Hispanic paradox: Difference between revisions

The '''Hispanic paradox''' is an [[Epidemiology|epidemiological]] finding that [[Hispanic Americans]] tend to have health outcomes that "[[paradox]]ically" are comparable to, or in some cases better than, those of their U.S. [[Non-Hispanic whites|non-Hispanic White]] counterparts, even though Hispanics have lower average income and education. Low [[Socioeconomic status|socioeconomic]] status is almost universally associated with worse population health and higher death rates everywhere in the world.<ref name=":0">{{cite journal |vauthors=Franzini L, Ribble JC, Keddie AM |title=Understanding the Hispanic paradox |journal=Ethn Dis |volume=11 |issue=3 |pages=496–518 |year=2001 |pmid=11572416}}</ref> The paradox usually refers in particular to low mortality among Hispanics in the [[United States]] relative to non-Hispanic Whites.<ref name="Abraido-Lanza, A. 1999">{{cite journal |doi=10.2105/AJPH.89.10.1543 |title=The Latino mortality paradox: A test of the "salmon bias" and healthy migrant hypotheses |year=1999 |last1=Abraído-Lanza |first1=Ana F |last2=Dohrenwend |first2=Bruce P |last3=Ng-Mak |first3=Daisy S |last4=Turner |first4=J Blake |journal=American Journal of Public Health |volume=89 |issue=10 |pages=1543–8 |pmid=10511837 |pmc=1508801}}</ref><ref name=":1">{{Cite journal|last1=Gallo|first1=Linda C.|last2=Penedo|first2=Frank J.|last3=Espinosa de los Monteros|first3=Karla|last4=Arguelles|first4=William|date=December 2009|title=Resiliency in the Face of Disadvantage: Do Hispanic Cultural Characteristics Protect Health Outcomes?|journal=Journal of Personality|volume=77|issue=6|pages=1707–1746|doi=10.1111/j.1467-6494.2009.00598.x|pmid=19796063|s2cid=21729536 |issn=0022-3506}}</ref><ref name=":7">{{Cite journal|last1=Abraído-Lanza|first1=Ana F.|last2=Chao|first2=Maria T.|last3=Flórez|first3=Karen R.|date=September 2005|title=Do healthy behaviors decline with greater acculturation?: Implications for the Latino mortality paradox|journal=Social Science & Medicine|volume=61|issue=6|pages=1243–1255|doi=10.1016/j.socscimed.2005.01.016|pmid=15970234|pmc=3587355|issn=0277-9536}}</ref><ref name=":2">{{Cite journal|last1=Abraído-Lanza|first1=A F|last2=Dohrenwend|first2=B P|last3=Ng-Mak|first3=D S|last4=Turner|first4=J B|date=October 1999|title=The Latino mortality paradox: a test of the "salmon bias" and healthy migrant hypotheses.|journal=American Journal of Public Health|volume=89|issue=10|pages=1543–1548|doi=10.2105/ajph.89.10.1543|pmid=10511837|pmc=1508801|issn=0090-0036}}</ref><ref name=":5">{{Cite journal|last1=Cagney|first1=Kathleen A.|last2=Browning|first2=Christopher R.|last3=Wallace|first3=Danielle M.|date=May 2007|title=The Latino Paradox in Neighborhood Context: The Case of Asthma and Other Respiratory Conditions|journal=American Journal of Public Health|volume=97|issue=5|pages=919–925|doi=10.2105/ajph.2005.071472|pmid=17395846|pmc=1854858|issn=0090-0036}}</ref><ref name=":3">{{Cite journal|last1=Ruiz|first1=John M.|last2=Campos|first2=Belinda|last3=Garcia|first3=James J.|date=May 2016|title=Special issue on Latino physical health: Disparities, paradoxes, and future directions.|journal=Journal of Latina/o Psychology|volume=4|issue=2|pages=61–66|doi=10.1037/lat0000065|issn=2163-0070}}</ref> According to the Center for Disease Control's 2015 ''Vital Signs'' report, Hispanics in the United States had a 24% lower risk of mortality, as well as lower risk for nine of the fifteen leading causes of death as compared to Whites.<ref>{{Cite journal|last=The Lancet|date=May 2015|title=The Hispanic paradox|journal=The Lancet|volume=385|issue=9981|pages=1918|doi=10.1016/s0140-6736(15)60945-x|pmid=26090624|issn=0140-6736|doi-access=free}}</ref>▼

Other hypotheses around the Hispanic paradox maintain that the phenomenon is real, and is caused by sociocultural factors which characterize the Hispanic population. Many of these factors can be described under the more broad categories of cultural values, interpersonal context, and community context.<ref name=":6">{{Cite journal|last1=Abraído-Lanza|first1=Ana F.|last2=Echeverría|first2=Sandra E.|last3=Flórez|first3=Karen R.|date=2016-03-18|title=Latino Immigrants, Acculturation, and Health: Promising New Directions in Research|journal=Annual Review of Public Health|volume=37|issue=1|pages=219–236|doi=10.1146/annurev-publhealth-032315-021545|pmid=26735431|pmc=5337110|issn=0163-7525}}</ref> Some health researchers attribute the Hispanic paradox to different eating habits, especially the relatively high intake of [[legumes]] such as beans and lentils.<ref>{{Cite journal|pmid = 25445942|year = 2014|last1 = Young|first1 = R. P.|last2 = Hopkins|first2 = R. J.|title = A review of the Hispanic paradox: Time to spill the beans?|journal = European Respiratory Review |volume = 23|issue = 134|pages = 439–449|doi = 10.1183/09059180.00000814| pmc=9487402 |s2cid = 6843365|doi-access = free}}</ref>▼

== Reasons for the paradox ==▼

=== Socio-economic factors ===▼

According to Alder and Estrove (2006), the more socioeconomically advantaged individuals are, the better their health.<ref>{{cite journal |doi=10.1111/j.1749-6632.1999.tb08101.x |title=Socioeconomic Status and Health: What We Know and What We Don't |year=1999 |last1=Adler |first1=Nancy E. |last2=Ostrove |first2=Joan M. |journal=Annals of the New York Academy of Sciences |volume=896 |issue=1 |pages=3–15 |pmid=10681884|bibcode=1999NYASA.896....3A |s2cid=41676972 }}</ref> Access to health insurance and preventative medical services are one of the main reasons for socioeconomic health disparities. Economic hardship within the household can cause distress and affect parenting, causing health problems among children leading to depression, substance abuse, and behavior problems. Low socioeconomic status is correlated with increased rates of morbidity and mortality. Mental health disorders are an important health problem for those of low socioeconomic status; they are two to five times more likely to develop a diagnosable disorder than those of high socioeconomic status, and are more likely to face barriers to getting treatment. Furthermore, this lack of treatment for mental disorders can affect educational and employment opportunities and achievement.<ref>{{cite web |url=http://www.apa.org/about/gr/issues/socioeconomic/ses-health.pdf |archive-url=https://web.archive.org/web/20121021040636/http://www.apa.org/about/gr/issues/socioeconomic/ses-health.pdf |archive-date=October 21, 2012 |title=Socioeconomic Status and Health |publisher=APA Public Interest Government Relations Office}}</ref>▼

Important to the understanding of migrant community health is the increasingly stratified American society, manifested in [[residential segregation]]. Beginning in the 1970s, the low to moderate levels of income segregation in the United States began to degrade.<ref name="Massey, Douglas S 2004">{{cite book |last1=Massey |first1=Douglas S. |chapter=The New Geography of Inequality in Urban America |chapter-url=https://books.google.com/books?id=_DmN-Zq-WPIC&pg=PA173 |pages=173–87 |year=2004 |editor1-first=C. Michael |editor1-last=Henry |title=Race, Poverty, and Domestic Policy |location=New Haven |publisher=Yale University Press |isbn=978-0-300-12984-7}}</ref> As the rich became richer, so did their neighborhoods. This trend was inversely reflected in the poor, as their neighborhoods became poorer. As sociologist Douglas Massey explains, "As a result, poverty and affluence both became more concentrated geographically."<ref name="Massey, Douglas S 2004"/> Professor of public administration and economics John Yinger writes that "one way for poor people to win the spatial competition for housing is to rent small or low-quality housing." However, he continues, low-quality housing often features serious health risks such as lead paint and animal pests. Though lead-based paint was deemed illegal in 1978, it remains on the walls of older apartments and houses, posing a serious neurological risk to children. [[Asthma]], a possible serious health risk, also has a clear link to poverty. Moreover, asthma attacks have been associated with certain aspects of poor housing quality such as the presence of cockroaches, mice, dust, dust mites, mold, and mildew. The 1997 [[American Housing Survey]] found that signs of rats or mice are almost twice as likely to be detected in poor households as in non-poor households.<ref name=Yinger2009>{{cite book |last1=Yinger |first1=John |chapter=Housing Discrimination and Residential Segregation as Causes of Poverty |chapter-url=https://books.google.com/books?id=vuy6JGuLdi0C&pg=PA359 |pages=[https://archive.org/details/understandingpov0000unse/page/359 359–91] |editor1-first=Sheldon H. |editor1-last=Danziger |editor2-first=Robert H. |editor2-last=Haveman |year=2009 |title=Understanding Poverty |publisher=Harvard University Press |isbn=978-0-674-03017-6 |url=https://archive.org/details/understandingpov0000unse/page/359 }}</ref>▼

Speculation of a sociocultural advantage stems from the idea that many traditional Hispanic cultural values are protective in health.<ref name=":3" /> One such value is that of ''simpatia'', a drive toward social harmony, which may serve to ameliorate social conflict and the negative stress-related health implications that come with it.<ref name=":1" /> ''Familismo'' (family-centeredness) and ''allocentrismo'' (valuing the group) are both values which emphasize the needs of the group in accordance to those of the individual.<ref name=":1" /> ''Respeto'' is another familial value in which family members are largely invested in care of their elders.<ref name=":3" /> Emphasis on family attachment in the [[Latino culture]] is believed to foster social cohesion and a sturdy social support network, which is protective of health during adverse circumstances.<ref name=":1" /><ref name=":3" /> Furthermore, familial support has been associated with higher likelihood of taking preventative health measures and of seeking medical attention when ill.<ref name=":1" /> Overall psychological and physical well-being has been found to be better in individuals who come from a supportive family than those who experience family conflict, which is why the family-centered culture of Hispanics may be advantageous in health.<ref name=":1" />▼

=== Interpersonal context ===▼

==== Social comparison theory ====▼

[[Social comparison theory]] proposes that individuals make comparisons with others, most often those of a similar group, in order to evaluate their own well-being and worth.<ref name=":4">{{Cite journal|last1=Campbell|first1=Kelly|last2=Garcia|first2=Donna M.|last3=Granillo|first3=Christina V.|last4=Chavez|first4=David V.|s2cid=56298042|date=2012-04-30|title=Exploring the Latino Paradox|journal=Hispanic Journal of Behavioral Sciences|volume=34|issue=2|pages=187–207|doi=10.1177/0739986312437552|issn=0739-9863}}</ref> The psychological implications that these comparisons present depend on the nature of the comparisons. Upward comparisons often result in negative psychological effects due to feelings of disadvantage when being compared to those higher in the hierarchy. Conversely, lateral and downward comparisons often result in satisfaction when one sees himself as better off than those lower in the hierarchy.<ref name=":4" /> Latino Americans and noncitizen Latinos are expected to make lateral or downward comparisons, either to other low-economic status Latinos and/or to relatives and friends in their home country. Such downward comparisons would result in boosted self-esteem and less psychological stress, resulting in better health.<ref name=":4" />▼

==== Social networks and support ====▼

Social capital is thought to be a significant moderator in the advantageous health outcomes of Latinos.<ref name=":1" /><ref name=":3" /> It has been found that the magnitude of the effect of social integration on mortality is greater than smoking fifteen cigarettes a day.<ref name=":3" /> Characteristic values of Latino culture such as ''familismo'' and ''allocentrismo'' contribute to greater social cohesion and social support networks.<ref name=":1" /> This tight social fabric is a mechanism which fosters resilience through social support.<ref name=":3" /> Resilience is the ability to adapt to a disadvantageous experience and high resilience is protective in health.<ref>{{Citation|last1=Smith|first1=Matthew Lee|title=Successful Aging and Resilience: Applications for Public Health, Health Care, and Policy|date=2018|work=Resilience in Aging|pages=17–33|publisher=Springer International Publishing|isbn=9783030045548|last2=Bergeron|first2=Caroline D.|last3=McCord|first3=Carly E.|last4=Hochhalter|first4=Angela K.|last5=Ory|first5=Marcia G.|doi=10.1007/978-3-030-04555-5_2}}</ref>▼

== Hypotheses ==▼