and tested in Spanish for the Diabetes Self-Management study [32]. Responses range from 1 (not at all confident) to 10 (completely confident) and the score for this scale is the average of the eight items. Higher averages indicate higher self-efficacy. (4) Medication adherence was measured using the Morisky scale, a four-item self-reported adherence measure (Cronbach alpha = 0.61) that addresses barriers to medication-taking. Responses are yes/no categories and the score is calculated by assigning 1 point for each “yes” answer, thus ranging from 0 to 4. Higher scores indicate poorer medication adherence [34].

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Iten, A.E., Jacobs, E.A., Lahiff, M. et al. Undocumented Immigration Status and Diabetes Care Among Mexican Immigrants In Two Immigration “Sanctuary” Areas. J Immigrant Minority Health 16, 229–238 (2014). https://doi.org/10.1007/s10903-012-9741-0

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