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MentalHealthDisparitiesAmongLow-IncomeUSHispanicResidentsofaUS-MexicoBorderColoniaGuadalupeMarquez-Velarde&SaraGrineski&KathleenStaudtReceived:14September2014/Revised:21January2015/Accepted:16February2015/Publishedonline:12March2015#W.
MontagueCobb-NMAHealthInstitute2015AbstractUnregulatedresidentialsettlementsalongtheUSsideoftheUS-Mexicoborder,oftencalled"colonias",aremainlypopulatedbylow-incomeMexican-originHispanics.
Coloniaresidentsfacenumeroussocial,environmental,eco-nomicandpublichealthchallenges.
Despitethis,thementalhealthofindividualslivingincoloniashasremainedlargelyunderstudied.
Drawingfromasurvey(N=98)conductedthroughacommunity-basedparticipatoryresearchprojectinonecoloniasufferingfromnumerousenvironmentalandsocialchallenges,thisstudyanalyzesresidents'mentalhealthout-comesandaccesstomentalhealthcarewithafocusonintra-ethnicdisparitiesbasedonenvironmentalconcerns,nativity,languageacculturation,comorbidity,gender,healthinsurance,andstressfullifeevents.
Datawereanalyzedusingdescriptivestatistics,correlation,andregression.
Morethanonethirdoftheresidentshavebeendiagnosedwithamentalhealthcondi-tionandoverhalfreportedstressandexcessworry.
Intermsofmentalhealthcare,77%ofindividualsdiagnosedwithamen-talhealthproblemhavesoughtadditionalhelpmainlythroughaprimarycareproviderdespitethehighlevelsofuninsuredindividuals.
Comorbidity,beingfemale,recentnegativelifeevents,andhighlevelsofenvironmentalconcernsweresignif-icantpredictorsofnegativementalhealthoutcomes.
Thisstudycontributestotheunderstandingofthecomplexhealthdynam-icsoftheUSHispanicpopulation.
Italsohighlightstheneedforadditionalresearchandresourcesdevotedtothementalhealthoflow-incomeminoritiesinisolatedcommunities.
KeywordsMentalhealth.
Colonia.
Hispanic.
Environmentalconcerns.
Mentalhealthcare.
US-MexicoborderIntroductionColoniasareunincorporatedandunregulatedperi-urbanset-tlementsalongtheUnitedStates-MexicoborderthatarehometoprimarilyMexican-originpopulations[1].
Coloniaresi-dentsfaceuniquehealthchallengesduetopoverty,lackofaccesstohealthcare,inadequateinfrastructure,andenviron-mentalthreats.
Thephysicalhealthofcoloniaresidentshasbeenpreviouslyexaminedandresearchershavedocumentedsignificantpublichealthchallenges[2–4].
Inspiteofthis,thementalhealthofcoloniaresidentsremainslargelyunderstudied.
Westway,thesiteofthisstudyofmentalhealth,isacolonia1inElPasoCounty(Texas).
Inthiscountyin2010,86,472residentslivedin321communitiesdefinedascolonias[5].
Westwayishometoabout4000oftheseindividuals.
Thepopulationis97%Hispanicand45.
5%areforeign-born,andofthoseforeign-bornresidents,only22.
2%arenaturalizedUScitizens[6].
WestwayislocatednexttoInterstate10,acrosstheArcelorMittalVintonsteelplantandproximatetootherpollutingindustriessuchasascrapmetalrecyclingplant.
InWestway,asinothercoloniaenvironments,aconflu-enceofchallengingsocio-environmentalconditionscontrib-utestoadifficultqualityoflifeforresidentsand,asaconse-quence,thepotentialforhighratesofmentalhealthissuesandbarriersincopingwiththem.
Assuch,wehavetwoobjectives:(1)characterizeWestwayresidents'ratesofmentalhealthout-comesandaccesstomentalhealthcareand(2)assessintra-ethnicdisparities(i.
e.
,basedonlevelofenvironmentalcon-cerns,nativity,languageacculturation,comorbidities,gender,healthinsurance,andstressfullifeevents)inmentalhealthoutcomeswithinthisimpoverished,Hispanicpopulation.
1Officially,Westwayisacollectionofsevencolonias(Westway1–Westway7;seehttp://www.
sos.
state.
tx.
us/border/colonias/reg-colonias/elpaso-6.
shtml),althoughresidentstreatitasonecontiguouscommunity.
G.
Marquez-Velarde(*):S.
Grineski:K.
StaudtTexasA&MUniversity,CollegeStation,TX,USAe-mail:gmarquez6@tamu.
eduJ.
RacialandEthnicHealthDisparities(2015)2:445–456DOI10.
1007/s40615-015-0091-1HealthandEnvironmentalConcernsinColoniasColoniastendtolackbasiccommunityinfrastructuresuchaspavedroads,sewersystem,electricity,gas,cleanwater,andhealthcareservices[1,3,7].
Thelackofinfrastructureandpovertycombinestofosterthespreadofdiseasessuchashepatitis,dysentery,andtuberculosis[1].
Povertyalsoleadstofoodinsecurityandpoornutritionalhealth,whichcancauseobesityanddiabetes,whicharecommonalongtheUS-Mexicoborder[8].
Chronicillnesses,suchasdiabetesandasthma,arealsoprevalentincolonias[3].
Unsafeenvironmentalconditions(e.
g.
,presenceofjunkyards)havebeenlinkedwithphysicalillnessincolonias.
Underdevelopmentandthepresenceofemptylotssometimesleadsbothcoloniaresidentsandotherstodisposeofhouse-holdandindustrialwastesintheneighborhoods,creatingphysicalhealthrisks[9].
Ramosetal.
[3]foundthatresidentslivingclosertojunkyardsordrycleanersintheCameronParkcoloniaineastTexashadsignificantlyhigherriskofdevelop-ingarespiratoryillnessthanthoselivingfartheraway.
Intermsofmentalhealth,thefocusofthispaper,Andersetal.
[4]foundhighratesofmentalillnessinanElPasoCountycolonia(notWestway);20%ofadultshadbeendiag-nosedwithdepressionand17%hadbeendiagnosedwithanxiety.
Itmayalsobethattheenvironmentalconditionsincoloniasarecorrelatedwithchronicstressandpsychologicaldistress,whichcanpermeatethephysicalandpsychologicalwell-beingofindividuals[10].
DowneyandVanWilligen[11]arguedthatenvironmentalstressors(aschronicstresssources)canhavelong-lastingeffectsonthepsychologicalwell-beingofresidentslivinginindustrializedareas.
Whilenotstudyingcolonias,DowneyandVanWilligen[11]foundthatIllinoisresidentslivingnearindustrialactivityreportedhigherdepres-sivesymptomatology,agreatersenseofdisorder,andmorefeelingsofpowerlessnessthanthosenotlivingclosetoindus-trialfacilities.
Similarfindingsrelatingenvironmentalcon-cernstomentaldisorderswerefoundinnational-leveldatasetsinSpain[12]andPortugal[13].
MentalHealthandAccesstoCareforHispanicsGiventhatcoloniaresidentsareMexican-originHispanics,itisrelevanttothisstudythatHispanicshavelowerratesofmentaldisordersthannon-Hispanicwhites[14].
WithintheHispanicpopulation,therearedisparitiesinmentalhealthout-comes,basedonthreeimportantcharacteristics:nativity,lan-guageacculturation,andchronicphysicalillness.
Intermsofnativity,immigrantstendtohavelowerratesofmentaldisor-dersthantheirUS-borncounterparts[15,16].
Hispanicsthathaveacculturatedtowhitemiddle-classnormsaremorepronetodevelopmentalhealthdisorders.
Forexample,English-speakingHispanicshavehigherratesofmentaldisorders[17]thanHispanicswhoarepredominantlySpanishspeaking.
Thosesufferingfromchronicphysicalillnesses(e.
g.
,diabetes)aremorelikelytodevelopamentalhealthcondition[17].
ThisfactisconcerninginHispanicpopulationsbecausetheyshowanearlyonsetandahighriskofdevelopingconditionssuchasdiabetes,kidneydisease,andhypertension[18]whichoftenco-occurwithdepression[19].
EventhoughHispanicshavelowerratesofmentalillness,theUSDepartmentofHealthandHumanServiceshasiden-tifiedcriticalmentalhealthdisparitiesthatapplytoHispanics,whichincludereducedaccesstomentalhealthservices,de-creasedlikelihoodtoreceiveneededservices,andpoorqualitytreatment[20].
Intermsofreducedaccesstoneededservices,foreign-born,primarilySpanishspeaking,recentimmigrant,firstgeneration,anduninsuredHispanicsshowedthelowestratesofaccesstomentalhealthservices[21].
HispanicswhodidnotspeakEnglishreceivedneededmentalhealthservicesatlowerratesthanproficientEnglishspeakers[22].
Mexican-originpeoplewithmentalhealthchallengeshaveverylowutilizationratesformentalhealthservicesevenwhencom-paredtootherHispanicsubgroups,likePuertoRicans[21].
ThelackofaccesstoqualitycareexperiencedbyHispanicsmakesthemmorepronetochronicityandhigherlevelsofimpairmentduetomentalillness[18].
PoorqualityofcareisreflectedinthefactthatHispanicsandotherminorities'mainsourceofmentalhealthcareisprimarycarephysiciansratherthanspecialistssuchaspsychiatrists[22].
OtherInfluencesonMentalHealthThereareotherinfluencesonmentalhealthbesidestheHispanicethnicfeaturesandindustrialconcernspreviouslydiscussed.
Theseincludegender,lackofhealthinsurance,andstressfullifeevents.
Intermsofgender,womenhavehigherratesthanmenofmajordepressivedisorder,anxietydisorders,posttraumaticstressdisorder,andeatingdisordersintheUnitedStates[23].
Lackofinsurancecoverageisanimportantbarrierwheninneedofmentalhealthservices,anditmightcauseadefermentoftreatment.
Finally,stressfullifeevents(e.
g.
,lossoflovedone)areassociatedwithpoormentalhealthbecausetheseeventscan"leadtostressbyadverselyalteringthemeaningofpersistentlifestrains"[24].
MaterialsandMethodsStudyAreaWestway(seeFig.
1)ishometoalow-incomepopulation:49.
2%livebelowthepovertyline,15.
4%haveanincomeoflessthan$10,000peryear,and35%receivedpublicassis-tanceduringthelast12months.
Only55.
4%ofWestwayresidentsareinthelaborforce,mainlyinserviceoccupations,sales,construction,maintenance,andtransportation[6].
446J.
RacialandEthnicHealthDisparities(2015)2:445–456Ninety-eightpercentofresidentsareHispanicandonly9.
4%reportspeakingonlyEnglishathome.
Over64.
3%ofSpanishspeakersspeakEnglishlessthanverywell[6].
Foradditionaldemographicinformation,seeTable1.
Westwayresidentsareexposedtonumerousenvironmentalhazards.
JustacrossInterstate10isthesteelplant,whichwasbuiltin1962andemitszinc,lead,andmanganeseintotheair[25].
Assuch,theelementaryschoollocatedinWestwaywasrankedinthesecondpercentilenationallyintermsofbadairqualityina2009report[26].
Strongseasonalwindsintheareaprovokeduststormsthatspreaddustfromunpavedroadsandlotsandcontaminantsfromindustry.
Residents'concernsabouttheenvironmentledthemtorequestthatateamofuniversityresearchersconductahealthscreeningsurveyintheircommunity[27];thispaperreportssomeoftheresultsfromthateffort.
DataCollectionandParticipantsThefirstauthorandanassistantcollectedthedatathroughdoor-to-doorsurveyingbetweenMarchandAugust2012.
Everyninthhousehold(outofthe1120lotunitsinWestway)wasaskedtoparticipate.
Iftheresidentswerenothome,theneighborsontheleftsidewereaskedtoparticipate.
Wemadecontactwithanadultover18at127households;23declinedandonewithdrewforan81%responserate(n=103).
Fortheanalysis,weexcludedtheonenon-Hispanicrespon-dentandfourrelativelyaffluentrespondents(i.
e.
,thoseearn-ingmorethanthecountypercapitaaverageforincome2)forafinalNof98low-incomerespondents.
Thesurvey,translatedbythefirstauthorandanassistant,bothofwhomarenativespeakersofSpanish,wasofferedinEnglishandSpanish.
Thesurveywasdesignedbytheresearchteamthroughacommunity-basedresearchprocessledbythethirdauthor.
Communityleaderswereinvolvedintheresearchprocessincludingmakingrevisionsandadditionstothequestionnaire.
ThisstudywasapprovedbytheInstitutionalReviewBoardattheauthors'homeinstitution.
MeasuresandAnalysisThefirstresearchobjectiveinvolvesdescriptivestatisticsforasuiteofmentalhealthvariablesandaccesstocarevariables.
Thementalhealthoutcomesincludethreesetsofvariables:diagnosesofspecificconditions,psychologicalsymptoms[28],andphysicalsymptoms[29].
WeutilizedaphysicalsymptomatologyscalebecauseHispanicsmighttendtoreportphysicalsymptomsinlieuofdepression,anxiety,and/orstress[14].
Table2showsallvariablesusedinthefirstresearchobjective,alongwithinformationaboutthesurveyquestions,coding,anddescriptivestatistics.
Thesecondresearchobjectiveinvolvescorrelationandre-gressionanalyses.
Table3reportsdescriptivestatisticsanddetailsforhowtheindependentvariables(i.
e.
,industrialcon-cerns,nativity,languageacculturation,comorbidities,gender,healthinsurance,andstressfullifeevents)wereconstructed.
Weused"industrialconcerns"asourmeasureofenvironmen-talconcerngiventhemanyindustrialsourcesofpollutioninFig.
1Westway,TexasTable1DemographiccharacteristicsofsurveyedWestwayresidents(N=98)VariableDescriptiveinformationAgeMin18Max80Mean47GenderFemale57%Male43%YearsofeducationMin0Max18Mean10OccupationProfessional5%Manufacturing3%Service60%Transportation3%Construction4%Retired13%Homemaking12%TimelivinginWestwayMin1monthMax52yearsMean18yearsNumberofindividualsinthehouseholdMin1Max10Mean3.
82Asapointofreference,theWestwaypercapitameaninoursamplewas$6255,thecountymeanwas$18,086,andtheUSmeanis$28,051(ACS,2008–2012).
J.
RacialandEthnicHealthDisparities(2015)2:445–456447Table2Descriptivestatisticsformentalhealthandaccesstocarevariablesforlow-incomeHispanicWestwayresidentsVariableSurveyquestionsCodingMinMaxMeanSDMentalhealthvariables(N=98)DepressionHaveyoueverbeendiagnosedwithdepression0=No1=Yes010.
290.
454AnxietyHaveyoueverbeendiagnosedwithanxiety0=No1=Yes010.
250.
434OtherdiagnosisHaveyouexperiencedanyothermentalcondition0=No1=Yes010.
050.
221SuicideHaveyouattemptedsuicide0=No1=Yes010.
040.
199StressHaveyouexperiencedstress0=No1=Yes010.
560.
499WorryHaveyouexperiencedexcessworry0=No1=Yes010.
390.
490NervousnessHaveyoubeennervousinthepast4weeks1=Noneofthetime;2=littleofthetime;3=someofthetime;4=mostofthetime;5=allthetime152.
081.
090DepressedHaveyoufeltdepressedinthepast4weeksSameasabove152.
141.
175NotcalmHaveyounotfeltcalmandpeacefulinthepast4weeksSameasabove152.
251.
000LowenergyDidyounothavealotofenergyinthepast4weeksSameasabove152.
781.
107TiredDidyoufeeltiredinthepast4weeksSameasabove152.
711.
075NothappyHaveyounotbeenhappyinthepast4weeksSameasabove152.
101.
030DizzinessInthepastweek,howmuchhaveyoubeendistressedorbotheredbyfaintnessordizziness1=Notatall;2=slightly;3=moderately;4=very;5=extremely151.
380.
891ShakinessInthepastweek,howmuchhaveyoubeendistressedorbotheredbynervousnessorshakinessinsideSameasabove151.
570.
984ChestpainInthepastweek,howmuchhaveyoubeendistressedorbotheredbyheartorchestpainSameasabove151.
510.
922NauseaInthepastweek,howmuchhaveyoubeendistressedorbotheredbynauseaorupsetstomachSameasabove151.
570.
934ShortnessofbreathInthepastweek,howmuchhaveyoubeendistressedorbotheredbytroublecatchingyourbreathSameasabove151.
530.
933WeaknessInthepastweek,howmuchhaveyoubeendistressedorbotheredbyweaknessSameasabove151.
761.
131NumbnessInthepastweek,howmuchhaveyoubeendistressedorbotheredbynumbnessortinglinginpartsofyourbodySameasabove151.
821.
170Accesstocarevariablesforthosediagnosedwithamentalhealthproblem(N=39)HelpIfyestothediagnosisquestions,haveyousoughthelp0=No1=Yes010.
770.
427Primarycare0=No010.
710.
461448J.
RacialandEthnicHealthDisparities(2015)2:445–456theneighborhoodandourknowledgeofresidents'concernabouttheseactivitiesintheirneighborhood.
Table3reportsthesameinformationforthefourdependentvariables.
(1)"Mentalhealthdiagnosis"iscoded1,iftherespondentsaid"yes"toadiagnosisofanxiety,depression,and/oranothermentalhealthillness;itiscoded0ifthepersonhadnoneofthosediagnoses.
(2)"Stressandexcessworry"iscoded1iftherespondentsaid"yes"toeitherorbothofthequestionsabouteverexperiencingstressandeverexperienc-ingexcessworryand0ifthepersonhasneverexperiencedeither.
(3)"Psychologicalsymptomsinthelast4weeks"wascreatedbyfactoranalyzing(PrincipalAxisFactoring)sixLikertitems(seeTable3).
DescriptivestatisticsfortheLikertitemscontainedinthisfactor(andthenextone)areincludedinTable3,alongwiththecomponentloadings.
(4)"Physicalsymptomsinthelast1week"wascreatedbyfactoranalyzing(PAF)sevenLikertitems(seeTable3).
Afterrunningbivariatecorrelationsbetweentheindepen-dentanddependentvariables,weranfourregressionmodelsincludingthesevenindependentvariablesdetailedinTable3.
Weusedbinarylogisticmodelsforthedichotomousdepen-dentvariablesandordinaryleastsquares(OLS)modesforthecontinuousdependentvariables.
Collinearitydiagnostics[i.
e.
,varianceinflationfactors(VIF)andtolerance]revealedthattherewerenoissueswithmulticollinearity;allindependentvariablesmetthestandardofaVIFbelow2.
9andatolerancevaluegreaterthan0.
4.
ResultsDescribingMentalHealthOutcomesandAccesstoCareOnethirdofsurveyedHispanicresidentshavebeendiagnosedwithdepressionandonequarterhavebeendiagnosedwithananxietydisorder;36%hadbeendiagnosedwithatleastoneofthefollowingmentalhealthissues:depression,anxiety,andposttraumaticstressdisorderorhadattemptedsuicide.
Nearly60%reportedeverfeelingstressedandexcessivelyworried.
Intermsofaccesstocareformentalhealthissues(seeTable2),77%ofindividualswithadiagnosedmentalhealthconditionhavereceivedhealthcareforit.
Ofthosereceivingcareforadiagnosedmentalillness,71%receivecarefromtheirprimarycarephysicianfortheirdiagnosedconditionand56%takeamedication.
Only7%haveseenaspecialistfortheirdiagnosisand17%havereceivedaformofpsycholog-icaltherapy.
Moregenerallyinthesample,46%ofallrespon-dentsdidnothavehealthinsurance(seeTable3).
Ofthetotalrespondents,18.
6%hadinsurancethroughtheirworkplace,20%hadMedicare,and7%hadMedicaid.
Eightpercenthadotherformsofhealthinsurance(e.
g.
,Mexicanhealthinsur-ance)(notshowninatable).
Table2(continued)VariableSurveyquestionsCodingMinMaxMeanSDIfdiagnosed,doyoureceivecarefromafamilydoctor/primarycarephysician1=YesSpecialistIfdiagnosed,doyoureceivecarefromaspecialist0=No1=Yes010.
070.
264MedicationIfdiagnosed,doyoureceivemedication0=No1=Yes010.
560.
502TherapyIfdiagnosed,doyoureceivetherapy0=No1=Yes010.
170.
381J.
RacialandEthnicHealthDisparities(2015)2:445–456449Table3Measuresusedinregressionanalysesofmentalhealthoutcomesamonglow-incomeHispanicWestwayresidentsVariableSurveyquestionsComponentloadingsOriginalresponseoptionsCodingMinMaxMeanSDIndustrialconcernsHowconcernedareyouabout:1=Notatallconcerned2=Alittleconcerned3=Somewhatconcerned4=Veryconcerned5=Don'tknowCreatedafactorusingPrincipalAxisFactoring(PAF).
VarimaxrotationwithKaiserNormalization.
Continuous1.
7941.
0640.
0200.
929–Accidentalreleasesofindustrialchemicals0.
782Odors(smells)inyourneighborhood0.
669SmokefromBorderSteel0.
862Hazardouswastesites0.
473Noiseafter10PM0.
383Fumesfromtraffic0.
371Languageacculturation–Whatlanguage(s)arespokenathome0.
9351=Spanishonly2=MoreSpanishthanEnglish3=MoreEnglishthanSpanish4=Englishonly1=Notatall2=Lessthanverywell3=VerywellCreatedafactorusingPAF.
VarimaxrotationwithKaiserNormalization.
Continuous1.
0042.
4940.
0300.
967–Whatlanguage(s)doadultsspeakathome0.
915–HowwelldoadultsinthishouseholdspeakEnglish0.
664USbornWereyoubornintheUSorborninMexico/elsewhere(Where)N/A1=US2=Mexico0=Foreignborn1=UnitedStates010.
370.
486ComorbidityOtherconditionsforrespondent1(list):diabetes,hypertension,arthritis,andheartdiseaseN/A0=No1=Yes0=No1=Yes010.
360.
482FemaleRespondents'genderN/A0=Male1=Female0=Male1=Female010.
580.
496InsuredHealthinsurancecurrentlyN/A0=None1=Insurancethroughworkplace2=Medicare3=Medicaid4=CHIP5=Mexicaninsurance6=Twoormoreplans7=Other0=No1=Yes:any010.
540.
501LifeeventsHaveyouexperiencedanyofthefollowingeventsinthepastyearDivorce,lossofalovedone,lossofjoband/ormovedtoanothercity/neighborhoodN/A0=No1=YesConstructedvariable0=No1=Yes,oneormore010.
560.
499Stressand/orexcessworry–Haveyouexperiencedstress–HaveyouexperiencedexcessworryN/A0=No1=Yes0=No1=Yes,stress,worry,orboth010.
580.
496Mentalhealthdiagnoses–Haveyoueverbeendiagnosedbyadoctorwithdepression–HaveyoueverbeendiagnosedbyadoctorwithanxietyHaveyoueverattemptedsuicideHaveyouexperiencedanyothermentalhealthproblemsN/A0=No1=Yes0=No1=Yes,1ormore010.
360.
483450J.
RacialandEthnicHealthDisparities(2015)2:445–456Table3(continued)VariableSurveyquestionsComponentloadingsOriginalresponseoptionsCodingMinMaxMeanSDPsychologicalsymptomsinlast4weeksInthepast4weeks,1=Noneofthetime2=Littleofthetime3=Someofthetime,4=Mostofthetime,5=AllthetimeCreatedafactorusingPAF.
Continuous1.
4022.
1870.
0000.
940–Haveyoubeennervous0.
766–Haveyoufeltdepressed0.
849Haveyounotfeltcalmandpeaceful0.
611Didyounothavealotofenergy0.
740Didyoufeeltired0.
566Haveyounotbeenhappy0.
638Physicalsymptomsinlast1weekInthepastweek,howmuchhaveyoubeendistressedorbotheredby:1=Notatall2=Slightly3=Moderately4=Very5=ExtremelyCreatedafactorusingPAF.
Continuous0.
7123.
090.
0220.
936Faintnessordizziness0.
513Nervousnessorshakinessinside0.
746Heartorchestpain0.
706Nauseaorupsetstomach0.
562Troublecatchingyourbreath0.
752–Weakness0.
655–Numbnessortinglinginpartsofyourbody0.
649J.
RacialandEthnicHealthDisparities(2015)2:445–456451AssessingDisparitiesinMentalHealthOutcomesTable4presentstheresultsfromthecorrelationalanalysisbetweentheindependentanddependentvariables.
Thefol-lowingstatisticallysignificantcorrelationswerefound:Languageacculturationwaspositivelycorrelatedwithstressandexcessworry.
Comorbiditywaspositivelycorrelatedwithdiagnosisofmentalhealthconditionandpsychologicalsymp-tomsinthepast4weeks.
Beingfemalewassignificantlycor-relatedwithalldependentvariables.
Havingmorestressfullifeeventsvariablewaspositivelycorrelatedwiththediagnosisvariablesaswellaspsychologicalandphysicalsymptomsvariables.
Finally,industrialconcernsweresignificantlycor-relatedwithstressandexcessworryandpsychologicalsymp-tomsofdistressinthepast4weeks.
Table5presentsresultsfromtheregressionmodels.
Forthelogisticmodelpredictingstressand/orexcessworry(Table5,A),therewerethreesignificant(p<0.
05)findingsandonefindingthatapproachedsignificance(p<0.
1).
Aone-unitin-creaseinthelanguageacculturationscale(whichis1standarddeviation)leadstoa2.
5timesincreaseintheoddsofare-spondentexperiencingstressand/orexcessworry.
Likewise,femalesare2.
6timesmorelikelytofeelstressedand/orwor-riedthanmales.
Individualswithoneormorecomorbidconditionsare2.
9timesmorelikelytoexperiencestressand/orexcessworry.
Aone-unitincreaseintheindustrialcon-cernsscaleresultsina2.
5timesincreaseintheoddsofarespondentexperiencingstressand/orworry.
US-bornindi-vidualsare0.
8timeslesslikelytoexperiencestressand/orexcessworrythanforeign-bornindividuals.
Forthelogisticmodelpredictingadiagnosisofamentalhealthcondition(Table5,B),thereweretwostatisticallysig-nificant(p<0.
05)findings.
Femalesandthosewhoexperi-encedoneormorelifeeventsinthepastyearareboth6.
9timesmorelikelytobediagnosedwithamentalillness.
FortheOLSmodelpredictingtherespondent'spsycholog-icalsymptomsofdistressinthelast4weeks(seeTable5,C),fourvariablesweresignificantatthep<0.
05level.
Forindi-vidualswithatleastonecomorbidcondition,thereisa0.
4increaseinthepsychologicalsymptomsscale.
Forfemales,thereisanincreaseof0.
5inthescalewhencomparedtomalesandthereisanincreaseof0.
7forthosewhoexperiencedoneormorelifeeventsinthelastyear.
Aone-unitincreaseintheindustrialconcernsscaleresultsinanincreaseof0.
255inthepsychologicalsymptomsscale.
FortheOLSmodelpredictingtherespondent'sphysicalsymptomsofdistressinthelastweek(Table5,D),therewerethreesignificantpredictors(p<0.
05).
FemaleshadascoreonTable4Correlationsbetweencovariatesandmentalhealthoutcomesforlow-incomeHispanicWestwayresidentsStressand/orexcessworryDiagnosisofmentalhealthissuesPsychologicalsymptomsinlast4weeksPhysicalsymptomsinlast1weekEnglishlanguageacculturationCorr.
0.
245*0.
1430.
1420.
021Sig.
0.
0150.
1630.
1730.
838N97979494BornintheUnitedStatesCorr.
0.
1370.
1330.
1200.
086Sig.
0.
1820.
1950.
2510.
410N97979494ComorbidconditionsCorr.
0.
1140.
200*0.
245*0.
164Sig.
0.
2630.
0480.
0170.
113N98989595FemaleCorr.
0.
245*0.
373**0.
307**0.
269**Sig.
0.
0150.
0000.
0020.
009N98989595HasinsurancecoverageCorr.
0.
1490.
0100.
0840.
083Sig.
0.
1440.
9210.
4200.
427N97979494RespondenthasexperiencedstressfullifeeventsCorr.
0.
1250.
359**0.
420**0.
280**Sig.
0.
2180.
0000.
0000.
006N98989595IndustrialrelatedconcernsCorr.
0.
271**0.
1520.
218*0.
195Sig.
0.
0080.
1440.
0380.
064N94949191*Correlationissignificantatthe0.
05level(two-tailed),**correlationissignificantatthe0.
01level(two-tailed)452J.
RacialandEthnicHealthDisparities(2015)2:445–456thephysicalsymptomsscalethatwas0.
5higherthanmalesandthosewhoexperiencedalifeeventalsohadanincreaseof0.
4inthescale.
Aone-unitincreaseintheindustrialconcernsscaleresultedina0.
2increaseinthephysicalsymptomsscale.
DiscussionIntermsofratesofmentalhealthproblems,Westwayresi-dentshaveratesofdiagnoseddepression(29%)thatweremorethanthreetimestheratesforTexasresidents(9%)andtheUSpopulation(7%)inanygivenyear[30,31].
Similarly,theiranxietyrates(25%)arehigherthanthenationalrateof18%inanygivenyearaccordingtotheNationalInstituteofMentalHealth[32,33].
Thirty-sixpercentofWestwayresi-dentsreportbeingdiagnosedwithatleastonementalillnesscontrastingwiththe18%ofindividualsover18withanymentalillnessinTexasandthe20%ofpeoplewithanymentalillnessintheUnitedStates[33].
Locally,WestwayresidentsalsoshowedgreaterratesofdiagnosedmentalhealthconditionsthantheresidentsoftheSanElizariocolonias(alsoinElPasoCounty,Texas)aspreviouslyreportedbyAndersetal.
[4].
Theyfounda20%depressionrateanda17%anxietyratecomparedtoourratesof29and25%,respective-ly.
ElevatedratesofmentalillnessinWestwayareconcerningbecauseifleftuntreatedorundertreated,theycancreateun-necessarydisabilityandfurthertheeconomicchallengesfacedbyresidents[34]exacerbatinginequality.
LiketherestoftheUSpopulation,mostWestwayresidentsdiagnosedwithamentalillnesstreattheirconditionsthroughprimarycarephysicians.
Seventy-onepercentofthosereceiv-ingcarefordepressionoranxietyreceiveitfromaprimarycareprovider,whichisslightlylowerthanthenationalstatis-ticsas74%ofAmericanswhoseekhelpfordepressiongotoafamilydoctorratherthanaspecialist[35].
Twenty-threepercentofWestwayresidentshavenotreceivedmentalhealthcaresincetheirdiagnosisofanxietyordepression.
Itisprob-ablethatalackofhealthinsuranceisrelatedtothislackoftreatment.
Westwayresidents'mostproximatesourceofhealthcareservicesisLaFeClinic,whichislocatedatthenorthedgeofthecommunity.
TheclinicispartoftheCentrodeSaludFamiliarLaFeInc.
,anon-profitorganizationdedi-catedtoprovidehealthcaretounderservedindividualsinElPasoCounty.
ResidentsofElPasoCountycanreceiveavari-etyofservicesataffordablepricesfromthisclinic,whicharedeterminedonaslidingscaleaccordingtoincome.
TheclinicalsoacceptsMedicareorMedicaid.
However,LaFedoesnothavementalhealthspecialistsandpsychiatryisnotincludedintheirlistofspecialtyreferralsaccordingtotheirwebsite.
Thislikelycontributestothelackofspecialtycareobservedamongsurveyedresidents,giventhatweknowthatagoodproportionofWestwayresidents,especiallytheuninsuredandthosewithstate-sponsoredinsurancecoverage,usetheLaFeclinicfortheirhealthcareneeds.
Thelackofaccesstospecialtymentalhealthcareisana-tionwideproblem.
Atthelocallevel,ElPasoCountyhasonly823mentalhealthprofessionals(andonly27ofthesearepsychiatrists),whichis107forevery100,000people[20].
InthestateofTexas,only34%ofpeoplewithmentalillnessesreceiveneededcare.
ThesituationisworseinWestwaywhereonly7%ofpeoplewithananxietyordepressiondiagnosishaveseenaspecialist.
Texasisthestatewiththeleasttreat-mentdollarspercapitaofallstatesanditsmentalhealthcaresystemhasreceivedaDgrade[36,37].
TheUnitedStatessystemalsohasaDgrade.
Nationwide,mentalhealthcareoftenlacksafocusonhealthandwellness;thedataonmentalhealthisinadequateandfundingisscarce;thementalhealthworkforceisnotsufficientlymaintainednordeveloped;andthereisadeficiencyinculturalcompetencyamongprovidersandacultureofdisrespectforthementallyill[36,37].
Table5Regressionmodelspredictingmentalhealthoutcomesforlow-incomeHispanicWestwayresidentsA.
Stressand/orexcessworry(logistic)B.
Diagnosisofmentalhealthcondition(logistic)C.
Psychologicalsymptomsinlast4weeks(OLS)D.
Physicalsymptomsinlast1week(OLS)NagelkerkeR20.
378NagelkerkeR20.
459AdjustedR20.
374AdjustedR20.
138BSESig.
Exp(B)BSESig.
Exp(B)BSEtSig.
BSEtSig.
Languageacculturation0.
9050.
3250.
0052.
4710.
5180.
3210.
1071.
6790.
1350.
0911.
4950.
1390.
0200.
106.
1870.
852USborn1.
3960.
5970.
0190.
2481.
0720.
6510.
1000.
3420.
2850.
1771.
6100.
1110.
0590.
208.
2820.
779Comorbidity1.
0540.
6070.
0832.
8681.
0010.
6090.
1002.
7210.
4470.
1782.
5210.
0140.
2280.
2141.
0660.
290Female0.
9410.
5250.
0732.
5621.
9420.
6190.
0026.
9730.
5220.
1623.
2250.
0020.
4750.
1942.
4530.
016Insured0.
7570.
5570.
1740.
4690.
6880.
6090.
2591.
9900.
1260.
1670.
7560.
4520.
1210.
2010.
6030.
548Lifeevents0.
1120.
5360.
8350.
8941.
9410.
6220.
0026.
9640.
6750.
1644.
1270.
0000.
4140.
1942.
1270.
037Industrialconcerns0.
9070.
3050.
0032.
4780.
5380.
3220.
0941.
7120.
2550.
0872.
9280.
0040.
2160.
1032.
0980.
039J.
RacialandEthnicHealthDisparities(2015)2:445–456453Intermsofassessingintra-ethnicdisparitiesinmentalhealthoutcomes,wefoundthatWestwayresidentswithhigherlevelsofindustrialconcernsweresignificantlymorelikelytoexperiencethreeofthefourmentalhealthoutcomestestedhere,andthefourth(diagnosis)approachedstatisticalsignifi-cance.
Whilenotthesubjectofmanystudies(seeonly12–13),therelationshipbetweenindustrialconcernsandmentalhealthproblemshasbeenfoundindiversesocialgroupsrangingfromthepopulationofSpain[12]toWestway,Texas.
Westwayresidentshavejoinedeffortswithcommunityor-ganizationstoaddressenvironmentalissuesintheircommu-nity.
TheyhaveparticipatedwiththeTexasIndustrialAreasFoundation(IAF)inElPasotoaffectpolicyinanumberofissuesincludingenvironmentalhealth.
ThenewerIAFgroupintheregion,BorderInterfaith(BI),hasworkedwithleadersinWestwaytomaketheTexasCommissiononEnvironmentalQuality(TCEQ)awareoftheirenvironmentalconcerns.
Afterseveralyearsofpressure,TCEQhasincreasedtheiroversight,albeitonasmallscale(e.
g.
,additionalhoursperyear)ofArcelorMittalVinton,oneoftheindustriesnearWestway[27].
Countertotheliterature[14–16],beingbornintheUnitedStatesisassociatedwithhavinglessstressandexcessworry(p<0.
05)andalowerlikelihoodofamentalillnessdiagnosisandfewerpsychologicalsymptomsinthelast4weeks(bothp<0.
10)amongthiscoloniapopulation.
However,previousstudies[14–16]didnotexamineexcessstressandworryspe-cificallyandinsteadfocusedonmentalillnessdiagnoses.
Theassociationbetweenbeingforeign-bornandhigherlevelsofstressandworrycouldbeattributedtothefactthatWestwayislocatedneartheUS-Mexicoborderandthatthereareroutinelylawenforcementandborderprotectionofficialsinthearea.
Thispolicepresencecouldcausestressandconcernforforeign-bornresidentsthatareunauthorizedtobeintheUnitedStates[38].
Additionally,cartelviolenceoccurringjustacrosstheborderinCiudadJuárezduringthedatacollectionmayhavecontributedtostressandworry,especiallyforforeign-bornresidents,wholikelymaintainedstrongtieswithrelativesinJuárez.
ThestrongpresenceoflawenforcementofficialsandthecartelviolenceinMexicoasfactorsinfluenc-ingforeign-bornborderresidentstoexperiencestressandworrywhilelivingintheUSarehypothesesthatshouldbeinvestigatedinfutureresearch.
Wefoundthathigherscoresonthelanguageacculturationscalepredictedexperiencingincreasedstressandexcessworry(p<0.
05).
Thisissurprisinginlightofthefindingthatforeignbirthisariskfactorforstressandexcessworry,althoughitalignswiththeliteratureonthehealth-damagingeffectsofacculturation[17].
Asexpected,US-birthandlanguageaccul-turationarecorrelatedat0.
351(tablenotshown).
Itmeansthatholdingconstanttheeffectofnativity(andtheothercovari-ates),Englishspeakingwasassociatedwithgreaterstressandexcessworry.
Thisreflectsotherstudiesfindingthatgreateracculturationisassociatedwithhigherratesofmentalillness[17].
InWestway,languageacculturationapproachedstatisti-calsignificance(p<0.
11)asapredictorofhigherratesofactualdiagnosedmentalillness.
Inastudyofmentalhealthoutcomespost-disasterinElPasoCounty,researchersalsofoundthatlanguageacculturationwasariskfactorforamen-talhealthproblem(i.
e.
,experiencingdepressionorposttrau-maticstress)post-floodamongthosewhosehomesweredam-aged[39].
Comorbiditywasasignificantpredictorofpsychologicalsymptomsinthelast4weeks,anditapproachedstatisticalsignificanceforthestress/worryanddiagnosisvariables(p<0.
10),aligningwiththestrongrelationshipbetweenchronicphysicalillnessandmentaldisorderspreviouslyob-served[18].
GiventhatHispanicsareatincreasedriskforthesechronicconditionsthatcommonlyco-occurwithdepres-sion,thisfindingisconcerningfromapublichealthperspective.
Beingafemalewasasignificantpredictor(p<0.
05)ofthediagnosis,psychologicalsymptoms,andphysicalsymptomsvariables,anditapproachedsignificanceforstress/worry(p<0.
10).
ThismeansthatpoorHispanicwomeninthiscolonia,likewomenelsewhere,aremorelikelytoexperiencementalhealthchallenges[23].
Lifeeventswerealsosignifi-cantpredictors(p<0.
05)ofdiagnosedmentalillness,psycho-logicalsymptoms,andphysicalsymptomsofdistress.
LimitationsThemainlimitationofthisstudyisthesmallsamplesize(N=98individualsin98differenthouseholds),whichisreflectiveofthesmallcommunityunderstudy(N=1120homes).
Alargersamplecouldallowforamoresophisticatedstatisticalanalysis.
Secondly,theCenterforEpidemiologicalStudies-Depression(CES-D)measure[40],whichisoneofthemostwidelyusedinstrumentstomeasuredepressivedisorders,wasnotusedinthisstudy,limitingitscomparability.
Third,whilebeyondthescopeofthiscommunity-basedparticipatorypro-ject,wedidnotcollectinformationaboutwhenthepersonwasdiagnosedwiththeirmentalillnessandhis/herhealthcare-seekingexperiences.
Last,studieswithHispanicsofmorediversebackgroundscouldalsoprovidemoreinformationonhowethnicityimpactsmentalhealthoutcomes.
RelevanceDespitethenumerouschallengesfacingindividualsincolonias,theirmentalhealthhasremainedunderstudiedandunaddressedbypolicymakersandactivists.
Mentalillnessescanbedebilitatingandtheyfurtherriskforphysicalillnesscomplications[41]andeconomicdecline[34].
Hispanicresi-dentsofthiscoloniahadhighratesofmentalhealthchallengesandfewresourcestodealwiththem;residents'percapita454J.
RacialandEthnicHealthDisparities(2015)2:445–456incomewasonequarteroftheUSaverageandhalflackedhealthinsurance.
AstheHispanicpopulationintheUScon-tinuestogrow,itisbecomingincreasinglyimportanttoun-derstandthecomplexitiesofHispanichealth[39,42].
ThiscasestudyinaUScoloniacontributestothatgoalbyillustrat-ingthehealthchallengesanddisparitiespresentwithinthisgroupoflargelyMexican-origin,low-incomeHispanics.
Evenwithinthissociallymarginalizedgroup,mentalhealthdisparitieswerepresentwithrespecttoenvironmentalcon-cerns,nativity,languageacculturation,comorbidity,gender,andlifeevents.
Thesefindingsunderscoretheimportanceofconsideringintra-ethnicdisparitiesinHispanichealthout-comes.
ThefindingsalsohighlightdeficienciesinmentalhealthcareintheUS,especiallyforlow-income,peri-urbanresidents,suchasthoseinWestway,andpointtotheneedforincreasedaccesstomentalhealthcareatcharityclinicsservingpoorpopulations.
AcknowledgmentsThisworkwasjointlysupportedbytheNationalInstituteofMinorityHealthandHealthDisparities(NIMHD)andtheUnitedStatesEnvironmentalProtectionAgency(AwardNumberP20MD002287-05S1).
ThecontentissolelytheresponsibilityoftheauthorsanddoesnotnecessarilyrepresenttheofficialviewsoftheNIMHDortheEPA.
WeacknowledgetheassistanceofOscarMoralesduringthedatacollectionphaseofthisprojectandDr.
MariaCristinaMoralesduringthestatisticalanalysis.
ResidentsofWestwayparticipatingintheprojectarealsogratefullyacknowledged.
ConflictofInterestGuadalupeMarquez-Velarde,SaraGrineski,andKathleenStaudtdeclarethattheyhavenoconflictofinterest.
InformedConsentAllproceduresfollowedwereinaccordancewiththeethicalstandardsoftheresponsiblecommitteeonhumanexperimen-tation(institutionalandnational)andwiththeHelsinkiDeclarationof1975,asrevisedin2000(5).
Informedconsentwasobtainedfromallpatientsforbeingincludedinthestudy.
Noanimalstudieswerecarriedoutbytheauthorsforthisarticle.
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MontagueCobb-NMAHealthInstitute2015AbstractUnregulatedresidentialsettlementsalongtheUSsideoftheUS-Mexicoborder,oftencalled"colonias",aremainlypopulatedbylow-incomeMexican-originHispanics.
Coloniaresidentsfacenumeroussocial,environmental,eco-nomicandpublichealthchallenges.
Despitethis,thementalhealthofindividualslivingincoloniashasremainedlargelyunderstudied.
Drawingfromasurvey(N=98)conductedthroughacommunity-basedparticipatoryresearchprojectinonecoloniasufferingfromnumerousenvironmentalandsocialchallenges,thisstudyanalyzesresidents'mentalhealthout-comesandaccesstomentalhealthcarewithafocusonintra-ethnicdisparitiesbasedonenvironmentalconcerns,nativity,languageacculturation,comorbidity,gender,healthinsurance,andstressfullifeevents.
Datawereanalyzedusingdescriptivestatistics,correlation,andregression.
Morethanonethirdoftheresidentshavebeendiagnosedwithamentalhealthcondi-tionandoverhalfreportedstressandexcessworry.
Intermsofmentalhealthcare,77%ofindividualsdiagnosedwithamen-talhealthproblemhavesoughtadditionalhelpmainlythroughaprimarycareproviderdespitethehighlevelsofuninsuredindividuals.
Comorbidity,beingfemale,recentnegativelifeevents,andhighlevelsofenvironmentalconcernsweresignif-icantpredictorsofnegativementalhealthoutcomes.
Thisstudycontributestotheunderstandingofthecomplexhealthdynam-icsoftheUSHispanicpopulation.
Italsohighlightstheneedforadditionalresearchandresourcesdevotedtothementalhealthoflow-incomeminoritiesinisolatedcommunities.
KeywordsMentalhealth.
Colonia.
Hispanic.
Environmentalconcerns.
Mentalhealthcare.
US-MexicoborderIntroductionColoniasareunincorporatedandunregulatedperi-urbanset-tlementsalongtheUnitedStates-MexicoborderthatarehometoprimarilyMexican-originpopulations[1].
Coloniaresi-dentsfaceuniquehealthchallengesduetopoverty,lackofaccesstohealthcare,inadequateinfrastructure,andenviron-mentalthreats.
Thephysicalhealthofcoloniaresidentshasbeenpreviouslyexaminedandresearchershavedocumentedsignificantpublichealthchallenges[2–4].
Inspiteofthis,thementalhealthofcoloniaresidentsremainslargelyunderstudied.
Westway,thesiteofthisstudyofmentalhealth,isacolonia1inElPasoCounty(Texas).
Inthiscountyin2010,86,472residentslivedin321communitiesdefinedascolonias[5].
Westwayishometoabout4000oftheseindividuals.
Thepopulationis97%Hispanicand45.
5%areforeign-born,andofthoseforeign-bornresidents,only22.
2%arenaturalizedUScitizens[6].
WestwayislocatednexttoInterstate10,acrosstheArcelorMittalVintonsteelplantandproximatetootherpollutingindustriessuchasascrapmetalrecyclingplant.
InWestway,asinothercoloniaenvironments,aconflu-enceofchallengingsocio-environmentalconditionscontrib-utestoadifficultqualityoflifeforresidentsand,asaconse-quence,thepotentialforhighratesofmentalhealthissuesandbarriersincopingwiththem.
Assuch,wehavetwoobjectives:(1)characterizeWestwayresidents'ratesofmentalhealthout-comesandaccesstomentalhealthcareand(2)assessintra-ethnicdisparities(i.
e.
,basedonlevelofenvironmentalcon-cerns,nativity,languageacculturation,comorbidities,gender,healthinsurance,andstressfullifeevents)inmentalhealthoutcomeswithinthisimpoverished,Hispanicpopulation.
1Officially,Westwayisacollectionofsevencolonias(Westway1–Westway7;seehttp://www.
sos.
state.
tx.
us/border/colonias/reg-colonias/elpaso-6.
shtml),althoughresidentstreatitasonecontiguouscommunity.
G.
Marquez-Velarde(*):S.
Grineski:K.
StaudtTexasA&MUniversity,CollegeStation,TX,USAe-mail:gmarquez6@tamu.
eduJ.
RacialandEthnicHealthDisparities(2015)2:445–456DOI10.
1007/s40615-015-0091-1HealthandEnvironmentalConcernsinColoniasColoniastendtolackbasiccommunityinfrastructuresuchaspavedroads,sewersystem,electricity,gas,cleanwater,andhealthcareservices[1,3,7].
Thelackofinfrastructureandpovertycombinestofosterthespreadofdiseasessuchashepatitis,dysentery,andtuberculosis[1].
Povertyalsoleadstofoodinsecurityandpoornutritionalhealth,whichcancauseobesityanddiabetes,whicharecommonalongtheUS-Mexicoborder[8].
Chronicillnesses,suchasdiabetesandasthma,arealsoprevalentincolonias[3].
Unsafeenvironmentalconditions(e.
g.
,presenceofjunkyards)havebeenlinkedwithphysicalillnessincolonias.
Underdevelopmentandthepresenceofemptylotssometimesleadsbothcoloniaresidentsandotherstodisposeofhouse-holdandindustrialwastesintheneighborhoods,creatingphysicalhealthrisks[9].
Ramosetal.
[3]foundthatresidentslivingclosertojunkyardsordrycleanersintheCameronParkcoloniaineastTexashadsignificantlyhigherriskofdevelop-ingarespiratoryillnessthanthoselivingfartheraway.
Intermsofmentalhealth,thefocusofthispaper,Andersetal.
[4]foundhighratesofmentalillnessinanElPasoCountycolonia(notWestway);20%ofadultshadbeendiag-nosedwithdepressionand17%hadbeendiagnosedwithanxiety.
Itmayalsobethattheenvironmentalconditionsincoloniasarecorrelatedwithchronicstressandpsychologicaldistress,whichcanpermeatethephysicalandpsychologicalwell-beingofindividuals[10].
DowneyandVanWilligen[11]arguedthatenvironmentalstressors(aschronicstresssources)canhavelong-lastingeffectsonthepsychologicalwell-beingofresidentslivinginindustrializedareas.
Whilenotstudyingcolonias,DowneyandVanWilligen[11]foundthatIllinoisresidentslivingnearindustrialactivityreportedhigherdepres-sivesymptomatology,agreatersenseofdisorder,andmorefeelingsofpowerlessnessthanthosenotlivingclosetoindus-trialfacilities.
Similarfindingsrelatingenvironmentalcon-cernstomentaldisorderswerefoundinnational-leveldatasetsinSpain[12]andPortugal[13].
MentalHealthandAccesstoCareforHispanicsGiventhatcoloniaresidentsareMexican-originHispanics,itisrelevanttothisstudythatHispanicshavelowerratesofmentaldisordersthannon-Hispanicwhites[14].
WithintheHispanicpopulation,therearedisparitiesinmentalhealthout-comes,basedonthreeimportantcharacteristics:nativity,lan-guageacculturation,andchronicphysicalillness.
Intermsofnativity,immigrantstendtohavelowerratesofmentaldisor-dersthantheirUS-borncounterparts[15,16].
Hispanicsthathaveacculturatedtowhitemiddle-classnormsaremorepronetodevelopmentalhealthdisorders.
Forexample,English-speakingHispanicshavehigherratesofmentaldisorders[17]thanHispanicswhoarepredominantlySpanishspeaking.
Thosesufferingfromchronicphysicalillnesses(e.
g.
,diabetes)aremorelikelytodevelopamentalhealthcondition[17].
ThisfactisconcerninginHispanicpopulationsbecausetheyshowanearlyonsetandahighriskofdevelopingconditionssuchasdiabetes,kidneydisease,andhypertension[18]whichoftenco-occurwithdepression[19].
EventhoughHispanicshavelowerratesofmentalillness,theUSDepartmentofHealthandHumanServiceshasiden-tifiedcriticalmentalhealthdisparitiesthatapplytoHispanics,whichincludereducedaccesstomentalhealthservices,de-creasedlikelihoodtoreceiveneededservices,andpoorqualitytreatment[20].
Intermsofreducedaccesstoneededservices,foreign-born,primarilySpanishspeaking,recentimmigrant,firstgeneration,anduninsuredHispanicsshowedthelowestratesofaccesstomentalhealthservices[21].
HispanicswhodidnotspeakEnglishreceivedneededmentalhealthservicesatlowerratesthanproficientEnglishspeakers[22].
Mexican-originpeoplewithmentalhealthchallengeshaveverylowutilizationratesformentalhealthservicesevenwhencom-paredtootherHispanicsubgroups,likePuertoRicans[21].
ThelackofaccesstoqualitycareexperiencedbyHispanicsmakesthemmorepronetochronicityandhigherlevelsofimpairmentduetomentalillness[18].
PoorqualityofcareisreflectedinthefactthatHispanicsandotherminorities'mainsourceofmentalhealthcareisprimarycarephysiciansratherthanspecialistssuchaspsychiatrists[22].
OtherInfluencesonMentalHealthThereareotherinfluencesonmentalhealthbesidestheHispanicethnicfeaturesandindustrialconcernspreviouslydiscussed.
Theseincludegender,lackofhealthinsurance,andstressfullifeevents.
Intermsofgender,womenhavehigherratesthanmenofmajordepressivedisorder,anxietydisorders,posttraumaticstressdisorder,andeatingdisordersintheUnitedStates[23].
Lackofinsurancecoverageisanimportantbarrierwheninneedofmentalhealthservices,anditmightcauseadefermentoftreatment.
Finally,stressfullifeevents(e.
g.
,lossoflovedone)areassociatedwithpoormentalhealthbecausetheseeventscan"leadtostressbyadverselyalteringthemeaningofpersistentlifestrains"[24].
MaterialsandMethodsStudyAreaWestway(seeFig.
1)ishometoalow-incomepopulation:49.
2%livebelowthepovertyline,15.
4%haveanincomeoflessthan$10,000peryear,and35%receivedpublicassis-tanceduringthelast12months.
Only55.
4%ofWestwayresidentsareinthelaborforce,mainlyinserviceoccupations,sales,construction,maintenance,andtransportation[6].
446J.
RacialandEthnicHealthDisparities(2015)2:445–456Ninety-eightpercentofresidentsareHispanicandonly9.
4%reportspeakingonlyEnglishathome.
Over64.
3%ofSpanishspeakersspeakEnglishlessthanverywell[6].
Foradditionaldemographicinformation,seeTable1.
Westwayresidentsareexposedtonumerousenvironmentalhazards.
JustacrossInterstate10isthesteelplant,whichwasbuiltin1962andemitszinc,lead,andmanganeseintotheair[25].
Assuch,theelementaryschoollocatedinWestwaywasrankedinthesecondpercentilenationallyintermsofbadairqualityina2009report[26].
Strongseasonalwindsintheareaprovokeduststormsthatspreaddustfromunpavedroadsandlotsandcontaminantsfromindustry.
Residents'concernsabouttheenvironmentledthemtorequestthatateamofuniversityresearchersconductahealthscreeningsurveyintheircommunity[27];thispaperreportssomeoftheresultsfromthateffort.
DataCollectionandParticipantsThefirstauthorandanassistantcollectedthedatathroughdoor-to-doorsurveyingbetweenMarchandAugust2012.
Everyninthhousehold(outofthe1120lotunitsinWestway)wasaskedtoparticipate.
Iftheresidentswerenothome,theneighborsontheleftsidewereaskedtoparticipate.
Wemadecontactwithanadultover18at127households;23declinedandonewithdrewforan81%responserate(n=103).
Fortheanalysis,weexcludedtheonenon-Hispanicrespon-dentandfourrelativelyaffluentrespondents(i.
e.
,thoseearn-ingmorethanthecountypercapitaaverageforincome2)forafinalNof98low-incomerespondents.
Thesurvey,translatedbythefirstauthorandanassistant,bothofwhomarenativespeakersofSpanish,wasofferedinEnglishandSpanish.
Thesurveywasdesignedbytheresearchteamthroughacommunity-basedresearchprocessledbythethirdauthor.
Communityleaderswereinvolvedintheresearchprocessincludingmakingrevisionsandadditionstothequestionnaire.
ThisstudywasapprovedbytheInstitutionalReviewBoardattheauthors'homeinstitution.
MeasuresandAnalysisThefirstresearchobjectiveinvolvesdescriptivestatisticsforasuiteofmentalhealthvariablesandaccesstocarevariables.
Thementalhealthoutcomesincludethreesetsofvariables:diagnosesofspecificconditions,psychologicalsymptoms[28],andphysicalsymptoms[29].
WeutilizedaphysicalsymptomatologyscalebecauseHispanicsmighttendtoreportphysicalsymptomsinlieuofdepression,anxiety,and/orstress[14].
Table2showsallvariablesusedinthefirstresearchobjective,alongwithinformationaboutthesurveyquestions,coding,anddescriptivestatistics.
Thesecondresearchobjectiveinvolvescorrelationandre-gressionanalyses.
Table3reportsdescriptivestatisticsanddetailsforhowtheindependentvariables(i.
e.
,industrialcon-cerns,nativity,languageacculturation,comorbidities,gender,healthinsurance,andstressfullifeevents)wereconstructed.
Weused"industrialconcerns"asourmeasureofenvironmen-talconcerngiventhemanyindustrialsourcesofpollutioninFig.
1Westway,TexasTable1DemographiccharacteristicsofsurveyedWestwayresidents(N=98)VariableDescriptiveinformationAgeMin18Max80Mean47GenderFemale57%Male43%YearsofeducationMin0Max18Mean10OccupationProfessional5%Manufacturing3%Service60%Transportation3%Construction4%Retired13%Homemaking12%TimelivinginWestwayMin1monthMax52yearsMean18yearsNumberofindividualsinthehouseholdMin1Max10Mean3.
82Asapointofreference,theWestwaypercapitameaninoursamplewas$6255,thecountymeanwas$18,086,andtheUSmeanis$28,051(ACS,2008–2012).
J.
RacialandEthnicHealthDisparities(2015)2:445–456447Table2Descriptivestatisticsformentalhealthandaccesstocarevariablesforlow-incomeHispanicWestwayresidentsVariableSurveyquestionsCodingMinMaxMeanSDMentalhealthvariables(N=98)DepressionHaveyoueverbeendiagnosedwithdepression0=No1=Yes010.
290.
454AnxietyHaveyoueverbeendiagnosedwithanxiety0=No1=Yes010.
250.
434OtherdiagnosisHaveyouexperiencedanyothermentalcondition0=No1=Yes010.
050.
221SuicideHaveyouattemptedsuicide0=No1=Yes010.
040.
199StressHaveyouexperiencedstress0=No1=Yes010.
560.
499WorryHaveyouexperiencedexcessworry0=No1=Yes010.
390.
490NervousnessHaveyoubeennervousinthepast4weeks1=Noneofthetime;2=littleofthetime;3=someofthetime;4=mostofthetime;5=allthetime152.
081.
090DepressedHaveyoufeltdepressedinthepast4weeksSameasabove152.
141.
175NotcalmHaveyounotfeltcalmandpeacefulinthepast4weeksSameasabove152.
251.
000LowenergyDidyounothavealotofenergyinthepast4weeksSameasabove152.
781.
107TiredDidyoufeeltiredinthepast4weeksSameasabove152.
711.
075NothappyHaveyounotbeenhappyinthepast4weeksSameasabove152.
101.
030DizzinessInthepastweek,howmuchhaveyoubeendistressedorbotheredbyfaintnessordizziness1=Notatall;2=slightly;3=moderately;4=very;5=extremely151.
380.
891ShakinessInthepastweek,howmuchhaveyoubeendistressedorbotheredbynervousnessorshakinessinsideSameasabove151.
570.
984ChestpainInthepastweek,howmuchhaveyoubeendistressedorbotheredbyheartorchestpainSameasabove151.
510.
922NauseaInthepastweek,howmuchhaveyoubeendistressedorbotheredbynauseaorupsetstomachSameasabove151.
570.
934ShortnessofbreathInthepastweek,howmuchhaveyoubeendistressedorbotheredbytroublecatchingyourbreathSameasabove151.
530.
933WeaknessInthepastweek,howmuchhaveyoubeendistressedorbotheredbyweaknessSameasabove151.
761.
131NumbnessInthepastweek,howmuchhaveyoubeendistressedorbotheredbynumbnessortinglinginpartsofyourbodySameasabove151.
821.
170Accesstocarevariablesforthosediagnosedwithamentalhealthproblem(N=39)HelpIfyestothediagnosisquestions,haveyousoughthelp0=No1=Yes010.
770.
427Primarycare0=No010.
710.
461448J.
RacialandEthnicHealthDisparities(2015)2:445–456theneighborhoodandourknowledgeofresidents'concernabouttheseactivitiesintheirneighborhood.
Table3reportsthesameinformationforthefourdependentvariables.
(1)"Mentalhealthdiagnosis"iscoded1,iftherespondentsaid"yes"toadiagnosisofanxiety,depression,and/oranothermentalhealthillness;itiscoded0ifthepersonhadnoneofthosediagnoses.
(2)"Stressandexcessworry"iscoded1iftherespondentsaid"yes"toeitherorbothofthequestionsabouteverexperiencingstressandeverexperienc-ingexcessworryand0ifthepersonhasneverexperiencedeither.
(3)"Psychologicalsymptomsinthelast4weeks"wascreatedbyfactoranalyzing(PrincipalAxisFactoring)sixLikertitems(seeTable3).
DescriptivestatisticsfortheLikertitemscontainedinthisfactor(andthenextone)areincludedinTable3,alongwiththecomponentloadings.
(4)"Physicalsymptomsinthelast1week"wascreatedbyfactoranalyzing(PAF)sevenLikertitems(seeTable3).
Afterrunningbivariatecorrelationsbetweentheindepen-dentanddependentvariables,weranfourregressionmodelsincludingthesevenindependentvariablesdetailedinTable3.
Weusedbinarylogisticmodelsforthedichotomousdepen-dentvariablesandordinaryleastsquares(OLS)modesforthecontinuousdependentvariables.
Collinearitydiagnostics[i.
e.
,varianceinflationfactors(VIF)andtolerance]revealedthattherewerenoissueswithmulticollinearity;allindependentvariablesmetthestandardofaVIFbelow2.
9andatolerancevaluegreaterthan0.
4.
ResultsDescribingMentalHealthOutcomesandAccesstoCareOnethirdofsurveyedHispanicresidentshavebeendiagnosedwithdepressionandonequarterhavebeendiagnosedwithananxietydisorder;36%hadbeendiagnosedwithatleastoneofthefollowingmentalhealthissues:depression,anxiety,andposttraumaticstressdisorderorhadattemptedsuicide.
Nearly60%reportedeverfeelingstressedandexcessivelyworried.
Intermsofaccesstocareformentalhealthissues(seeTable2),77%ofindividualswithadiagnosedmentalhealthconditionhavereceivedhealthcareforit.
Ofthosereceivingcareforadiagnosedmentalillness,71%receivecarefromtheirprimarycarephysicianfortheirdiagnosedconditionand56%takeamedication.
Only7%haveseenaspecialistfortheirdiagnosisand17%havereceivedaformofpsycholog-icaltherapy.
Moregenerallyinthesample,46%ofallrespon-dentsdidnothavehealthinsurance(seeTable3).
Ofthetotalrespondents,18.
6%hadinsurancethroughtheirworkplace,20%hadMedicare,and7%hadMedicaid.
Eightpercenthadotherformsofhealthinsurance(e.
g.
,Mexicanhealthinsur-ance)(notshowninatable).
Table2(continued)VariableSurveyquestionsCodingMinMaxMeanSDIfdiagnosed,doyoureceivecarefromafamilydoctor/primarycarephysician1=YesSpecialistIfdiagnosed,doyoureceivecarefromaspecialist0=No1=Yes010.
070.
264MedicationIfdiagnosed,doyoureceivemedication0=No1=Yes010.
560.
502TherapyIfdiagnosed,doyoureceivetherapy0=No1=Yes010.
170.
381J.
RacialandEthnicHealthDisparities(2015)2:445–456449Table3Measuresusedinregressionanalysesofmentalhealthoutcomesamonglow-incomeHispanicWestwayresidentsVariableSurveyquestionsComponentloadingsOriginalresponseoptionsCodingMinMaxMeanSDIndustrialconcernsHowconcernedareyouabout:1=Notatallconcerned2=Alittleconcerned3=Somewhatconcerned4=Veryconcerned5=Don'tknowCreatedafactorusingPrincipalAxisFactoring(PAF).
VarimaxrotationwithKaiserNormalization.
Continuous1.
7941.
0640.
0200.
929–Accidentalreleasesofindustrialchemicals0.
782Odors(smells)inyourneighborhood0.
669SmokefromBorderSteel0.
862Hazardouswastesites0.
473Noiseafter10PM0.
383Fumesfromtraffic0.
371Languageacculturation–Whatlanguage(s)arespokenathome0.
9351=Spanishonly2=MoreSpanishthanEnglish3=MoreEnglishthanSpanish4=Englishonly1=Notatall2=Lessthanverywell3=VerywellCreatedafactorusingPAF.
VarimaxrotationwithKaiserNormalization.
Continuous1.
0042.
4940.
0300.
967–Whatlanguage(s)doadultsspeakathome0.
915–HowwelldoadultsinthishouseholdspeakEnglish0.
664USbornWereyoubornintheUSorborninMexico/elsewhere(Where)N/A1=US2=Mexico0=Foreignborn1=UnitedStates010.
370.
486ComorbidityOtherconditionsforrespondent1(list):diabetes,hypertension,arthritis,andheartdiseaseN/A0=No1=Yes0=No1=Yes010.
360.
482FemaleRespondents'genderN/A0=Male1=Female0=Male1=Female010.
580.
496InsuredHealthinsurancecurrentlyN/A0=None1=Insurancethroughworkplace2=Medicare3=Medicaid4=CHIP5=Mexicaninsurance6=Twoormoreplans7=Other0=No1=Yes:any010.
540.
501LifeeventsHaveyouexperiencedanyofthefollowingeventsinthepastyearDivorce,lossofalovedone,lossofjoband/ormovedtoanothercity/neighborhoodN/A0=No1=YesConstructedvariable0=No1=Yes,oneormore010.
560.
499Stressand/orexcessworry–Haveyouexperiencedstress–HaveyouexperiencedexcessworryN/A0=No1=Yes0=No1=Yes,stress,worry,orboth010.
580.
496Mentalhealthdiagnoses–Haveyoueverbeendiagnosedbyadoctorwithdepression–HaveyoueverbeendiagnosedbyadoctorwithanxietyHaveyoueverattemptedsuicideHaveyouexperiencedanyothermentalhealthproblemsN/A0=No1=Yes0=No1=Yes,1ormore010.
360.
483450J.
RacialandEthnicHealthDisparities(2015)2:445–456Table3(continued)VariableSurveyquestionsComponentloadingsOriginalresponseoptionsCodingMinMaxMeanSDPsychologicalsymptomsinlast4weeksInthepast4weeks,1=Noneofthetime2=Littleofthetime3=Someofthetime,4=Mostofthetime,5=AllthetimeCreatedafactorusingPAF.
Continuous1.
4022.
1870.
0000.
940–Haveyoubeennervous0.
766–Haveyoufeltdepressed0.
849Haveyounotfeltcalmandpeaceful0.
611Didyounothavealotofenergy0.
740Didyoufeeltired0.
566Haveyounotbeenhappy0.
638Physicalsymptomsinlast1weekInthepastweek,howmuchhaveyoubeendistressedorbotheredby:1=Notatall2=Slightly3=Moderately4=Very5=ExtremelyCreatedafactorusingPAF.
Continuous0.
7123.
090.
0220.
936Faintnessordizziness0.
513Nervousnessorshakinessinside0.
746Heartorchestpain0.
706Nauseaorupsetstomach0.
562Troublecatchingyourbreath0.
752–Weakness0.
655–Numbnessortinglinginpartsofyourbody0.
649J.
RacialandEthnicHealthDisparities(2015)2:445–456451AssessingDisparitiesinMentalHealthOutcomesTable4presentstheresultsfromthecorrelationalanalysisbetweentheindependentanddependentvariables.
Thefol-lowingstatisticallysignificantcorrelationswerefound:Languageacculturationwaspositivelycorrelatedwithstressandexcessworry.
Comorbiditywaspositivelycorrelatedwithdiagnosisofmentalhealthconditionandpsychologicalsymp-tomsinthepast4weeks.
Beingfemalewassignificantlycor-relatedwithalldependentvariables.
Havingmorestressfullifeeventsvariablewaspositivelycorrelatedwiththediagnosisvariablesaswellaspsychologicalandphysicalsymptomsvariables.
Finally,industrialconcernsweresignificantlycor-relatedwithstressandexcessworryandpsychologicalsymp-tomsofdistressinthepast4weeks.
Table5presentsresultsfromtheregressionmodels.
Forthelogisticmodelpredictingstressand/orexcessworry(Table5,A),therewerethreesignificant(p<0.
05)findingsandonefindingthatapproachedsignificance(p<0.
1).
Aone-unitin-creaseinthelanguageacculturationscale(whichis1standarddeviation)leadstoa2.
5timesincreaseintheoddsofare-spondentexperiencingstressand/orexcessworry.
Likewise,femalesare2.
6timesmorelikelytofeelstressedand/orwor-riedthanmales.
Individualswithoneormorecomorbidconditionsare2.
9timesmorelikelytoexperiencestressand/orexcessworry.
Aone-unitincreaseintheindustrialcon-cernsscaleresultsina2.
5timesincreaseintheoddsofarespondentexperiencingstressand/orworry.
US-bornindi-vidualsare0.
8timeslesslikelytoexperiencestressand/orexcessworrythanforeign-bornindividuals.
Forthelogisticmodelpredictingadiagnosisofamentalhealthcondition(Table5,B),thereweretwostatisticallysig-nificant(p<0.
05)findings.
Femalesandthosewhoexperi-encedoneormorelifeeventsinthepastyearareboth6.
9timesmorelikelytobediagnosedwithamentalillness.
FortheOLSmodelpredictingtherespondent'spsycholog-icalsymptomsofdistressinthelast4weeks(seeTable5,C),fourvariablesweresignificantatthep<0.
05level.
Forindi-vidualswithatleastonecomorbidcondition,thereisa0.
4increaseinthepsychologicalsymptomsscale.
Forfemales,thereisanincreaseof0.
5inthescalewhencomparedtomalesandthereisanincreaseof0.
7forthosewhoexperiencedoneormorelifeeventsinthelastyear.
Aone-unitincreaseintheindustrialconcernsscaleresultsinanincreaseof0.
255inthepsychologicalsymptomsscale.
FortheOLSmodelpredictingtherespondent'sphysicalsymptomsofdistressinthelastweek(Table5,D),therewerethreesignificantpredictors(p<0.
05).
FemaleshadascoreonTable4Correlationsbetweencovariatesandmentalhealthoutcomesforlow-incomeHispanicWestwayresidentsStressand/orexcessworryDiagnosisofmentalhealthissuesPsychologicalsymptomsinlast4weeksPhysicalsymptomsinlast1weekEnglishlanguageacculturationCorr.
0.
245*0.
1430.
1420.
021Sig.
0.
0150.
1630.
1730.
838N97979494BornintheUnitedStatesCorr.
0.
1370.
1330.
1200.
086Sig.
0.
1820.
1950.
2510.
410N97979494ComorbidconditionsCorr.
0.
1140.
200*0.
245*0.
164Sig.
0.
2630.
0480.
0170.
113N98989595FemaleCorr.
0.
245*0.
373**0.
307**0.
269**Sig.
0.
0150.
0000.
0020.
009N98989595HasinsurancecoverageCorr.
0.
1490.
0100.
0840.
083Sig.
0.
1440.
9210.
4200.
427N97979494RespondenthasexperiencedstressfullifeeventsCorr.
0.
1250.
359**0.
420**0.
280**Sig.
0.
2180.
0000.
0000.
006N98989595IndustrialrelatedconcernsCorr.
0.
271**0.
1520.
218*0.
195Sig.
0.
0080.
1440.
0380.
064N94949191*Correlationissignificantatthe0.
05level(two-tailed),**correlationissignificantatthe0.
01level(two-tailed)452J.
RacialandEthnicHealthDisparities(2015)2:445–456thephysicalsymptomsscalethatwas0.
5higherthanmalesandthosewhoexperiencedalifeeventalsohadanincreaseof0.
4inthescale.
Aone-unitincreaseintheindustrialconcernsscaleresultedina0.
2increaseinthephysicalsymptomsscale.
DiscussionIntermsofratesofmentalhealthproblems,Westwayresi-dentshaveratesofdiagnoseddepression(29%)thatweremorethanthreetimestheratesforTexasresidents(9%)andtheUSpopulation(7%)inanygivenyear[30,31].
Similarly,theiranxietyrates(25%)arehigherthanthenationalrateof18%inanygivenyearaccordingtotheNationalInstituteofMentalHealth[32,33].
Thirty-sixpercentofWestwayresi-dentsreportbeingdiagnosedwithatleastonementalillnesscontrastingwiththe18%ofindividualsover18withanymentalillnessinTexasandthe20%ofpeoplewithanymentalillnessintheUnitedStates[33].
Locally,WestwayresidentsalsoshowedgreaterratesofdiagnosedmentalhealthconditionsthantheresidentsoftheSanElizariocolonias(alsoinElPasoCounty,Texas)aspreviouslyreportedbyAndersetal.
[4].
Theyfounda20%depressionrateanda17%anxietyratecomparedtoourratesof29and25%,respective-ly.
ElevatedratesofmentalillnessinWestwayareconcerningbecauseifleftuntreatedorundertreated,theycancreateun-necessarydisabilityandfurthertheeconomicchallengesfacedbyresidents[34]exacerbatinginequality.
LiketherestoftheUSpopulation,mostWestwayresidentsdiagnosedwithamentalillnesstreattheirconditionsthroughprimarycarephysicians.
Seventy-onepercentofthosereceiv-ingcarefordepressionoranxietyreceiveitfromaprimarycareprovider,whichisslightlylowerthanthenationalstatis-ticsas74%ofAmericanswhoseekhelpfordepressiongotoafamilydoctorratherthanaspecialist[35].
Twenty-threepercentofWestwayresidentshavenotreceivedmentalhealthcaresincetheirdiagnosisofanxietyordepression.
Itisprob-ablethatalackofhealthinsuranceisrelatedtothislackoftreatment.
Westwayresidents'mostproximatesourceofhealthcareservicesisLaFeClinic,whichislocatedatthenorthedgeofthecommunity.
TheclinicispartoftheCentrodeSaludFamiliarLaFeInc.
,anon-profitorganizationdedi-catedtoprovidehealthcaretounderservedindividualsinElPasoCounty.
ResidentsofElPasoCountycanreceiveavari-etyofservicesataffordablepricesfromthisclinic,whicharedeterminedonaslidingscaleaccordingtoincome.
TheclinicalsoacceptsMedicareorMedicaid.
However,LaFedoesnothavementalhealthspecialistsandpsychiatryisnotincludedintheirlistofspecialtyreferralsaccordingtotheirwebsite.
Thislikelycontributestothelackofspecialtycareobservedamongsurveyedresidents,giventhatweknowthatagoodproportionofWestwayresidents,especiallytheuninsuredandthosewithstate-sponsoredinsurancecoverage,usetheLaFeclinicfortheirhealthcareneeds.
Thelackofaccesstospecialtymentalhealthcareisana-tionwideproblem.
Atthelocallevel,ElPasoCountyhasonly823mentalhealthprofessionals(andonly27ofthesearepsychiatrists),whichis107forevery100,000people[20].
InthestateofTexas,only34%ofpeoplewithmentalillnessesreceiveneededcare.
ThesituationisworseinWestwaywhereonly7%ofpeoplewithananxietyordepressiondiagnosishaveseenaspecialist.
Texasisthestatewiththeleasttreat-mentdollarspercapitaofallstatesanditsmentalhealthcaresystemhasreceivedaDgrade[36,37].
TheUnitedStatessystemalsohasaDgrade.
Nationwide,mentalhealthcareoftenlacksafocusonhealthandwellness;thedataonmentalhealthisinadequateandfundingisscarce;thementalhealthworkforceisnotsufficientlymaintainednordeveloped;andthereisadeficiencyinculturalcompetencyamongprovidersandacultureofdisrespectforthementallyill[36,37].
Table5Regressionmodelspredictingmentalhealthoutcomesforlow-incomeHispanicWestwayresidentsA.
Stressand/orexcessworry(logistic)B.
Diagnosisofmentalhealthcondition(logistic)C.
Psychologicalsymptomsinlast4weeks(OLS)D.
Physicalsymptomsinlast1week(OLS)NagelkerkeR20.
378NagelkerkeR20.
459AdjustedR20.
374AdjustedR20.
138BSESig.
Exp(B)BSESig.
Exp(B)BSEtSig.
BSEtSig.
Languageacculturation0.
9050.
3250.
0052.
4710.
5180.
3210.
1071.
6790.
1350.
0911.
4950.
1390.
0200.
106.
1870.
852USborn1.
3960.
5970.
0190.
2481.
0720.
6510.
1000.
3420.
2850.
1771.
6100.
1110.
0590.
208.
2820.
779Comorbidity1.
0540.
6070.
0832.
8681.
0010.
6090.
1002.
7210.
4470.
1782.
5210.
0140.
2280.
2141.
0660.
290Female0.
9410.
5250.
0732.
5621.
9420.
6190.
0026.
9730.
5220.
1623.
2250.
0020.
4750.
1942.
4530.
016Insured0.
7570.
5570.
1740.
4690.
6880.
6090.
2591.
9900.
1260.
1670.
7560.
4520.
1210.
2010.
6030.
548Lifeevents0.
1120.
5360.
8350.
8941.
9410.
6220.
0026.
9640.
6750.
1644.
1270.
0000.
4140.
1942.
1270.
037Industrialconcerns0.
9070.
3050.
0032.
4780.
5380.
3220.
0941.
7120.
2550.
0872.
9280.
0040.
2160.
1032.
0980.
039J.
RacialandEthnicHealthDisparities(2015)2:445–456453Intermsofassessingintra-ethnicdisparitiesinmentalhealthoutcomes,wefoundthatWestwayresidentswithhigherlevelsofindustrialconcernsweresignificantlymorelikelytoexperiencethreeofthefourmentalhealthoutcomestestedhere,andthefourth(diagnosis)approachedstatisticalsignifi-cance.
Whilenotthesubjectofmanystudies(seeonly12–13),therelationshipbetweenindustrialconcernsandmentalhealthproblemshasbeenfoundindiversesocialgroupsrangingfromthepopulationofSpain[12]toWestway,Texas.
Westwayresidentshavejoinedeffortswithcommunityor-ganizationstoaddressenvironmentalissuesintheircommu-nity.
TheyhaveparticipatedwiththeTexasIndustrialAreasFoundation(IAF)inElPasotoaffectpolicyinanumberofissuesincludingenvironmentalhealth.
ThenewerIAFgroupintheregion,BorderInterfaith(BI),hasworkedwithleadersinWestwaytomaketheTexasCommissiononEnvironmentalQuality(TCEQ)awareoftheirenvironmentalconcerns.
Afterseveralyearsofpressure,TCEQhasincreasedtheiroversight,albeitonasmallscale(e.
g.
,additionalhoursperyear)ofArcelorMittalVinton,oneoftheindustriesnearWestway[27].
Countertotheliterature[14–16],beingbornintheUnitedStatesisassociatedwithhavinglessstressandexcessworry(p<0.
05)andalowerlikelihoodofamentalillnessdiagnosisandfewerpsychologicalsymptomsinthelast4weeks(bothp<0.
10)amongthiscoloniapopulation.
However,previousstudies[14–16]didnotexamineexcessstressandworryspe-cificallyandinsteadfocusedonmentalillnessdiagnoses.
Theassociationbetweenbeingforeign-bornandhigherlevelsofstressandworrycouldbeattributedtothefactthatWestwayislocatedneartheUS-Mexicoborderandthatthereareroutinelylawenforcementandborderprotectionofficialsinthearea.
Thispolicepresencecouldcausestressandconcernforforeign-bornresidentsthatareunauthorizedtobeintheUnitedStates[38].
Additionally,cartelviolenceoccurringjustacrosstheborderinCiudadJuárezduringthedatacollectionmayhavecontributedtostressandworry,especiallyforforeign-bornresidents,wholikelymaintainedstrongtieswithrelativesinJuárez.
ThestrongpresenceoflawenforcementofficialsandthecartelviolenceinMexicoasfactorsinfluenc-ingforeign-bornborderresidentstoexperiencestressandworrywhilelivingintheUSarehypothesesthatshouldbeinvestigatedinfutureresearch.
Wefoundthathigherscoresonthelanguageacculturationscalepredictedexperiencingincreasedstressandexcessworry(p<0.
05).
Thisissurprisinginlightofthefindingthatforeignbirthisariskfactorforstressandexcessworry,althoughitalignswiththeliteratureonthehealth-damagingeffectsofacculturation[17].
Asexpected,US-birthandlanguageaccul-turationarecorrelatedat0.
351(tablenotshown).
Itmeansthatholdingconstanttheeffectofnativity(andtheothercovari-ates),Englishspeakingwasassociatedwithgreaterstressandexcessworry.
Thisreflectsotherstudiesfindingthatgreateracculturationisassociatedwithhigherratesofmentalillness[17].
InWestway,languageacculturationapproachedstatisti-calsignificance(p<0.
11)asapredictorofhigherratesofactualdiagnosedmentalillness.
Inastudyofmentalhealthoutcomespost-disasterinElPasoCounty,researchersalsofoundthatlanguageacculturationwasariskfactorforamen-talhealthproblem(i.
e.
,experiencingdepressionorposttrau-maticstress)post-floodamongthosewhosehomesweredam-aged[39].
Comorbiditywasasignificantpredictorofpsychologicalsymptomsinthelast4weeks,anditapproachedstatisticalsignificanceforthestress/worryanddiagnosisvariables(p<0.
10),aligningwiththestrongrelationshipbetweenchronicphysicalillnessandmentaldisorderspreviouslyob-served[18].
GiventhatHispanicsareatincreasedriskforthesechronicconditionsthatcommonlyco-occurwithdepres-sion,thisfindingisconcerningfromapublichealthperspective.
Beingafemalewasasignificantpredictor(p<0.
05)ofthediagnosis,psychologicalsymptoms,andphysicalsymptomsvariables,anditapproachedsignificanceforstress/worry(p<0.
10).
ThismeansthatpoorHispanicwomeninthiscolonia,likewomenelsewhere,aremorelikelytoexperiencementalhealthchallenges[23].
Lifeeventswerealsosignifi-cantpredictors(p<0.
05)ofdiagnosedmentalillness,psycho-logicalsymptoms,andphysicalsymptomsofdistress.
LimitationsThemainlimitationofthisstudyisthesmallsamplesize(N=98individualsin98differenthouseholds),whichisreflectiveofthesmallcommunityunderstudy(N=1120homes).
Alargersamplecouldallowforamoresophisticatedstatisticalanalysis.
Secondly,theCenterforEpidemiologicalStudies-Depression(CES-D)measure[40],whichisoneofthemostwidelyusedinstrumentstomeasuredepressivedisorders,wasnotusedinthisstudy,limitingitscomparability.
Third,whilebeyondthescopeofthiscommunity-basedparticipatorypro-ject,wedidnotcollectinformationaboutwhenthepersonwasdiagnosedwiththeirmentalillnessandhis/herhealthcare-seekingexperiences.
Last,studieswithHispanicsofmorediversebackgroundscouldalsoprovidemoreinformationonhowethnicityimpactsmentalhealthoutcomes.
RelevanceDespitethenumerouschallengesfacingindividualsincolonias,theirmentalhealthhasremainedunderstudiedandunaddressedbypolicymakersandactivists.
Mentalillnessescanbedebilitatingandtheyfurtherriskforphysicalillnesscomplications[41]andeconomicdecline[34].
Hispanicresi-dentsofthiscoloniahadhighratesofmentalhealthchallengesandfewresourcestodealwiththem;residents'percapita454J.
RacialandEthnicHealthDisparities(2015)2:445–456incomewasonequarteroftheUSaverageandhalflackedhealthinsurance.
AstheHispanicpopulationintheUScon-tinuestogrow,itisbecomingincreasinglyimportanttoun-derstandthecomplexitiesofHispanichealth[39,42].
ThiscasestudyinaUScoloniacontributestothatgoalbyillustrat-ingthehealthchallengesanddisparitiespresentwithinthisgroupoflargelyMexican-origin,low-incomeHispanics.
Evenwithinthissociallymarginalizedgroup,mentalhealthdisparitieswerepresentwithrespecttoenvironmentalcon-cerns,nativity,languageacculturation,comorbidity,gender,andlifeevents.
Thesefindingsunderscoretheimportanceofconsideringintra-ethnicdisparitiesinHispanichealthout-comes.
ThefindingsalsohighlightdeficienciesinmentalhealthcareintheUS,especiallyforlow-income,peri-urbanresidents,suchasthoseinWestway,andpointtotheneedforincreasedaccesstomentalhealthcareatcharityclinicsservingpoorpopulations.
AcknowledgmentsThisworkwasjointlysupportedbytheNationalInstituteofMinorityHealthandHealthDisparities(NIMHD)andtheUnitedStatesEnvironmentalProtectionAgency(AwardNumberP20MD002287-05S1).
ThecontentissolelytheresponsibilityoftheauthorsanddoesnotnecessarilyrepresenttheofficialviewsoftheNIMHDortheEPA.
WeacknowledgetheassistanceofOscarMoralesduringthedatacollectionphaseofthisprojectandDr.
MariaCristinaMoralesduringthestatisticalanalysis.
ResidentsofWestwayparticipatingintheprojectarealsogratefullyacknowledged.
ConflictofInterestGuadalupeMarquez-Velarde,SaraGrineski,andKathleenStaudtdeclarethattheyhavenoconflictofinterest.
InformedConsentAllproceduresfollowedwereinaccordancewiththeethicalstandardsoftheresponsiblecommitteeonhumanexperimen-tation(institutionalandnational)andwiththeHelsinkiDeclarationof1975,asrevisedin2000(5).
Informedconsentwasobtainedfromallpatientsforbeingincludedinthestudy.
Noanimalstudieswerecarriedoutbytheauthorsforthisarticle.
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