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A Reflection on the Special AJPH Issue: Health Without Borders Editorial Team Joint Session

A Reflection on the Special AJPH Issue: Health Without Borders Editorial Team Joint Session . Hector Balcazar, PhD, Felipe Gonz á lez Castro, MSW, PhD., Mary Northridge, MPH, PhD & Farzana Kapadia PhD, MPH. Editorial Independence. Peer Review. Level III. Level I. Future Direction.

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A Reflection on the Special AJPH Issue: Health Without Borders Editorial Team Joint Session

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  1. A Reflection on the Special AJPH Issue: Health Without Borders Editorial Team Joint Session Hector Balcazar, PhD, Felipe González Castro, MSW, PhD., Mary Northridge, MPH, PhD & Farzana Kapadia PhD, MPH

  2. Editorial Independence Peer Review Level III Level I Future Direction Ethical Principles Level II AJPH Conceptual Framework for Advancing Public Health

  3. Health Without Borders: What is The New Paradigm For Advancing Public Health Develop New Research Paradigms in the Context of Ecodevelopmental Models Learning From History- Learning from the New Contemporary World Learning the New Epidemiology and Social Determinants of Immigrant Health Learning from Humanistic Approaches Learning from Ethics to Build Value for Social Justice/Equity Foundations For Advancing Public Health as a Health Without Borders

  4. P143 Health Without Borders: Some Editorial Observations Felipe González Castro, M.S.W., Ph.D. Department of Psychology and Southwest Interdisciplinary Research Center. Arizona State University Felipe.Castro@asu.edu Presentation at the 136th Annual Meeting of the American Public Health Association October 29, 2008, San Diego, CA.

  5. I Overview Perspectives on Health Without Borders

  6. Health Challenges within the Context of Immigration * Immigration as a pervasive world-wide phenomenon * Acculturation as a process of adaptation to new environments * From a biopsychosocial perspective, health as a form of human capital that is maintained, enhanced or lost as a consequence of sociocultural, community, familial, individual and biological events. * Immigration involves gains and losses in social and human capital that can enhance or compromise health status

  7. 5. SOCIOCULATURAL SYSTEMS 4. COMMUNITY SYSTEMS Institutionalized Racism Community Groceries and Restaurants Community Exercise and Recreational Facilities Health-Related Community Norms Social Policies Limiting Access to Health Care Discriminatory Social Policies 3. FAMILIAL SYSTEMS American Cultural Values: Freedom, Individuality, Capitalism Ethnic Cultural Values: Familism, Collectivism, Collaboration Family Social Supports for Health Family Food Preferences Family Exercise Habits and Activities Differential Acculturation 2. INDIVIDUAL SYSTEMS Personal Health Lifestyle Health Motivation 1. ORGANIC SYSTEMS Organs, Cells, Genes (2, 4) Consumer Behaviors Community Health Activities (2, 5) Acculturation Stressors Perceived Racism

  8. II Theory On Acculturation and Adaptive Change

  9. Background on Acculturation: A Definition * Acculturation was originally defined as a group process, a: * “phenomena which results when groups of individuals having different cultures come into continuous first-hand contact with subsequent changes in the original culture patterns of either or both groups.” (Redfield, Linton, & Herskovitz, 1936; as cited by Trimble, 2003). * Redfield, R., Linton, R., & Herskovitz, M. (1936). Memorandum for the study of acculturation. American Psychologist, 38, 149-152. * Trimble, J. E. (2003). Introduction: Social change and acculturation. In K. M. Chun, P. M. Organista, & G. Marin (Eds.), Acculturation: Advances in theory, measurement and applied research (pp. 3-13). Washington DC: American Psychological Association.

  10. A-B Model of Acculturation II. Individual-Level Model of Acculturation/Assimilation Mainstream American Society Immigrant/Latino Group B A A1 A2 A4 A3 Elite 1. Migration Mainstream Fringe 2. & 3. Acculturation 4. Full Assimilation ?

  11. The Concept of Acculturation 1. Acculturation: Originally a process of group change; could be uni-directional or bi-directional * A weaker group assimilates into the dominant group 2. Individual change process involving cultural migration (acculturation) and perhaps full assimilation 3. Orthogonal model- two dimensions of acculturation towards: (a) ethnic culture (e.g. Latino) and (b) mainstream culture (e.g., North American) (Berry, 1998) Berry, J. W. (1998). Acculturative Stress. In P. B. Organista, K. M. Chun, & G. Marin (Eds). Readings in Ethnic Psychology (pp. 117-122). New York: Routledge.

  12. Criticisms of the Orthogonal Acculturation Model * The two-factor (orthogonal) model of acculturation has also been criticized as creating illusory categories (Rudmin, 2003) * Additionally, most acculturation studies are cross-sectional in design, and have not really examined the longitudinal process of acculturation Rudmin, F. W. (2003). Critical history of the acculturation psychology of assimilation, separation, integration, and marginalization. Review of General Psychology, 7, 3-37.

  13. Acculturation Stress * Acculturation stress rather than acculturation per se has been proposed as a factor that may operate as a form of psychological distress, that can promote mental disorder, and other negative health outcomes. * Racial/ethnic discrimination, forced assimilation,family disruptions, differential acculturation between parents and children, are some of the factors related to acculturation stress occurring among Mexican Americans and other Latinos and Latinas. * The lack of supportive social relations may also operate as a risk factor for distress and psychiatric disorder.

  14. Some Observations and Conclusions * Greater acculturation thus appears to be associated with higher rates of various types of psychiatric disorder. * Why might “Westernization” promote psychiatric disorder? * May this occur as moderated by certain other factor(s)? Alderete, E., Vega, W. A., Kolody, B., & Aguilar-Gaxiola, S. (2000). Lifetime prevalence of and risk factors for psychiatric disorders among Mexican migrant farmworkers in California. American Journal of Public Health, 90, 608-614.

  15. Some Observations and Conclusions * An epidemiological paradoxhas emerged where better health outcomes are observed among lowest-income immigrants to the United States- this is an “ Hispanic/Latino Paradox ” or an “ Immigrant Paradox ” (Alderate, Vega, Kolody & Aguilar-Gaxiola, 2000) * Within the Latino population, potential protectivesociocultural factors may be: social supports, strong family ties, and group identity, and perhaps ethnic pride.   Alderete, E., Vega, W. A., Kolody, B., & Aguilar-Gaxiola, S. (2000). Lifetime prevalence of and risk factors for psychiatric disorders among Mexican migrant farmworkers in California. American Journal of Public Health, 90, 608-614.

  16. Criticisms of Acculturation Research * Contemporary critics of acculturation research have argued that acculturation studies have: * Failed to define this construct, * Been methodologically weak, * Produced contradictory findings, * Created more confusion than clarity, * Promoted stereotypes, * Generated misleading outcomes, and * Such research should be discontinued (Hunt, Schneider & Comer, 2004). * Don’t abolish; improve! Hunt, L. M., Schneider, S., Comer, B. (2004). Should “acculturation” be a variable in health research? A critical review of research on US Latinos. Social Science and Medicine, 59, 973-986.

  17. III Critique Some Editorial Observations and Comments

  18. Defining the Population * Many confusing racial-ethnic labels * White Americans: non-Hispanic whites, Caucasians, Anglo Americans, Whites * Latinos: Hispanics; Hispanic ancestry * Subgroups by nationality: Mexican Americans, Chicanos(as), Puerto Ricans, Island Puerto Ricans, New Yoricans, etc. * Ethnic gloss - Hispanics: which of over 44.3 million have we sampled? (US Census, 2008) * Acknowledge complex racial-ethnic combinations * Acknowledge differences by migration cohort * Level of acculturation as a moderator variable U.S. Census. (2008) Table of Hispanic demographic variables. Retrieved October 25th 2008 from http://www.census.gov/population/www/socdemo/hispanic/files/Hispanic%20population.xls.

  19. Justice to the “Real World” Phenomenon * Measurement of Acculturation * Proxy measures: language, generation, etc. * Scaled measures * 20 items, 10 items, 5 items, 1 item, What’s next? * Economics of measurement regarding the complex phenomenon of acculturation * “You get what you pay for with more limited measures” * We need more in-depth measurement, not less

  20. Justice to the “Real World” Phenomenon * Moving beyond “proxy” or “marker” variables of acculturation and cultural adaptation * Acknowledge the multiple ecodevelopmental contexts in which acculturation occurs * What are the best indicators * What about: * Immigration contexts * Host country’s economic and political environment * Native country’s economic and political environment, etc.

  21. The Pivotal Research Issues * What about the Latino Paradox may be real? * Is this an immigrant effect only? * What about subgroups and their acculturative trajectories; which groups prosper and enjoy wellness, which enter into poverty and disease, and why? * Empirical research studies that move beyond the Latino Paradox * What are the major ecodevelopmental determinants of health and prosperity for Latino and other immigrants? * New research knowledge is needed on these resilience effects and how they can be captured and incorporated into effective health promotion programs.

  22. IV A Few Questions & Discussion

  23. P143 Health Without Borders: Special Attention to Formats Farzana Kapadia, M.P.H., Ph.D. Steinhardt School of Culture, Education and Human Development. New York University

  24. Enhancing submissions to AJPH:Examples from the Health without Borders theme issue

  25. The Journal • Mission of the Journal is to advance public health research, policy, practice, and education • Publish papers for a broad public health audience • Also, seek to balance between findings meaningful to a general public health audience and those addressing specific topics

  26. Is the Journal the right venue? • Broad readership • Rigorous scientific standards • Quality peer review

  27. Is the Journal the right venue? (cont.) • Different formats: • Departments: Public Health Then & Now, Voices from the Past, Field Action Reports, Framing Health Matters • Commentaries • Analytic Essays: Govt, politics & law, Health policy & ethics • Research & Practice: Full length reports, Brief reports • Look at past TOCs!

  28. Examples • Public Health Then and Now: • PT O’Shaughnessy, ‘Parachuting cats and crushed eggs: The controversy over the use of DDT to control malaria’ 98(11):1940-1948. • Voices from the Past: • ‘The World Health Organization and it’s work’ 98(9): 1594-1597. • Abel, Fee & Brown, ‘Milton I. Roemer Advocate of Social Medicine, International Health, and National Health Insurance’ 98(9): 1596-1597.

  29. Examples (cont.) • Field Action Reports: • Venters et al., ‘Bringing Health Care Advocacy to a Public Defender's Office’ 98(11): 1953-1955. • Rifat et a.l., ‘From Mosques to Classrooms: Mobilizing the Community to Enhance Case Detection of Tuberculosis’ 98(9): 1550-1552. • Framing Health Matters: • Higgins & Hirsch, ‘Pleasure, Power, and Inequality: Incorporating Sexuality Into Research on Contraceptive Use’ 98(10):1803-1813.

  30. Examples (even more!) • Analytic Essays: • Prah Ruger, ‘Ethics in American Health 1: Ethical Approaches to Health Policy’ 98(10): 1751-1756. • Gable et al., ‘HIV/AIDS, Reproductive and Sexual Health, and the Law’ 98(10): 1779-1786. • Commentaries: • Gruskin et al., ‘HIV and Pregnancy Intentions: Do Services Adequately Respond to Women's Needs?’ 98(10): 1746-1750.

  31. Research and Practice Formats • Brief Reports • Used to present preliminary findings or those from pilot studies • Bassett et al., Purchasing Behavior and Calorie Information at Fast-Food Chains in New York City, 2007’ 98(8): 1457-1459. • Full length articles • Lutsey et al., ‘Associations of Acculturation and Socioeconomic Status With Subclinical Cardiovascular Disease in the Multi-Ethnic Study of Atherosclerosis’ 98(11): 1963-1970. • Patterson et al., Efficacy of a Brief Behavioral Intervention to Promote Condom Use Among Female Sex Workers in Tijuana and Ciudad Juarez, Mexico’ 98(11): 2051-2057

  32. Crossing the border: going from full length to brief report • Not a downgrade! • But it can be difficult to distill a 3500 report into “800 words in main text, 2 tables/figures, and an abstract of up to 80 words” • Key things to keep in mind: • Introduction: Summarize background so that objectives are appropriately highlighted • Methods: are there prior papers that can be cited? • Results: what are the key findings? • Discussion: what are the most relevant strengths, limitations and implications?

  33. AJPH Awards 2008 Mary Northridge, M.P.H., Ph.D. Editor-in-Chief

  34. Outstanding Author: Martin Meyer Weiss

  35. Outstanding Reviewer: TarynLindhorst

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