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Exploring Sleep and the Hispanic Paradox in Mexico-Born U.S

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Exploring Sleep and the Hispanic Paradox in Mexico-Born U.S EXPLORING SLEEP AND THE HISPANIC PARADOX IN MEXICO-BORN U.S. ADULT IMMIGRANTS by SINZIANA SEICEAN MD, MPH Submitted in partial fulfillment of the requirements For the degree of Doctor of Philosophy Dissertation Adviser: Dr. DUNCAN NEUHAUSER Department of Epidemiology and Biostatistics CASE WESTERN RESERVE UNIVERSITY August, 2010 CASE WESTERN RESERVE UNIVERSITY SCHOOL OF GRADUATE STUDIES We hereby approve the thesis/dissertation of SINZIANA SEICEAN MD, MPH ______________________________________________________ PhD candidate for the ________________________________degree *. DUNCAN NEUHAUSER PhD (signed)______________________________________________ (chair of the committee) ________________________________________________ SUSAN REDLINE MD, MPH ________________________________________________ SIRAN KOROUKIAN-HAJINAZARIAN PhD ________________________________________________ ________________________________________________ ________________________________________________ JULY 1, 2010 (date) _______________________ *We also certify that written approval has been obtained for any proprietary material contained therein. 2 DEDICATION: To all women in my family, beloved role models and sources of inspiration for my moral values and academic career aspirations: my grandmothers Aurora Popescu- Silisteni and Maria Pârlog, my mother Olimpia Pârlog, my aunt Hortensia Pârlog, and my daughter Andreea Ana-Maria Seicean. To my grandfather Gheorghe Pârlog, my uncle George Manole, and my son Dan Nicholas Seicean, always loving and supporting me. To all U.S. immigrants of all times, whose courage and determination for a better life for their families and future generations have served to build America. 3 TABLE OF CONTENTS: Committee Signature……………………………………………………………………...2 Dedication………………………………………………………………………...............3 Table of Contents………………………………………………………………................4 List of Tables……………………………………………………………………...............7 List of Figures……………………………………………………………………………10 Acknowledgements……………………………………………………………………....13 Abstract…………………………………………………………………………………..15 CHAPTER 1……………………………………………………………………………..17 Introduction 1.1 Immigrant Health………………………………………………………………….…18 1.2 Former Theories/Models Used in Immigrant Health Research……………………...19 1.3 Critical Realism Theory in Immigrant Health Research……………………………..21 1.4 WHO? Mexico-born immigrants in the US………………………………………….23 1.5 WHAT? Sleep Health……………………………………………………………….25 1.6 WHY? Sleep in Mexico-born Immigrants………………………………………......26 1.7 Summary………………………………………………………………………..........27 CHAPTER 2……………………………………………………………………...……...29 Conceptual Framework 2.1 Background on Immigrant Health…………………………………………………...30 2.2 Acculturation and Acculturation Theories…………………………………………...31 2.3 The Hispanic Paradox and Explanatory Theories…………………………………....37 2.4 Critical Realism Theory and the Hispanic Paradox………………………………….43 4 2.5 The Open System Conceptual Model of Volunteer (No –asylum, Non-refugee) Immigrant Health ………………………………………………………………………..56 CHAPTER 3…………………………………………………………………………..…74 An Exploration of Differences in Sleep Characteristics between Mexico-born U.S. Immigrants and Other Americans to Address the Hispanic Paradox 3.1 Reviewing the conceptual framework applicability for comparisons between immigrant and non-immigrant populations in U.S………………………………………74 3.2 Introduction…………………………………………………………………………..79 3.3 Methods……………………………………………………………………………....82 3.4 Results………………………………………………………………………………..89 3.5 Discussion…………………………………………………………………………..117 CHAPTER 4………………………………………………………………………...….123 Proportion of Lifetime in Immigration (PLI) and Cohort Analysis in Immigrant Populations: Longitudinal Perspective and Non-linear Relationship with Unsatisfactory Health Status in Mexico-born U.S. Immigrants 4.1. Cohort Analysis and PLI in Immigrant Health Research ………………………...124 4.2 Conceptual Framework and Multi-Theory Approach applicability in Predicting Non-Linear association between self-reported unsatisfactory health status (UHS) and proportion lifetime in U.S. immigration (PLI) in Mexico-born individuals (MI)……………………………………………………....127 4.3 Quantitative Research……………………………………………………………....130 4.3.1 Abstract ………………………………………………………………………..…130 4.3.2 Introduction……………………………………………………………………….131 5 4.3.3 Methods…………………………………………………………………………...132 4.4 Results………………………………………………………………………………138 4.5 Discussion ……………….…………………………………………………………148 CHAPTER 5…………………………………………………………………………....151 Mexico-Born Ethnicity and Insomnia in U.S. Immigrants Adjusting for the Proportion of Lifetime Spent in Immigration in the U.S. 5.1 Abstract……………………………………………………………………………..153 5.2 Introduction………………………………………………………………………....154 5.3 Methods……………………………………………………………………………..156 5.4 Results………………………………………………………………………….…...163 5.5 Discussion…………………………………………………………………………..180 CHAPTER 6....................................................................................................................185 Conclusion Bibliography…………………………………………………………………………....195 Bibliography Ch 1…………………………………………………………….………...195 Bibliography Ch 2……………………………………………………………….……...199 Bibliography Ch 3………………………………………………………………….…...210 Bibliography Ch 4………………………………………………………………….…...217 Bibliography Ch 5…………………………………………………………………........222 Bibliography Ch 6…………………………………………………………………........230 6 LIST OF TABLES Table 2.1 Theories Incorporated into “The Open System of Conceptual Model of Immigrant Health”…………………………………………... ……………………….66 Table 3.1a General Characteristics: Mexico-born immigrants, Mexican–Americans and All U.S. individuals, By Gender………………...……………91 Table 3.1b Sleep Characteristics Mexico-born immigrants, Mexican–Americans and All U.S. individuals, By Gender………………..……………95 Table 3.2 Age adjusted population prevalence of Poor Sleep Outcomes in U.S. Adults 20 years and Older in Mexico-born U.S. Immigrants, U.S.-born Mexican Americans and the General U.S. Population Sample, By Gender…………………...….96 Table 3.3 Multivariate Odds Ratios (OR) with 95% Confidence Intervals (95% CI) of Poor Sleep Outcomes Associated with Mexico-Born status in the Overall U.S. Analytic Sample and By Gender……………………………..……102 Table 3.4 Univariate Odds Ratios (OR) with 95% Confidence Intervals (95% CI) of Poor Sleep Outcomes, By Gender in Mexican-Americans .............….…..104 Table 3.5 Multivariate Odds Ratios (OR) with 95% Confidence Intervals (95% CI) of Poor Sleep Outcomes, By Gender in Mexican-Americans Without* and With**Adjustments for Language Preference at home…………………106 Table 3.6 Step 2 referred as “correlations” in fig 3.2 (significant associations): Univariate Odds Ratio OR (95% CI) between Mexico-born Immigrant Status (X) and Covariates (Y) as potential mediators (Proc survey analyses) ……………………113 7 Table 3.7 Referred as “correlations” in fig 3.2 (significant associations): Regression coefficients, standard error and p value between Mexico-born Immigrant status (X) and continuous Covariates (Y) as potential mediators (Proc survey analyses) ……………………………………………...............................113 Table 3.8 Percent of total effect (%)*of the Mexico-born immigrant status (x) on sleep outcomes (Y on columns) mediated by covariates and ratios of the indirect to the direct effect** (Bivariate analyses to test partial mediation just for qualifying covariates based on step 2 and 3)…………….......114 Table 3.9 Insomnia with short sleeping hours: Example of Assessing Multiple Mediation in Mexican American Men………………………………….……115 Table 4.1 Individual Predictions of the Theories Incorporated into “The Open System of Conceptual Model of Immigrant Health”……………………... 129 Table 4.2 General Characteristics of the Mexico-born Immigrant cohort……..………139 Table 4.3 Correlations between Individual and Immigration related Participant Characteristics of Mexico-Born immigrants……………………………………………141 Table 4.4 Univariate Odds Ratios (OR) with 95% Confidence Intervals (95% CI) of Unsatisfactory Health Status (UHS) in Mexico-Born U.S. Immigrants (MI)……………………………………………………………………..…146 Table 4.5 Multivariate Odds Ratios (OR) with 95% Confidence Intervals (95% CI) of Unsatisfactory Health Status (UHS) in Mexico-born U.S. Immigrants (MI)…………………………………………………………………...……147 Table 5.1a General Characteristics Mexico-born U.S. Immigrants, Other Latino U.S. Immigrants and Non-Latino U.S. Immigrants, By Gender...………166 8 Table 5.1b Insomnia and other Sleep Characteristics Mexico-born U.S. Immigrants, Other Latino U.S. Immigrants and Non-Latino U.S. Immigrants, By Gender…………………………………………………………………167 Table 5.2 Age adjusted population prevalence of Poor Sleep Outcomes in U.S. Adults 20 years and Older in Mexico-born U.S. Immigrants, Other Latino U.S. Immigrants and Non-Latino U.S. Immigrants, By Gender……...…173 Table 5.3 Univariate and Multivariate Odds Ratios (OR) with 95% Confidence Intervals (95% CI) of Severe Insomnia in U.S. immigrants…………………………....178 9 LIST OF FIGURES Figure 2.1 Conceptual Model……………………………………………………………64 Figure 2.2 Independent variables used in chapters 3-5……………………………….....67 Figure 2.3 Dependent variables used in chapters 3-5………………………………...…68 Figure 2.4 Covariates (2) used in this research at least in sensitivity analyses…………69 Figure 2.5 Covariates used in this research……………………………………………...70 Figure 2.6 Other covariates (1)………………………………………………………….71 Figure 2.7 Other covariates (2)……………………………………………………….…72 Fig 3.1 Mediation steps used to verify mediation (Baron and Kenny, 1986) ………..….77 Fig 3.2 Applying theories of probability, statistics, and error to the portion of the Open System conceptual model used
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