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The Latina Love Project profiles the lives of women — mothers, daughters, sisters — who often sacrifice their self-care in their struggle to balance and care for family, friends, and work. In this series sponsored by Fordwe spotlight their struggles and triumphs and learn how they create time for their themselves. Self-care has become a phenomenon among millennials who seek to position their time and health above the pressures of everyday life — dating, personal relationships, working, social media and more. A quick search for selfcare on Instagram pulls up more than 4 million that feature guys and girls working out, practicing yoga, soaking in aromatherapy baths and meditating. Loba, who eschews the use of pronouns, argues that for women and queers of color self-care is a method of survival.
We examined social ecological predictors of health care utilization among Latina young adults during their initial year after immigration to the United States. We used multiple logistic regression to test predictors of health care usage. Dimensions of marianismo differentially associated with usage.
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Usage also was more likely for participants who reported more social network attachment, better health, greater neighborhood cohesion, and possessed a job and health insurance. Findings inform interventions to increase health care usage globally among women after immigration.
Recent increased migration rates around much of the world resulted in immigration policies by numerous governments to inhibit migration, including limiting access to health care for immigrants [e. Insufficient health care can put migrants at great risk. Thus, in the present study, we investigated social and cultural determinants of health care usage among young Latina women ages 18—23 who had immigrated to the US in — These obstacles are especially problematic for Latina young adults in the US given that medical practitioners recommend that Latina young women receive regular cancer screening due to the disproportionately high prevalence rates in the US Bickell, ; Nodora et al.
Understanding potential determinants of health care soon after immigration to the US among young women may foster an evidence base for early interventions targeting health disparities affecting Latina young adults as well as similar immigrant populations internationally. Proximal factors are direct, reciprocal interactions between individuals and environmental contexts, whereas distal factors include constructs which affect an individual indirectly via her context.
The four hypothesized proximal factors were a endorsement of marianismo i.
Alternatively, marianismo also may inhibit health care utilization. Furthermore, endorsement of the marianismo belief that Latinas should be spiritual leaders of the family may hinder use of conventional health care because more endorsement of spirituality is positively linked with use of alternative treatments for physical ailments among Latinas in the US e. Marianismo also encourages Latina women to make sacrifices and endure suffering for the family.
Overall, we expected that higher endorsement of the different dimensions of marianismo would differentially associate with use of health care during initial months in the US. Similar to marianismo, commitment to Latina ethnic identity may affect health care usage.
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Older Latinas in the US who indicated a greater sense of belonging to their ethnic group i. A greater sense of ethnic identity is posited to cause less interaction with individuals from the receiving country i. Latina women in the US and in Latin American countries with a greater sense of ethnic identity also may not prioritize their health if doing so would conflict with the aforementioned marianismo and other collectivistic values e. Therefore, we expected that higher commitment to Latina ethnic identity would be inversely associated with use of health care during initial months in the US.
An influential proximal system in the lives of Latina immigrants in the US and other nations may be their attachment to their social network.
This may be due, in part, to social networks providing information about health care services and encouraging loved ones to be healthy. Social networks may be the sole resource for information about health screenings or instrumental support that may promote use of care e. However, recent Latina immigrants may experience separation from social supports during immigration to the US or other countries Ayala et al.
Thus, we expected that weaker social network attachment bonds would be linked with less use of care in the present sample.
Negative health status relates to greater utilization of health care among US Latinos Garcini et al. However, Latina immigrants living in the US for decades report difficulty accessing care even when they have serious health problems Shelton et al.
For example, having a negative health status relates with economic difficulties, which may prevent utilization of expensive health care in the US Shelton et al. Thus, we ed for perceived health status as a proximal determinant in the present sample. These enclaves may foster neighborhood collective efficacy, defined as social cohesion and willingness to intervene on behalf of others in a community Sampson et al.
Individuals living in more cohesive, safe neighborhoods are more likely to obtain preventative health care because safe neighborhoods allow for walking to appointments or neighbors who may offer referrals and transportation Prentice, ; Shelton et al. Based on these benefits, we expected collective efficacy to positively associate with use of health care among Latina young adult immigrants during initial year in US. Health insurance status and SES also are expected to be positively linked with health care usage in the present study.
Immigrants in the US tend to report lower income and educational levels in comparison to US-born Latinas Marshall et al. Thus, we expected certain distal factors i. The institutional review board of a large southeastern university in the US approved the study. Participants met eligibility criteria if they identified as a Latina woman, aged 18—23 years old, and immigrated to the US from a Latin American country within 36 months of recruitment. RDS involves asking each participant or seed to recruit three other women in her social network who meet study inclusionary criteria.
This procedure is repeated up to five times, at which point a new seed begins to avoid skewing the respondent sample. Seed participants were recruited through advertisements at various community-based agencies e. Consent procedures and all survey interviews were in Spanish by four Latina research assistants. Assessors conducted interviews at a safe location chosen by participants or in university offices.
Participants resided in the US for an average of This item enabled us to measure whether participants had been to a health care appointment for necessary or preventative care, as suggested by the CDC i. The MBS measured the extent to which participants endorsed five dimensions of traditional gender role beliefs about Latina women. The measure asked participants to rate their feelings about and affiliation with their ethnic group on a scale ranging from 1 Strongly Disagree to 5 Strongly Agree. Participants were asked to assess their level of trust and communication in current relationships with their mothers, fathers, partners, and friends.
Latina young adults’ use of health care during initial months in the united states
More specifically, they were asked to assess the accuracy of 25 questions for each of the four types of relationships i. Items from the trust and communication subscales for each relationship were averaged to arrive at a total attachment with social network score.
The mean of the responses for each of the four types of social network members reflected a total score for separation. A higher score indicated better perceived health status. A total score was calculated by averaging CES items. Higher scores indicated more perceived community solidarity. Perceived SES of family of origin was utilized in the present study as opposed to other measures, such as current income, because participants were living in the US for less than a year on average and lacked variability in income. The analytic plan consisted of three major steps.
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First, correlation coefficients between all study variables were calculated to assess evidence of discriminant validity and multicollinearity. The scales were combined by calculating an average of the two scale scores for each participant.
Third, the hypothesized proximal and distal predictor variables were entered into a multiple logistic regression analysis ing for hypothesized potential social and cultural determinants of health care usage. Descriptive statistics and correlations are presented in Table 1. Only of regression analysis are presented in Table 2. We found that Latina young women differed in their utilization of health care depending on their endorsement of marianismo.
Participants used health care services approximately three times more often when they more strongly endorsed the belief that women should be a source of strength in the family. Our findings concerning separation with social network are consistent with findings that companionship provided by close friends and family contributes to health e.
Functional support e. Unexpectedly, healthier participants were more likely to utilize care.
Health status tends to inversely predict health care among US-born Latinos and immigrants residing in the US for decades Garcini et al. Less healthy participants may not use care due to the barriers to accessing health care in the US that are described in our study and others e.
Alternatively, those who accessed care may perceive themselves as healthier because they received health services. Women who reported more collective efficacy were more likely to utilize health care. Employment and health insurance were overlapping distal factors related to utilization of care.
In the US health care system, employment may provide access to insurance that makes health care more affordable Marshall et al.
For instance, even authorized immigrants are currently ineligible for some forms of government assistance Medicaid within their first five years of legal residence and often have difficulty paying for or obtaining health insurance Raymond-Flesch et al. The strengths of this study include the size of the sample and the recent immigration of participants.
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However, study limitations should be noted. Second, health care usage was operationalized using a dichotomous measure and a cross-sectional de. Future studies need to elucidate type and frequency of care accessed over time via longitudinal des. Findings provide a multitude of potential determinants of health care usage among an underserved population in the US. On an international level, medical practitioners and researchers are encouraged to attend to traditional cultural gender role beliefs that may influence access to health care resources.
Additionally, findings support the development of structural interventions to increase social network attachment and neighborhood collective efficacy in the US and other nations e. For example, interventions could promote health benefits of neighborhood collective efficacy by developing capacity-building partnerships that foster civic activities for greater sense of cohesive community and concern and support for community members e.
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Structural interventions also could educate community agencies [e. We recommend future interventions to facilitate utilization of health care by young adult women with perceived negative health status during their initial time in receiving countries globally. These women may be most in jeopardy of developing the health disparities affecting this population. We also suggest potential novel skill building areas e. Such initiatives are critical, as they may promote the health of the largest and growing in the US as well as promote the health of similar immigrant populations of women in other countries.