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NIH-PA Author Manuscript To collect dried blood spots for CRP, a finger tip was pricked with a sterile lancet and blood
was allowed to drop onto filter paper. Samples were then allowed to dry for at least 6 hours.
NIH-PA Author Manuscript A microtiter plate-based sandwich enzyme immunoassay was used to measure CRP in
specimens eluted from dried blood spots overnight in assay buffer (Brindle, Fujita, Shofer, &
NIH-PA Author Manuscript O'Connor, n.d.). Salivary cortisol was collected using a Sarstedt Salivette©, which involves
the study participant chewing on a cotton roll for 1 minute. Participants did not eat or drink
anything 30 minutes prior to collection. The authors acknowledge that a one-time morning
saliva collection does not provide an ideal measure for cortisol levels. However, collecting this
particular sample demonstrated that study participants were willing to undergo this sort of
procedure. Conventionally, salivary cortisol is measured from three collections: just before
sleeping, upon rising the next morning, and 30 minutes after rising. Salivary cortisol was
analyzed using the typical enzyme-linked immunosorbent assay competitive binding strategy.
An AL score was calculated based on the conventional method of summing the number of
biological parameters in which the study participant was in the highest quartile (above the 75th
percentile within the sample) (Seeman et al., 2001; Seeman, Singer, Rowe, Horwitz, &
McEwen, 1997). AL scores could range from 0 to 6, but for this sample the range was 0 to 4.
The sample AL score was subsequently dichotomized at the median to obtain low (< 2) and
high (≥ 2) categories.
Survey Interview—Survey questions assessed a variety of work-related, economic, and
social stressors.
Work-related Stressors: Five questions, reflective of working under precarious or hazardous
conditions, were asked (e.g., “Have you ever worked a job where you feared you might be hurt
or killed?” and “Do you feel your immigration status affects how safe your job is?”). These
were used in a previous study of urban day laborers conducted by Seixas et al. (2008). A
question about employment frustration (“Do you find it difficult to find the work you want
because you are of Latino descent?” was also asked (Finch, Catalano, Novaco, & Vega,
2003). Response choices to these six items were yes or no. Participants were also asked how
many years they had been working as a day laborer.
Economic Stressors: Four items were used to assess economic-related stressors. For example,
participants were asked, “Would you say you have more money than you need? (not enough,
just enough, or more than enough)” and “How do you feel about the economic opportunity you
have had in the United States? (very dissatisfied, dissatisfied, neither dissatisfied nor satisfied,
satisfied, or very satisfied).” These items have been used in previous studies of financial and
economic strain (Aldana & Liljenquist, 1998; Krause, 1987; Krause, Jay, & Liang, 1991;
Takeuchi, Williams, & Adair, 1991), including studies of immigrants (de Castro, Gee, &
Takeuchi, 2009; Franzini & Fernandez-Esquer, 2004; Vega, Kolody, & Valle, 1987).
Additionally, subjective social status was measured with the ladder scale developed by Adler
and colleagues (Adler, 2006; Adler, Epel, Castellazzo, & Ickovics, 2000). Participants were
shown a drawing of a ladder with 10 rungs and told that the lowest rung represents those earning
the least money, having the least education, and working in the least respected jobs or having
no jobs, whereas the top rung represents those who are the best off. Participants were asked to
separately identify on which rung they stood (1 being lowest and 10 being highest) currently
and relative to others in the United States. This ladder scale has been used in several previous
studies, including studies of immigrant populations (Adler et al., 2008; de Castro et al.,
2009; Franzini & Fernandez-Esquer, 2006; Leu et al., 2008; Ostrove, Adler, Kuppermann, &
Washington, 2000).
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NIH-PA Author Manuscript Social Stressors: Everyday discrimination was measured using a 9-item scale adapted from
Williams, Yu, Jackson, and Anderson (1997). Participants were asked how frequently they
perceived experiences of chronic and routine unfair treatment. Examples of items include,
“You are treated with less courtesy than other people,” “People act as if they are afraid of you,”
and “You are called names or insulted.” Responses ranged from 1 (never) to 6 (almost
everyday); they were summed and then divided by 9 to calculate an everyday discrimination
score. Scores ranged from 1 to 6 for this sample. Participants were subsequently asked to
identify what they thought was the main reason for these experiences (e.g., gender, race, age,
sexual orientation, other).
Eight items from the Hispanic Stress Inventory (Cervantes, Padilla, & Salgado de Snyder,
1990, 1991) were also included. Examples of these items included, “Do you feel guilty for
leaving family or friends in your country of origin?”, “Do you feel that in the United States
you have the respect you had in your country of origin?”, “Do you find it hard interacting with
others because of difficulties you have with the English language?”, and “Do you think you
will be deported if you go to a social or government agency?” Response choices to these items
were yes or no.
NIH-PA Author Manuscript Health Status: Two items assessing self-rated health were included. Participants were asked,
“How would you rate your overall physical (or overall mental) health?” (1 = poor to 5 =
excellent). These one-item measures have been shown to predict morbidity (Idler & Benyamini,
1997; Singh-Manoux et al., 2006). For this study, responses were dichotomized into “poor/
fair” and “good/very good/excellent,” consistent with prior studies (de Castro et al., 2009;
Manor, Matthews, & Power, 2000; Ponce, Hays, & Cunningham, 2006).
An additional item assessing “unhealthy days,” used by the Centers for Disease Control and
Prevention (CDC, 2000) to measure the effects of numerous disorders, short- and long-term
disabilities, and diseases among different populations, was included. Participants were asked
for the number of days in the past month that poor physical or mental health prevented their
usual activities, such as self-care, work, or recreation. Six items from the CDC's Behavioral
Risk Factor Surveillance Survey (www.cdc.gov/BRFSS) assessed cigarette and alcohol use.
These items measured respondents' use of tobacco (i.e., current smoking status, lifetime
smoking history, and daily cigarette consumption) and alcohol (i.e., drinking patterns in the
past month). Questions included, “Do you now smoke cigarettes every day, some days, or not
at all?” and “In the past month, on the days when you drank, how many drinks did you have?”
NIH-PA Author Manuscript Analysis Demographics: Participants were also asked general demographic questions. These involved
age, marital status, native language, country of birth, education, year first arrived in the United
States, previous training in a specific profession or occupation, and whether a participant
currently held another job in addition to being a day laborer.
Percentages and mean scores, as appropriate, were calculated for each of the study measures
for the entire sample as well as by low and high AL categories. Although this was a pilot study
with a sample size of only 30 participants, differences in scores between low and high AL
groups were explored using either t-tests or Fisher's exact test. All analyses were conducted
using the STATA 10.0 statistical package.
RESULTS
Table 1 displays demographic characteristics of the sample. On average, the participants were
46 years old and had been in the United States for 12 years. Most were married (47%), natively
spoke Spanish (97%), were from Mexico (77%), and had completed some elementary school
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NIH-PA Author Manuscript as their highest level of education (43%). Approximately 17% stated that they had previous
training in a specific profession or occupation, and only 7% currently held another job in
NIH-PA Author Manuscript addition to working as a day laborer.
NIH-PA Author Manuscript For each of the six AL measures examined, means with standard deviations and ranges are
displayed in Tables 2 and 3. Mean SBP and DBP were 129.2 and 79.5 mmHg, respectively.
The sample had an average BMI of 28.4 and an average WHR of 0.9. Mean CRP and salivary
cortisol levels were 2.1 mg/L and 13.9 ng/ml, respectively. Table 2 also shows the 25th, 50th,
and 75th percentile scores for each of the AL measures. As described above, individuals' AL
score was based on the number of biological measures for which they were above the 75th
percentile. AL scores ranged from 0 to 4, with the largest group (23.3%) scoring 2 (Table 3).
Those with AL scores of 0 or 1 were classified as low AL (50% of study participants) and those
with AL scores of 2, 3, or 4 were classified as high AL (50% of study participants).
Table 4 provides descriptive statistics for work-related, economic, and social stressors by low
and high AL groups and the total sample. Overall, no statistically significant differences were
observed between the two groups across all measures. On average, those with high AL had
been working as a day laborer for nearly 11 years, compared to just under 5 years for those
with low AL. Furthermore, participants with high AL had worked in a job with a fear of being
hurt or killed (53% vs. 33%), had left a job because it was dangerous (27% vs. 7%), were more
likely to report concerns about hazardous working conditions to employers (93% vs. 80%),
and felt that their immigration status affected how safe their job was (60% vs. 47%). In contrast,
more of those with low AL reported that it is difficult to find the work they want because of
their Latino descent (67% vs. 60%).
Regarding economic stressors, generally more of those with high AL reported not having
enough money, having difficulties paying bills and buying food, and being dissatisfied to very
dissatisfied with their economic opportunity in the United States, compared to those with low
AL. Also, those with high AL rated their current subjective social status lower than that of
those with low AL (3.8 vs. 4.7) but higher relative to others in the United States (3.9 vs. 3.2).
In terms of social stressors, those with high AL reported higher everyday discrimination scores
(2.5 vs. 2.0), having been questioned about their legal status (53% vs. 20%), and fear of being
deported if they went to a social or government agency (73% vs. 53%). Additionally, fewer of
the high AL group felt they had the same respect they had in their country of origin (33% vs.
53%).
Finally, Table 5 shows descriptive statistics for health status measures by low and high AL
groups and the total sample. Comparing the low and high AL groups, more high AL workers
reported fair/poor physical health (93%) and more low AL workers reported excellent/very
good/good physical health (40%). Additionally, those with high AL reported an average of 5.1
unhealthy days in the past month, compared to 2.1 for those with low AL. More of those with
high AL smoked at least 100 cigarettes in their lifetime (60%), had at least one drink of alcohol
in the past month (40%), and drank 5 or more alcoholic drinks an average of 2.4 times in the
past month, compared to those with low AL (47%, 13%, and 0.5 times, respectively).
DISCUSSION
This pilot study primarily evaluated the feasibility of conducting research with Latino day
laborers, a hard-to-reach worker population. Specifically, the researchers assessed whether
these workers would participate in a study involving the collection of biological markers and
a survey interview exploring how work-related, economic, and social stressors might contribute
to AL among Latino day laborers. AL has been used as a composite measure of the
physiologically damaging response to exposure to chronic stressors in general population
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NIH-PA Author Manuscript studies, but few have specifically focused on the experience of worker populations. Previously
published research considering AL among workers was primarily conducted in Europe with
NIH-PA Author Manuscript native-bom samples who had relatively stable employment (Bellingrath et al., 2008;
Schnorpfeil et al., 2003; von Thiele et al., 2006). No study was found that had been conducted
NIH-PA Author Manuscript among immigrant and contingent workers. The examination of AL has particular relevance for
Latino day laborers, who face extreme chronic stressors such as long-term employment
insecurity, working in unregulated high-hazard jobs, exploitation, discrimination, separation
from family and friends, and the inability to pay for housing and food. These factors
independently and in concert can have detrimental effects on health status at the individual
level, and can also contribute to broader health disparities at the population level.
Although the data are from a small sample (N = 30), study findings suggest that stressors in
the contexts of work, economics, and society may contribute to high AL for Latino day laborers.
For example, those with high AL had been working as day laborers for an average of 11 years,
compared to 5 years for those with low AL. This indicates that chronic employment insecurity
adversely affects physiologic health. Regarding economic and social stress, those with high
AL reported lower general subjective socioeconomic status and higher everyday discrimination
scores compared to those with low AL. These findings are consistent with previous studies
examining the adverse health impact of job insecurity (Ferrie, Shipley, Stansfeld, & Marmot,
2002; Quinlan & Bohle, 2009), low subjective socioeconomic status (Adler et al., 2000,
2008), and discrimination (Gee, Ryan, Laflamme, & Holt, 2006). Additionally, a variety of
health status measures were explored in relation to low and high AL. Those with high AL rated
their physical health much worse and reported a greater overall smoking history (as defined
by smoking more than 100 cigarettes in their lifetime) and consumption of alcohol.
Overall, these findings suggest that working as a day laborer has potential health consequences
beyond simply experiencing an injury or illness directly resulting from a worksite hazard (e.g.,
falling from a rooftop or a struck-by incident). Because AL is a measure of physiologic “wear
and tear” reflective of pre-clinical disease outcomes, this study suggests that the stressful
experiences of day laborers have implications for health outcomes that may not be readily
perceived to be “work-related.” Further investigation that considers more specific clinical
health outcomes and how AL mediates relationships between the kinds of stressors that day
laborers encounter is needed to more fully evaluate this hypothesis.
Although the researchers contrasted a variety of measures between those with low and those
with high AL within this sample, comparison to general population samples of Latinos could
provide insight into the relative stress experience and health status of day laborers. For example,
previous studies note that 1% and 4% of a nationally representative sample of Mexicans
reported being very dissatisfied and dissatisfied, respectively, with economic opportunity in
the United States (Guarnaccia et al., 2007), whereas, overall, this study sample reported 43%
and 10%, respectively. In terms of subjective social status, a general population of Mexican
immigrants reported a mean score of 4.7 (Franzini & Fernandez-Es-quer, 2006), whereas this
sample's overall score was 4.3. Another study of labor migrants reported that 20% experienced
difficulties finding work they wanted because of their Mexican descent (Finch et al., 2003);
63% of this sample reported so. Additionally, this sample reported lower ratings for general
physical and mental health compared to those in the National Latino and Asian American Study
(NLAAS). Seventy-seven percent and 47% of this sample rated their physical and mental health
as fair or poor, respectively; the NLAAS reported 28% and 12%, respectively (Mulvaney-Day,
Alegria, & Sribney, 2007). Collectively, these examples suggest that Latino day laborers
experience greater severity of stressors and are less healthy than the general Latino population.
The primary objective of this pilot study was to assess the feasibility of conducting research
with an immigrant day labor population, collecting interview and biologic data. Because of
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NIH-PA Author Manuscript important, sensitive characteristics specific to the day labor population (e.g., low
socioeconomic status, working on a contingent basis, having undocumented status, and
NIH-PA Author Manuscript potential suspicion of university-based researchers), the study staff had no previous knowledge
or experience regarding how day laborers would respond to participating in such a study or
whether the worker center, CASA Latina, would be receptive to the recruitment of study
participants at its location.
The researchers note that before this pilot study was undertaken, members of the research team
had established a trust relationship with CASA Latina during 4 years by providing a variety
of services, such as assessing occupational exposures, injuries, and illnesses (Seixas et al.,
2008), providing health and safety training, and trialing an injury and illness surveillance
system. This allowed the authors to comfortably propose this pilot to CASA Latina's leadership.
The researchers directly consulted CASA Latina's staff about how to maintain the center's
operations and respect sensitivities of day laborers' concerns and culture. Soliciting input
provided insights that informed the successful conduct of this pilot study.
In terms of day laborers' response to participating in the study, only one individual, among
those selected through the lottery, refused to participate. This occurred when obtaining
informed consent. The high participation rate could be attributed to two primary reasons. First,
recruitment was held among those day laborers who were not selected for a job. The alternative
to not working and not earning any money was to earn $60 for participating in the study.
Second, after the initial two groups participated in data collection, word about the project spread
among other day laborers, especially that study participants had a positive experience.
It was also important to include a service benefit for study participants. Again, in consultation
with CASA Latina staff, study participants were screened for potential hypertension, although
none met criteria for clinical referral. All participants were given a list of local health clinics,
including those serving primarily Latino clients, and counseled as to where they could receive
health care services free of charge and without need to show documentation.
NIH-PA Author Manuscript LIMITATIONS
Because the research was a pilot study, the researchers were limited to a small sample size of
30 study participants. As such, the authors were unable to test for correlations between stressors
and AL or to detect differences across measures between low and high AL groups. However,
the data did allow the researchers to assess trends that provide preliminary insight into the
stressor-AL experience for immigrant day laborers. Additionally, the researchers did not collect
the full battery of AL measures (e.g., HbA1c, NE and EPI, HDL, and DHEA-S) conventionally
used in previous research, primarily due to cost and logistical difficulties with sample collection
(e.g., collecting 12-hour overnight urine for NE and EPI). They were also unable to collect
multiple saliva samples for cortisol, which is ideally obtained three times (before sleeping,
upon rising, and 30 minutes after rising). Further, they note that elevated CRP may be
associated with muscle damage after high physical exertion (Kim, Lee, & Kim, 2007;
Neubauer, Konig, & Wagner, 2008), potentially confounding its use as an indicator of AL,
particularly among day laborers, who typically take on physically demanding jobs. Future
studies should include a wider array of biological markers that can be used to derive a richer,
more complete measure of AL. Despite this, the study included a selection of biological markers
that use different collection techniques (e.g., saliva, dried blood spots, BP, and anthropometric
measurement), revealing that day laborers were willing to participate in such data collection.
The authors also recognize that interview responses are based on self-report, which is
potentially subject to recall and social desirability biases. Future studies could collect
qualitative data in addition to survey data to tap into stress constructs that standardized
instruments may not fully capture. Finally, because the data are cross-sectional, the researchers
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NIH-PA Author Manuscript believe that a prospective study would better reflect the chronic impact of stressors among day
laborers. It is possible that these data are subject to the healthy worker effect. As such,
longitudinal data could better track changes in AL measures and other aspects of health status.
NIH-PA Author Manuscript IMPLICATIONS FOR PRACTICE
NIH-PA Author Manuscript The profile of the U.S. work force is changing. First, it is becoming increasingly racially and
ethnically diverse. Second, it is becoming increasingly contingent. Previous reports highlight
disparate health consequences among minority workers (Birdsey, Alterman, & Petersen,
2007; Friedman & Forst, 2008; Murray, 2003) and workers threatened with job insecurity
(Ferrie et al., 2002; Quinlan & Bohle, 2009; Rugulies, Aust, Burr, & Bultmann, 2008). Latino
day laborers, many being undocumented immigrants and contingently employed over long
periods, are simultaneously confronted with extreme forms of stressors related to these
characteristics. This study sheds light on the variety of stressors that day laborers experience
and their impact on physical health. These workers would benefit from services that
occupational health nurses could provide, most notably worker training about injury prevention
and health education. More broadly, day laborers need preventive, public health-oriented
nursing services, which occupational health nurses are trained to deliver.
This study also applies the concept of AL to chronic stressors in an immigrant, contingent work
context. As stated, the examination of AL has not been previously conducted with day laborers.
Given the positive experience with this project, the researchers are optimistic that a more
comprehensive study of AL is possible. Occupational health nurses can assume several roles
in studies of AL, such as informing research questions, determining features of study design
and protocol, participating in data collection, and crafting interventions based on research
findings.
Further, this project demonstrates that research collaborations can be successfully developed
between academic institutions and community-based organizations. As advocates for worker
health, occupational health nurses can encourage and facilitate such relationships. Being
mindful of workers' circumstances and needs while concurrently understanding the goals of
research, occupational health nurses can serve a key role in negotiating the benefits for both
parties. Also, occupational health nurses have a responsibility to ensure that the ethical
treatment of workers is a priority. This can be especially important when addressing sensitive
issues about workers, such as documentation status among Latino day laborers.
Finally, this study was conceptualized with an expanded perspective of occupational health.
Guided by an ecological framework, this study takes into account how broader economic and
social factors beyond the workplace contribute to worker well-being. Occupational health
nurses should consider how factors external to the immediate work environment and spanning
the many layers of society impact the health of worker populations. Such factors can have work
performance and organizational implications for worker productivity, absenteeism, and
presenteeism.
CONCLUSION
This study explored how stressors relevant to Latino day laborers may have consequences for
AL, a composite measure of the physiologic burden of chronic stress. Findings suggest that
Latino day laborers are potentially at risk for high AL in relation to work-related, economic,
and social stressors. The researchers also demonstrated that a study involving the collection of
interview and biologic measures with this hard-to-reach population is feasible. However, from
the authors' experience, success of such an undertaking is predicated on establishing trust and
working collaboratively to determine study goals and procedures with the partnering
community-based organization. The prospect of conducting a larger-scale research project that
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can more comprehensively examine the stressor-AL relationship among day laborers is
promising.
NIH-PA Author Manuscript Acknowledgments
NIH-PA Author Manuscript The authors thank Hilary Stern and the CASA Latina staff for their partnership and assistance with participant
recruitment; Allison Crollard, Lesley Hoare, and Coby Jansen for their support with data collection; Eleanor Brindle
NIH-PA Author Manuscript and Ernie Tolentino for their assistance with laboratory analysis; and Tessa Rue for her assistance with statistical
analysis. This publication was made possible by funds from grant number 3T42OH008433 from the Centers for Disease
Control and Prevention—National Institute for Occupational Safety and Health (CDC-NIOSH) and grant number
1KL2RR025015-01 from the National Center for Research Resources (NCRR), a component of the National Institutes
of Health (NIH) and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and
do not necessarily represent the official view of NCRR or NIH. Information on NCRR is available at
www.ncrr.nih.gov. Information on Re-engineering the Clinical Research Enterprise can be obtained from
http://nihroadmap.nih.gov/clinicalresearch/overview-translational.asp.
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Table 1
Sample Demographics
NIH-PA Author Manuscript Characteristic %a
Age in years
M 45.8
SD 13.2
Years in the United States
M 12.1
SD 9.7
Marital status
Married 46.7
Separated, divorced, or widowed 23.3
Never married 30.0
Native language
Spanish 96.7
Quiche 3.3
NIH-PA Author Manuscript Country of birth
Mexico 76.7
Guatemala 10.0
El Salvador 6.7
Honduras 3.3
Peru 3.3
Education
None 6.7
Elementary school (grades 1 to 6) 43.3
Middle school (grades 7 to 8) 23.3
High school (grades 9 to 12) 10.1
College 3.3
Vocational school 13.3
Trained in a specific profession or occupation?b
Yesc 16.7
NIH-PA Author Manuscript No 43.3
Current job other than day labor?
Yes 6.7
No 93.3
Note.
a
Numbers are percentages unless otherwise noted.
b
Thirty percent of the participants refused to answer this question.
cThese included chauffeur, air conditioning repair, tourism, military, and bricklayer. Of these, 60.0% stated they wished they were working in that
job.
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Mean, Standard Deviation, Range, and Percentile Cut-Points for Allostatic Load Measures
AL Measure Normal M SD Range 25th Percentile 50th Percentile 75th Percentilea
SBP (mmHg) < 120 129.2 18.7 102.5–189.0 117.5 124.0 138.0
DBP (mmHg) < 80 79.5 10.0 55.0–98.5 72.5 79.0 87.5
BMI 18.4–24.9 28.4 6.4 20.9–55.5 24.7 27.2 28.5
WHR < 1.0 0.9 0.1 0.8–1.1 0.9 0.9 0.9
CRP (mg/L) - 2.1 4.0 0.1–21.6 0.4 0.8 1.8
Cortisol (salivary) (ng/ml) - 13.9 33.0 3.1–187.9 5.5 7.4 10.7
Note. AL = allostatic load; SBP = systolic blood pressure; DBP = diastolic blood pressure; BMI = body mass index; WHR = waist-to-hip ratio; CRP = C-reactive protein.
a
Individuals having two allostatic load measures at or above the 75th percentile were categorized as “high AL.”
Page 16
de Castro et al. Page 17
Table 3
Distribution of Overall Allostatic Load Scores
NIH-PA Author Manuscript Allostatic Load Scorea % of Participants
0 30.0
1 20.0
2 23.3
3 16.7
4 10.0
5 0.0
6 0.0
Note.
aPossible range of 0 to 6. Allostatic load score of 0 to 1 was classified as low allostatic load; allostatic load score of 2 to 4 was classified as high
allostatic load.
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NIH-PA Author Manuscript Table 4
Percentage or Mean Score of Work-Related, Economic, and Social Stressors Among Day Laborers by Allostatic
Load Score
Low AL (n = 15) High AL (n = 15) Total (N = 30)
Work-related stressor
Years working as a day laborer (M; SD) 4.6; 6.0 10.5; 8.7 7.6; 8.0
Have you ever worked a job where you feared you might be hurt or killed? (Yes) 33.3 53.3 43.3
Have you ever left or not done a job because it was dangerous? (Yes) 6.7 26.7 16.7
Would you report concerns of hazardous working conditions to the on-site 80.0 93.3 86.7
employer? (Yes)
If faced with a workplace hazard, would you ask the employer for safety equipment/ 100.0 93.3 96.7
tools? (Yes)
Do you feel your immigration status affects how safe your job is? (Yes) 46.7 60.0 53.3
Do you find it difficult to find the work you want because you are of Latino descent? 66.7 60.0 63.3
(Yes)
Economic stressor
Would you say you have more money than you need?
Not enough 80.0 100.0 90.0
NIH-PA Author Manuscript Just enough 20.0 0.0 10.0
More than enough 0.0 0.0 0.0
How difficult is it for you to pay your monthly bills?
Very 46.7 66.6 56.7
Somewhat 40.0 20.0 30.0
Not very 13.3 6.7 10.0
Not at all 0.0 6.7 3.3
How often in the past 12 months have you not been able to buy food?
Often 39.9 33.3 36.7
Sometimes 46.7 53.3 49.9
Rarely 6.7 6.7 6.7
Never 6.7 6.7 6.7
How do you feel about the economic opportunity you have had in the United States?
Very dissatisfied 6.7 13.3 10.0
Dissatisfied 33.3 53.3 43.3
NIH-PA Author Manuscript Neither dissatisfied nor satisfied 33.3 26.7 30.1
Satisfied 20.0 6.7 13.3
Very satisfied 6.7 0.0 3.3
Subjective social status at this current time; range = 1 to 10 (M; SD) 4.7; 2.3 3.8; 2.1 4.3; 2.2
Subjective social status relative to others in the United States; range = 1 to 10 (M; 3.2; 1.4 3.9; 1.9 3.5; 1.6
SD)
Social stressor
Everyday discriminationa; range = 1 to 6 (M; SD) 2.0; 1.0 2.5; 1.3 2.2; 1.1
Do you feel guilty for leaving family or friends in your country of origin? (Yes) 40.0 40.0 40.0
Do you feel that in the United States you have the respect you had in your country 53.3 33.3 43.3
of origin? (Yes)
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de Castro et al. Page 19
Low AL (n = 15) High AL (n = 15) Total (N = 30)
Do you feel that living out of your country of origin has limited your contact with 73.3 66.7 70.0
family or friends? (Yes)
NIH-PA Author Manuscript
Do you find it hard interacting with others because of difficulties you have with 86.7 66.7 76.7
the English language? (Yes)
Do people treat you badly because they think you do not speak English well or 26.7 26.7 26.7
speak with an accent? (Yes)
Have you been questioned about your legal status? (Yes) 20.0 53.3 36.7
Do you think you will be deported if you go to a social or government agency? 53.3 73.3 63.3
(Yes)
Do you avoid seeking health services due to fear of immigration officials? (Yes) 33.3 33.3 33.3
Note. AL = allostatic load. Low AL = 0 to 1; high AL = 2 to 4.
aTop three reasons for experiencing everyday discrimination were “race” (7 participants), “ancestry or national origin” (6 participants), and “skin
color” (2 participants).
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NIH-PA Author Manuscript Table 5
Percentage or Mean Score of Health Status, Smoking, and Alcohol Use Among Day Laborers by Allostatic Load
Score
Low AL (n = High AL (n = Total (N = 30)
15) 15)
NIH-PA Author Manuscript Health status 60.0 93.3 76.7
Self-rated physical health 40.0 6.7 23.3
Fair/poor
Excellent/very good/good 46.7 46.7 46.7
Self-rated mental health 53.3 53.3 53.3
Fair/poor 2.1; 4.6 5.1; 10.4 3.7; 8.1
Excellent/very good/good
In the past month, the number of days that poor physical or mental health prevented 46.7 60.0 53.3
your usual activities, such as self-care, work, or recreation (M; SD) 42.8 11.1 25.0
Smoking 28.6 22.2 25.0
28.6 66.7 50.0
Smoked at least 100 cigarettes in lifetime (Yes)
Frequency of cigarette smokinga 5.3; 4.0 15.0b 7.8; 5.9
2.5; 0.7 1.5; 0.7 2.0; 0.8
Everyday
Some days 13.3 40.0 26.7
None at all 6.5; 7.8 3.8; 4.3 4.5; 4.8
Number of cigarettes per day 0.5; 0.7
Among everyday smokers (M; SD) 2.4; 2.9 1.9; 2.5
Among some days smokers (M; SD)
Alcohol use
In the past month, had at least one alcoholic drink (e.g., beer, wine, liquor) (Yes)
In the past month, on days when drank, number of drinks had; only among those having
had at least one alcoholic drink in past month (M; SD)c
In the past month, the number of times had 5 or more drinks on an occasion; only
among those having had at least one alcoholic drink in the past month (M; SD)d
NIH-PA Author Manuscript Note. AL = allostatic load; low AL = 0 to 1; high AL = 2 to 4.
aPercents based on 16 total participants who had smoked at least 100 cigarettes in lifetime (n = 7 in low AL group, n = 9 in high AL group).
b
Only one individual in this cell.
c
Percents based on 8 total participants who had at least one alcoholic drink in the past month (n = 2 in low AL group, n = 6 in high AL group).
dPercents based on 7 total participants who had at least one alcoholic drink in the past month (n = 2 in low AL group, n = 5 in high AL group) as 1
participant was “not sure” for this question.
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568782 HJBXXX10.1177/0739986314568782Hispanic Journal of Behavioral SciencesGalvan et al.
research-article2015
Article
Chronic Stress Among Hispanic Journal of Behavioral Sciences
Latino Day Laborers 2015, Vol. 37(1) 75– 89
© The Author(s) 2015
Reprints and permissions:
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DOI: 10.1177/0739986314568782
hjb.sagepub.com
Frank H. Galvan1, Amy Rock Wohl2,
Juli-Ann Carlos2, and Ying-Tung Chen1
Abstract
Latino day laborers endure many hardships as they struggle to adjust as an
immigrant community in the United States. This study sought to identify the
extent of chronic stress reported by day laborers and the factors associated
with stress. A total of 725 Latino day laborers were interviewed. The most
reported sources of stress were having immigration-related problems, not
having enough money to cover basic needs, having no savings, and having
work hours change for the worse. Higher chronic stress was associated with
homelessness (p < .001) and HIV-related risk behaviors in the previous 12
months (p < .05). In addition, chronic stress was found to be higher among
respondents reporting incomes of US$5,000 to US$10,000 (p = .007) and
still higher among respondents reporting incomes greater than US$10,000
(p < .001) compared with those in the lowest income level. Lower chronic
stress was associated with having a partner (p < .05) or being single (p =
.001) compared with being married. Addressing the stress experienced by
day laborers is necessary to prevent potential negative health and mental
health consequences among this population.
Keywords
Latinos, day laborers, immigrants, chronic stress
1Bienestar Human Services, Los Angeles, CA, USA
2Los Angeles County Department of Public Health, CA, USA
Corresponding Author:
Frank H. Galvan, Bienestar Human Services, 5326 East Beverly Blvd., Los Angeles, CA 90022,
USA.
Email: [email protected]
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76 Hispanic Journal of Behavioral Sciences 37(1)
Introduction
Latino day laborers have been described as being a “structurally vulnerable
population,” suggesting that their difficult living situation in society is the
result of specific global, economic, and political conditions beyond their con-
trol (Organista et al., 2013). Day workers seek jobs primarily through infor-
mal locations, such as standing in front of businesses, home improvement
stores, gas stations, and on busy streets (Valenzuela, Theodore, Melendez, &
Gonzalez, 2006). Day labor work can be very precarious and contribute to the
stress experienced by a population already struggling to adjust as a mostly
immigrant community in the United States. Chief among the struggles expe-
rienced by Latino day laborers is the need to obtain sufficient income for their
families and themselves.
Ethnographic studies conducted with Latino day laborers reveal that most
day laborers report coming to the United States to financially support their
families in their countries of origin (Walter, Bourgois, & Loinaz, 2004;
Walter, Bourgois, Loinaz, & Schillinger, 2002). They are oftentimes the sole
providers to their families (Nelson, Schmotzer, Burgel, Crothers, & White,
2012). In addition, many borrow money from friends or relatives to cover
their transit costs and, as a result, may spend their first few months after
arrival repaying their debts (Walter et al., 2004; Walter et al., 2002). Given
their focus on earning enough money to send home to their families, day
laborers endure hardships (Walter et al., 2004) that include homelessness and
high-density shared housing with other men in order to save on housing costs
(Nelson et al., 2012).
Day labor work itself can also pose many challenges for those relying
upon it as a source of income. In a sample of 217 Latino urban day laborers
in San Francisco, the participants reported being successful only about one
third of the time in securing work on the days that they sought employment
(Nelson et al., 2012). In addition, day labor work is often brief (Duke,
Bourdeau, & Hovey, 2010), resulting in the need to continually be in the
search for new employment opportunities. This situation makes day laborers
particularly vulnerable economically when considering that most day labor-
ers rely on their day labor work as their only source of income and most are
at or below the federal poverty level (Valenzuela et al., 2006). Violations of
day laborers’ rights, such as not being paid for their work, working under
hazardous conditions, and receiving insults from employers, also occur
(Negi, 2011; Nelson et al., 2012; Valenzuela et al., 2006). Day laborers also
experience a high degree of risk for work-related injuries from their jobs
(Walter et al., 2002).
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Galvan et al. 77
In addition to negative working conditions, other factors contribute to the
vulnerable situation of Latino day laborers. Given that the majority of Latino
day laborers are undocumented residents (Valenzuela et al., 2006), this makes
them particularly vulnerable in the present political situation in the United
States. They may be subject to deportation based on current federal immigra-
tion policy. In addition, there exists a climate of xenophobia against immi-
grants that contributes to experiences of discrimination against them (Duke
et al., 2010). An example of this is being treated with suspicion by police
authorities (Negi, 2011).
Discrimination also takes the form of being victimized by others. The
criminal victimization of Latino day laborers has been described as being an
increasing yet often underreported phenomenon (Negi, Cepeda, & Valdez,
2013). In response to such forms of discrimination, many day laborers may
choose to intentionally socially isolate themselves in order to avoid encoun-
tering experiences of hostility from others (Negi, 2011).
These negative experiences can affect the health and mental health of
Latino day laborers. For example, over half of 217 day laborers interviewed
for a study in San Francisco described their health status as fair or poor
(Nelson et al., 2012). Hopelessness and sadness are also prominent in the
lives of such workers (Negi, 2011). Negative mental health consequences are
often associated with discriminatory experiences from others. For example,
in a study of 150 Latino day laborers, discrimination and stigma associated
with one’s ethnicity was found to be related to psychological distress and
social isolation (Negi, 2013). Higher levels of discrimination and social iso-
lation were both associated with more psychological distress.
Not surprisingly, a large percentage of Latino day laborers report experi-
encing stress in their lives. Among 102 day laborers interviewed in San
Francisco, 57.8% reported high rates of work-related stress (Duke et al.,
2010). Additionally, in a study of 30 Latino day laborers in Seattle, stress
associated with work, personal finances, and everyday discrimination was
found to place day laborers at risk for high allostatic load (a measure of the
physiologic effects of chronic stress; de Castro, Voss, Ruppin, Dominguez, &
Seixas, 2010).
Examining the issue of stress among Latino day laborers is important
because stress-provoking situations are unequally distributed among groups
based on their different social positions in society (Pearlin, 1991), making
some groups more vulnerable than others to certain types of stressors. In
addition, it is also important to examine which subpopulations among vulner-
able groups experience more stress. Some preliminary work on this topic
among Latino day laborers has been conducted.
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78 Hispanic Journal of Behavioral Sciences 37(1)
In a study of 102 Latino day laborers in Northern California, day laborers
who were married or living as married reported higher levels of stress than
those who were not (Duke et al., 2010). Those with children under the age of
18 years reported more stress than those who had no children. No other
sociodemographic variables were found to be associated with stress. In a
smaller study of 30 Latino day laborers in Seattle, no statistical differences
were found in the stress scores of all of the work-related (e.g., years working
as a day laborer), economic (e.g., available financial resources), and social
stress (e.g., discrimination) indicators measured (de Castro et al., 2010). This
may have been due to the small sample size used by the study.
The present study sought to contribute to the literature on stress experi-
enced by Latino day laborers by identifying the extent of stress reported by
them and the factors associated with stress among day laborers. Furthermore,
it utilized a larger sample of day laborers than those used previously in other
studies. It also incorporated a random selection of the participants recruited
into the study with the hope that the generalizability of the results would be
improved. Information on stress and the factors associated with stress among
Latino day laborers can be of use to agencies and providers of services work-
ing with this population.
Method
Identifying Day Labor Sites
This study was part of an overall research project examining the HIV testing
behaviors and HIV-related risk behaviors of Latino day laborers. For Phase 1
of the study, we began by developing a list of day labor sites, guided by the
approaches described by Valenzuela (2000) and MacKellar et al. (2007). For
this purpose, we used the Service Planning Areas (SPAs) of Los Angeles
County. SPAs are the geographical areas used by the Los Angeles County
government in planning services for the population. We used SPAs 4 (Metro
Los Angeles), 6 (South), 7 (East), and 8 (South Bay). These areas were cho-
sen because 73% of all male Latino HIV/AIDS cases have been identified in
these SPAs (HIV Epidemiology Program, Los Angeles County Department
of Public Health, 2011) and also because of their geographical proximity to
the research partner organizations involved in the project.
We identified known day labor sites on a large wall map of Los Angeles
County. For any apparent gaps (large geographical areas) where day labor
sites had not been identified, we drove to these in the early morning to look
for other day labor sites. We also identified through telephone directories all
home improvement stores, lumber yards, and so forth, where day laborers
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Galvan et al. 79
could likely gather and then visited all of them to determine whether day
laborers actually congregated there. A universe of all known day laborer sites
in these four SPAs was then created.
Determining the Sites With the Largest Number of Day
Laborers Reporting High-Risk Activities in Phase 1 of the Study
After we identified the universe of all known day laborer sites in these four
SPAs, we determined which of these sites contained the largest number of
day laborers reporting high-risk sexual and substance-using activities (Phase
1 of the study). Depending on the type of high-risk behavior under consider-
ation in different studies of Latino day laborers or migrants in California,
estimates of the number who have screened positive for that behavior or
related indicator have ranged from less than 1% (i.e., syphilis; Wong, Tambis,
Hernandez, Chaw, & Klausner, 2003) to 72% (i.e., defined as “medium-high”
and “high” risk using very broadly defined sexual risk behaviors with women;
Ehrlich, Organista, & Oman, 2007). Other estimates have fallen in between
these two broad ranges (Denner, Organista, Dupree, & Thrush, 2005;
Organista, & Kubo, 2005; Sanchez et al., 2004).
Given this variability in the estimates of high-risk activities among Latino
day laborers or migrants based on different criteria of what defines “high-
risk” activities, we developed our own screening instrument for measuring
“high-risk activities” for this particular population. Topics included recent
unprotected sex with someone of unknown HIV-positive status, sex under the
influence of intoxicants, and so forth. Each activity on the list was then
ranked as being either “high risk,” “some risk,” or “no risk.” In determining
the final items for our screener, we eliminated all activities ranked by all of
us as being “no risk.” The remaining items were then assessed as being “high
risk” or “some risk.” An example of a high-risk behavior was “had unpro-
tected anal sex with a man”; an example of a moderate-level risk behavior
was “had sex while high or intoxicated.” We then reduced the number of total
items in order to shorten the screener. We subsequently used this screener in
Phase 1 to identify those sites with the largest number of day laborers report-
ing high-risk activities; we were also able to determine the sites with the
largest number of day laborers reporting “some risk” activities. We visited
these sites at randomly selected times and randomly sampled 15% of the
individuals who were present when we arrived.
The participant inclusion criteria were the following: Latino ethnicity,
male gender, and age 18 years or older. An implied informed consent form
was administered. The study interview lasted less than 15 minutes, and the
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80 Hispanic Journal of Behavioral Sciences 37(1)
participants received US$5 in cash for completion of the interview.
TheInstitutional Review Boards of the Los Angeles County Department of
Public Health and Charles R. Drew University of Medicine and Science pro-
vided approval for the study.
A total of 300 individuals were interviewed for the first phase of the study.
Among the original 62 day labor sites visited during this part of the study, a
total of 31 were identified for the next stage of the project, Phase 2. These
included 12 sites where the participants reported high levels of risk behaviors
and an additional 19 where moderate levels of risk behaviors were reported.
Sampling Plan for Study Recruitment in Phase 2
For Phase 2 of the study, a sampling unit of “site-day” was calculated where
“site” referred to the day labor site and “day” to the day of the week. Sampling
units with a very small attendance were excluded from the study. The sam-
pling plan for the study recruitment involved the following stages: the
monthly random selection of the day labor sites, the monthly random selec-
tion of the sampling units, and the random selection of participants at the day
labor sites. The enrollment of individuals for this second phase of the study
occurred between March 2011 and January 2012. We developed an alphanu-
meric “metric” consisting of a combination of numeric and letter indicators
to be used during data analysis to identify possible repeaters. This metric
consisted of the participant’s father’s initials, mother’s initials, and the par-
ticipant’s year of birth.
Measures
Chronic stress. Chronic stress was assessed using the Chronic Burden Scale of
Gurung, Taylor, Kemeny, and Myers (2004). This 21-item scale was chosen
because many of its individual items address concerns that would be relevant
for a population of Latino day laborers, for example, insufficient money to
meet the basic needs of life, insufficient savings, being laid off from work,
work hours that change for the worse, being a victim of a crime, immigration
problems, residence in a high-crime area, discrimination because of one’s
nationality, and housing problems. In addition, it includes generic items
reflective of stress that anyone could experience (e.g., transportation, hous-
ing, divorce/separation, unresolved conflict with someone important).
Each question had four possible responses: (1) not a problem for me in the
past month, (2) a little bit of a problem for me in the past month, (3) some-
what of a problem for me in the past month, and (4) a major problem for me
in the last month. The possible range of scores was from 21 to 84 with a
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Galvan et al. 81
higher score being indicative of higher chronic stress. The scale was found to
have a Cronbach’s alpha reliability score of .651 for the present sample.
Sociodemographic data. All participants were asked for sociodemographic
information (such as age, educational level, previous year’s income, use of
Spanish and English languages, country of birth, relationship status, length of
time in the United States, legal residency status, sexual orientation, and
whether they had been homeless in the previous 12 months). In addition,
participants reported the number and gender of their sexual partners in the
previous 12 months (this question was asked only of those who reported hav-
ing been sexually active during that period). Participants were also asked a
series of HIV-related risk behavior questions, such as whether they had
engaged in any penetrative anal sexual activity with a man without a condom
in the previous 12 months or having had any sexually transmitted disease in
the previous 12 months.
The study questionnaire was interviewer administered. Participants in this
second phase of the study were administered a full consent form for their
approval and signature. Participants were compensated with a US$20 gift
card.
Statistical Analysis
Descriptive statistics were obtained for all the main study variables. To exam-
ine the bivariate associations between chronic stress and the various sociode-
mographic variables, Pearson correlation tests were used. Variables that were
associated with chronic stress at the bivariate level at p < .20 (Hosmer &
Lemeshow, 1989) were included in the final multivariate regression model
predicting chronic stress. In addition, multicollinearity statistics (i.e., toler-
ance and variance inflation factors [VIF]) were obtained to examine the
extent to which the independent variables in the final model were correlated
with each other.
Results
A total of 725 Latino day laborers participated of the 2,064 approached.
Based on an examination of the alphanumeric “metric” described above in
the “Measures” section, which was developed to identify possible repeaters
in the study, we discovered that no individual had participated more than
once in the project.
The mean age for the sample was 38.5 years (SD = 8.4). Over 40% had a
sixth-grade education or less; an additional 29% reported having had up to an
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82 Hispanic Journal of Behavioral Sciences 37(1)
additional 2 years of education. Seventy percent reported an income of
US$10,000 or less in the previous year. A slight majority (55%) spoke only
Spanish. Mexico (55%) was the country most reported as the nation of origin,
followed by Guatemala (25%) and El Salvador (15%). Forty percent were
single, 28% reported having a partner, and 26% were married. Of the 188
men who reported being married, 59% stated that their spouse lived with
them in the United States, while 41% reported that they did not. Years lived
in the United States were almost equally divided between less than 10 years
(49%) and 10 or more (51%). Almost all of the participants described their
residency status as being undocumented (94%) and their sexual orientation as
heterosexual (96%). Half reported having had one sexual partner in the previ-
ous 12 months; an additional third reported two or more partners during that
same time period. Almost all (97%) reported having had only women as their
sexual partners. Additionally, almost all (96%) reported having engaged in no
HIV-related sexual risk behaviors in the previous 12 months. Seven percent
reported having been homeless during that same period.
Chronic stress had a mean score of 37.2 (SD = 6.08) and an actual range
of 21 to 66. The individual respondent scores for this measure approximated
a normal distribution, requiring no transformation for statistical analysis. The
items with the highest scores were the following: having immigration-related
problems (M = 3.53, SD = 1.009), not having enough money to cover basic
needs (M = 3.47, SD = 0.834), having no savings (M = 3.46; SD = 0.842), and
having work hours change for the worse (M = 3.26, 1.125). Other items that
had lower scores included the following: having housing problems (M = 1.64,
SD = 0.951); experiencing divorce or separation from partner (M = 1.28,
SD = 0.755); experiencing discrimination (M = 1.24, SD = 0.661); experienc-
ing a serious accident, illness, or new injury (M = 1.16, SD = 0.565); and
being the victim of a crime or physical assault (M = 1.05, SD = 0.315).
Table 1 provides the results of the multivariate model of chronic stress.
Higher chronic stress was associated with homelessness in the previous 12
months, both higher income levels, compared with the lowest income cate-
gory of less than US$5,000, and having engaged in HIV-related risk behav-
iors in the previous 12 months. Individuals who had a partner or were single,
compared with those who were married, reported lower chronic stress.
Discussion
Overall, the chronic stress mean score was unexpectedly low, considering the
gravity of the living circumstances of day laborers, for example, mostly
undocumented immigrants and largely marginally employed. The scale used
in this study included both generic items reflective of stress that anyone could
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Galvan et al. 83
Table 1. Multivariate Regression of Chronic Stress.
Unstandardized Standardized Collinearity statistics
coefficients coefficients
p Tolerance VIF
Variables B SE β
.000
(Constant) 36.99 1.26 —
−0.020
Years lived in the United States — .613 0.855 1.17
0.479 —
Less than 10 years — −0.126
— −0.053 .151 0.173 5.792
10 years or more −0.242 1.109 −0.004 .531 0.184 5.430
1.132 −0.71 .960 0.265 3.779
Education 1.201 .315 0.265 3.778
1.219 0.146
None —
0.884 —
Grades 1 to 6 −1.596
— 0.150
Grades 7 to 8 −0.710
0.684 0.236
Grades 9 to 11 −0.061
0.766 0.087
Grade 12/GED/ −1.225
1.245 —
some college/ 0.041
— −0.025
degree 0.680 −0.079
0.815
Homeless in past 12 3.423 0.808 — <.001 0.936 1.068
−0.107
months — −0.166
0.615
Income 0.596 0.027
1.029
Less than — — — — —
— −0.042 .007 0.423 2.366
US$5,000 0.548 −0.027 <.001 0.395 2.531
0.658 .022 0.927 1.079
US$5,000 to 1.839 1.085 0.001
US$10,000
Greater than 3.123
US$10,000
HIV-related risk 2.859
behaviors in past
12 months
Number of sexual partners
None — —— —
.467 0.424 2.361
One 0.495 .602 0.597 1.674
.119 0.523 1.914
Two −0.425
—— —
Three or more 1.261 .019 0.642 1.559
.001 0.575 1.740
Marital status .519 0.775 1.290
Married — —— —
.281 0.857 1.167
Partner −1.451 .489 0.873 1.145
.972 0.935 1.069
Single −2.061
Other 0.665
Country of birth
Mexico —
Guatemala −0.591
El Salvador −0.456
Other 0.039
Note. A total of 725 observations read; 707 observations used. VIF = variance inflation factors; GED =
General Educational Development.
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84 Hispanic Journal of Behavioral Sciences 37(1)
experience as well as items specific to a migrant population. The utility of the
scale used in this study was reflected by the fact that every item of the scale
had affirmative responses by at least some individuals in the sample, albeit in
varying amounts. Nonetheless, if a different scale had been selected for mea-
suring chronic stress, the scores obtained could have been higher relative to
the scores obtained from the scale used in this study.
Given that almost all of the participants described their residency status as
being undocumented, not surprisingly, the most mentioned problem related
to chronic stress was having immigration-related problems. This was fol-
lowed closely by not having enough money to cover basic needs, having no
savings, and having work hours change for the worse. These findings are
consistent with national data reported by Valenzuela et al. (2006) who found
that the work instability that day laborers experience in day labor was signifi-
cant. This, along with low monthly earnings, places them among the “work-
ing poor” of the nation.
Higher chronic stress was associated with having been homeless in the
previous 12 months, which was reported by 7% of the sample. Homelessness
in this sample was in the low range compared with other studies of Latino day
laborers where homelessness has ranged from 4.9% to 25.5% (Duke et al.,
2010; Organista & Kubo, 2005; Wong et al., 2003). Our finding of the asso-
ciation between chronic stress and homelessness is consistent with previous
research among Latino day laborers, which has found homelessness to be
associated with the stress of feeling instable (Duke et al., 2010). Such insta-
bility is characterized by the feeling of being often on the move and not set-
tled, feeling isolated and finding it hard to meet people, defining one’s
housing situation as being inadequate to one’s needs, and experiencing stress
related to having no stores nearby for shopping.
Both higher income levels (US$5,000-US$10,000 and greater than
US$10,000) were associated with more chronic stress compared with the
lowest income category (less than US$5,000). This result was not anticipated
as one would have expected that having the lowest income level would have
been associated with higher stress compared with having higher income lev-
els (Cummins, 2000; Schulz et al., 2012). Other literature, however, provides
support for such counterintuitive results. It could be that those with higher
incomes reported more chronic stress compared with those in the lowest
income category because the very fact of obtaining a higher income may
have been associated with stress that came with wanting to achieve one’s
goals (Kahneman, Krueger, Schkade, Schwarz, & Stone, 2006). Further
research with Latino day labor populations should examine the extent to
which this may have been the reason for the association that was found
between higher income levels and more chronic stress.
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Galvan et al. 85
Higher chronic stress was also found to be associated with having engaged
in HIV-related risk behaviors in the previous 12 months. This is consistent
with previous research with Latino immigrant men and other populations that
has found sexual and other risk behaviors to be associated with reports of
stress in one’s life. For example, increased stress among immigrant Latino
men recently arrived in the United States has been found to be related to
sexual risk behaviors (Rhodes et al., 2009). Such associations between stress
and sexual risk behaviors are documented as well among other populations.
For example, among HIV-positive African American men who have sex with
men, experiencing traumatic stress, such as being physically assaulted
because of their race, has been associated with greater sexual risk taking
(Fields et al., 2013). Programs developed to help Latino day laborers lower
their stress may have the additional benefit of helping to decrease risk behav-
iors among them. This can help them to lead healthier lives, which can also
benefit their partners, families, and communities at large.
Individuals who had a partner or were single compared with those who
were married reported lower chronic stress. This association between chronic
stress and marital status may be explained by the fact that those who were
married may have had more financial obligations (such as economic obliga-
tions to children living back in their home country with their mother) than
those who were single or had a partner. Given the importance that Latino day
laborers place on their families (Negi, 2011; Nelson et al., 2012; Organista
et al., 2013; Walter et al., 2004), it is not surprising that not being able to meet
one’s financial obligations to one’s family would be a source of great stress
among day laborers.
One limitation of this study was the large nonresponse rate of the partici-
pants recruited into the second phase of the study. This may have been due to
different factors. For example, given that the primary focus of the parent
study was to examine the HIV testing behaviors and HIV-related risk behav-
iors of Latino day laborers, participants were initially approached with the
offer of an HIV test and/or screenings for other health conditions. Those not
interested in such screenings declined participation in the test. It is also pos-
sible that participants did not want to risk jeopardizing getting a job offer
from a potential employer while engaged in a research study interview for
which they would be compensated with only a US$20 gift card. It is also pos-
sible that some may have chosen not to participate because of concerns over
their undocumented status and worries about what participation in a research
project could involve. As a result, the large nonresponse rate prevents us from
being able to generalize the results of our study to the wider population of
Latino day laborers.
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86 Hispanic Journal of Behavioral Sciences 37(1)
It is also possible that the choice of the chronic stress scale used in this
study may have been problematic. The Cronbach’s alpha reliability score of
the scale was somewhat below .70, which is considered to be the minimum
acceptable score in social science research (DeVellis, 1991). Using a scale
with greater reliability would have provided more confidence in our measure
of chronic stress. In addition, as already noted above, using a different scale
for measuring chronic stress could have resulted in higher scores relative to
the ones obtained with the scale used in this study. Nonetheless, the use of a
scale that included both generic items of stress and ones specific to a migrant
population resulted in our being able to examine chronic stress from a broader
perspective.
Another limitation was the cross-sectional nature of the research design.
Thus, we are not able to make any conclusions about causal associations
among the variables examined. Nevertheless, with the large number of day
laborers who actually participated in the study, we were able to identify the
extent of chronic stress among the day laborers in our sample and some fac-
tors associated with this stress. Addressing the stress experienced by day
laborers is necessary to prevent potential negative health and mental health
consequences among this population.
Acknowledgments
We express our appreciation to the staff of Bienestar Human Services, Inc., who
assisted in the execution of this study (Ivan Sanchez, Albert Martinez, Victor
Martinez, and Joe Montes) and in the preparation of this article (Megan Stafford,
MA). Appreciation is also extended to the day laborers who gave of their time to
participate in this study.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research,
authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research,
authorship, and/or publication of this article: Appreciation is extended to the California
HIV/AIDS Research Program of the University of California Office of the President
for the funding of this research project (CR08-BHS-480, CR08-DREW-481,
CR08-LAC-481A).
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Author Biographies
Frank H. Galvan is the Director of Research and Evaluation at Bienestar Human
Services, Inc. His studies with Latinos have focused on gay and bisexual men, trans-
gender Latinas, and Latino day laborers. He has published in the areas of sexual risk
behaviors, HIV stigma, social support, engagement in medical care, treatment
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Galvan et al. 89
adherence, religiosity, and alcohol use among HIV-positive populations and also on
sexual risk behaviors and HIV testing among those at risk for HIV infection. He has a
master’s in Latin American studies from the University of California, Los Angeles
(UCLA), a master’s in social work from the University of Southern California (USC),
and a PhD in social welfare from UCLA.
Amy Rock Wohl is a Chief Epidemiologist and Unit Chief for the Special Projects
Unit in the Division of HIV and STD Programs at the Los Angeles County Department
of Public Health and an Adjunct Research Associate Professor in the Department of
Preventive Medicine at the USC Keck School of Medicine. Her responsibilities
include overseeing demonstration projects to improve linkage and reengagement of
HIV-positive persons in care, monitoring of STD epidemiologic trends, analysis of
STD partner services activities, and clinical and behavioral monitoring of HIV-
infected persons in Los Angeles County. She has a master’s in public health in health
services administration and epidemiology from the Yale University School of Public
Health and a PhD in epidemiology from the UCLA School of Public Health.
Juli-Ann Carlos is an epidemiologist in the Division of HIV and STD Programs at
the Los Angeles County Department of Public Health. She has served as a coinvesti-
gator to research projects estimating the prevalence of HIV risk behaviors and expo-
sure to HIV prevention among American Indians and transgender women of color
living in Los Angeles County. She has a master’s in public health in behavioral sci-
ence and epidemiology from Boston University.
Ying-Tung Chen is the statistical evaluation manager at Bienestar Human Services,
Inc. He provides statistical support for research projects in the areas of study design,
data extraction, statistical analysis, and the interpretation of study results. He received
a master’s of science in biostatistics from the UCLA School of Public Health.
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J Immigrant Minority Health (2015) 17:1518–1525
DOI 10.1007/s10903-014-0066-z
ORIGINAL PAPER
Stress, Place, and Allostatic Load Among Mexican Immigrant
Farmworkers in Oregon
Heather H. McClure • J. Josh Snodgrass • Charles R. Martinez Jr. •
Erica C. Squires • Roberto A. Jime´nez • Laura E. Isiordia •
J. Mark Eddy • Thomas W. McDade • Jeon Small
Published online: 28 February 2015
Ó Springer Science+Business Media New York 2015
Abstract Cumulative exposure to chronic stressors has AL. Among women, lower family support related to higher
been shown to contribute to immigrants’ deteriorating AL in White majority communities only. Findings suggest
health with more time in US residence. Few studies, that Latino immigrants’ cumulative experiences in the US
however, have examined links among common psychoso- significantly compromise their health, with important dif-
cial stressors for immigrants (e.g., acculturation-related) ferences by community context.
and contexts of immigrant settlement for physical health.
The study investigated relationships among social stres- Keywords Allostatic load Á Health Á Stress Á Mexican
sors, stress buffers (e.g., family support), and allostatic load immigrants Á Place Á Farm worker Á Ethnic enclave
(AL)—a summary measure of physiological ‘‘wear and
tear’’—among 126 adult Mexican immigrant farm workers. Introduction
Analyses examined social contributors to AL in two lo-
cales: (1) White, English-speaking majority sites, and (2) a In recent decades, Latino population growth in the United
Mexican immigrant enclave. Our six-point AL scale in- States has exceeded that of all other racial and ethnic
corporated immune, cardiovascular, and metabolic mea- groups. Due in part to immigration, mostly from Mexico,
sures. Among men and women, older age predicted higher this growth has been particularly striking in Oregon and 21
similar states that have limited experience with large in-
H. H. McClure (&) Á C. R. Martinez Jr. Á J. Small fluxes of immigrant newcomers [1, 2]. This rapid growth
Center for Equity Promotion, College of Education, combined with unprepared health and social service sys-
6215 University of Oregon, Eugene, OR 97403-6215, USA tems may heighten stressors in the lives of Mexican im-
e-mail: [email protected] migrants in these states.
H. H. McClure Á J. Josh Snodgrass Á E. C. Squires Extensive evidence exists that long-term exposure to
Department of Anthropology, University of Oregon, Eugene, psychosocial stressors can lead to dysregulation of the
OR, USA body’s homeostatic functions [3–6] and eventually to
greater wear and tear and impaired health [7]. Allostatic
R. A. Jime´nez load (AL) represents an attempt to operationalize this
Farmworker Housing Development Corporation, Woodburn, process, and is a mechanistically based concept that sum-
OR, USA marizes dysregulation across multiple physiological sys-
tems, including aspects of immune, endocrine, metabolic,
L. E. Isiordia and cardiovascular function [3]. Increasingly, research
Capaces Leadership Institute, Woodburn, OR, USA indicates that AL is a powerful tool for the identification of
individuals at risk of cognitive decline, disability, and early
J. M. Eddy mortality [5, 8–12]. The measure of AL may be particularly
Partners for Our Children, School of Social Work, University of meaningful in studies, such as this one, involving a
Washington, Seattle, WA, USA relatively young sample where few individual measures
T. W. McDade
Department of Anthropology and Institute for Policy Research,
Northwestern University, Evanston, IL, USA
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J Immigrant Minority Health (2015) 17:1518–1525 1519
rise to the level of clinical diagnosis [13]; in these in- To this end, we investigate two research questions: (1)
stances, a summary indicator may provide a glimpse into what are the relationships between common psychosocial
pre-disease pathways that establish trajectories of future stressors and AL among Mexican immigrants; and (2) are
disease risk. relationships between stressors and AL different by
residential locale? The first question takes the investigation
Research among Latinos suggests that foreign-born in- of the acculturation hypothesis one step further by con-
dividuals have more favorable health profiles (e.g., lower sidering the potential influence of family support on AL
cardiovascular disease prevalence) than do US born. This [22]. The second question explores AL in two contexts
‘‘healthy immigrant’’ effect [14–16] is most likely due to with potentially different types and degrees of psychosocial
selective immigration and to immigrants’ practice of pro- stress exposure for Mexican immigrants. The first setting is
tective health behaviors rooted in cultures of origin [17, a small town with a substantial Mexican immigrant
18]. Despite initial promising health indicators, cumulative population where embedded social networks and institu-
stress exposure as measured by AL appears to contribute to tions support the maintenance of cultures of origin and
immigrants’ deteriorating health over time in the US [19, engagement in Spanish is possible and functional [41–44].
20]. This finding remains even when controlling for age, In the second setting, the majority population is Caucasian,
health behaviors, and medical care utilization [19], and has English-speaking, and US born, there is little support for a
been attributed to chronic psychosocial stress related to dual cultural society, and the burden of communication
acculturation processes (adjustment to life in the US), in- with monolingual English speakers is often borne by im-
cluding exposure to discrimination, poverty, and assimila- migrants and their children [45, 46].
tion pressures, though little AL research to date has
investigated these links [20–22]. Some immigrant health Methods
studies rely upon individual biological markers, and our
own work has investigated links between sociocultural Participants
stressors and Latino farmworkers’ cardiovascular,
metabolic, and immunological function [13, 23–26]. The current project involved collaboration with a well-re-
Though this system-specific approach may illuminate the spected farmworker housing organization. The target con-
heterogeneity of dysregulation in response to stressors venience sample of 126 immigrant adults ([18 years of
among immigrants, the use of the summative index of AL age) was recruited from one of three Willamette Valley
allows for a more comprehensive view of the impact of farmworker housing locations in: (1) a small White ma-
stressors across key regulatory systems, and has the added jority rural community (pop. 8,200); (2) a White majority
statistical benefit of reducing the chances of type I error area on the outskirts of one of Oregon’s medium-sized
[27]. Few immigrant health studies, however, incorporate cities (pop. 149,000); and (3) within a town (pop. 22,000)
AL frameworks [21, 22]. that contains an established Mexican origin enclave. The
Institutional Review Board at the University of Oregon
Finally, though strong evidence exists of links between approved the research protocol and all participants pro-
racial residential segregation and poor health [28, 29], the vided written consent prior to the assessment. All respon-
effects of ethnic enclaves on residents’ health are less con- dents were assessed in Spanish.
clusive [30–34]. To our knowledge, no study has examined
the effects of community context on residents’ AL. Re- Approximately 42 % of men and 34 % of women had a
searchers have argued that co-ethnic communities may share third grade education or less, with 7 % of men and 18 % of
economic, social and cultural resources [35, 36]. When co- women completing high school or receiving post-sec-
ethnics are immigrants, they may bring with them cultural ondary education. Heads of household reported an annual
practices that promote health and discourage risk behaviors median household income of $16,218 to support an average
[37–39]. Most research on immigrant health, however, has household of 5 people (SD = 1.5); 93 % of men and 47 %
been conducted in traditional immigrant settlement states of women were employed, and 37 % of women reported
(e.g., CA, TX, FL, NY, IL, NJ) whose urban centers have being homemakers.
dense and historic immigrant communities with diverse in-
stitutionalized (e.g., health care centers, churches, civic or- Measures
ganizations) and non-institutionalized (e.g., social network)
supports. A study of community context and AL may be In keeping with past research, we quantified AL as a
particularly salient in Oregon, where the recent growth of the summary measure of function across multiple physio-
Mexican immigrant population has been exponential and logical systems [11, 47]. Our AL variable incorporated six
highly decentralized [40]. Though there exist a few Mexican measures including immune function (high-sensitivity
origin enclaves, most new arrivals settle in towns unaccus-
tomed to immigrants [35, 38].
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1520 J Immigrant Minority Health (2015) 17:1518–1525
Table 1 Cut-off values (75th percentile) for each parameter of al- three items reflecting respondents’ enjoyment of English
lostatic load language activities (e.g., music, TV or radio programs;
1 = don’t enjoy to 5 = enjoy very much) and comfort
Biological parameters Highest risk (top quartile) speaking and reading in English (1 = very uncomfortable
to 5 = very comfortable) [52]. Higher ELO factor scores
Women Men reflected greater orientation to English language activities.
The Kaiser–Meyer–Olkin (KMO) test of sampling
Systolic blood pressure (mmHg) 124.5 127.9 adequacy was 0.637 (considered acceptable); this factor
Diastolic blood pressure (mmHg) 79.0 78.8 explained 61.3 % of observed variance.
Waist circumference (cm)
Glucose (mg/dL) 100.5 100.8 Respondents were asked whether they had been treated
Total cholesterol (mg/dL) 90.0 92.0 as if inferior because of their race, ethnicity, skin color,
C-reactive protein (mg/l) language, or nationality within the past 3 months, and
171.0 168.0 about their related experience of stress (1 = not at all
2.0 1.4 stressful to 5 = extremely stressful) [53]. Family support
was appraised in a (reverse-coded) item that asked par-
CRP), cardiovascular function [systolic and diastolic blood ticipants whether they agreed/disagreed with the statement
pressure (SBP, DBP)], body composition [waist circum- ‘‘when there are problems you should count on family’’,
ference (WC)] and metabolic function (fasting glucose and and family as referents was assessed through the item
total cholesterol) (Table 1). Following standard proce- ‘‘family should be consulted about important decisions’’
dures, each measure was computed as a dichotomous (1 = completely disagree to 5 = completely agree) [54].
variable reflecting either ‘‘1’’ (for highest quartile of risk) Potential confounders included age (a continuous variable),
or ‘‘0’’ (for all other quartiles) and these variables were smoking (yes/no to having smoked at least 100 cigarettes in
summed to create an AL index; cut-off values for each lifetime), alcohol use (number of days in past month drank
parameter are included in Table 1. at least one cup of alcohol), food security (1 = food se-
cure; 2 = food insecure without hunger; 3 = food insecure
All health measures were recorded using standard pro- with hunger [55] ), current medical insurance, average
cedures (e.g., WC [48]). Blood pressure was measured level of combined back, neck or joint pain (1–10), and
using an Omron HEM-422CRLC manual inflation oscil- average hours of daily TV viewing. We also computed a
lometric blood pressure monitor (Vernon Hills, IL), and dichotomous variable reflecting residence within a White
measured two separate times for each participant. Glucose dominant locale or within the Mexican origin enclave.
and total cholesterol concentrations (mg/dL) were obtained
from fasted participants using 30 ll samples of capillary Analyses focused on 126 Mexican immigrant adults (84
blood collected from finger prick and using a CardioChek females, 42 males). Distributional assumptions were ex-
PA analyzer and PTS Panels (Polymer Technology Sys- amined using Kolmogorov–Smirnov tests. To ensure a
tems, Indianapolis, IN). This professional glucose and normal distribution for analysis purposes, CRP values were
cholesterol testing system meets standard clinical guideli- log10-transformed and logCRP used in subsequent analyses
nes for accuracy and precision. High-sensitivity enzyme (tables include original [non log10-transformed] CRP val-
immunoassay using validated protocols adapted for dried ues for comparison purposes). Student’s t tests were used to
blood spots was used to analyze CRP from dried blood examine differences by sex and place for AL, sociodemo-
spots on standardized filter paper, with four individuals graphic, lifestyle, and health data (Table 2). Pearson’s
with current infections (serum equivalent CRP concentra- correlations were used to investigate AL in relation to in-
tions [5 mg/L) excluded due to acute effects of infection dependent variables of income, education, arrival age, TR,
on inflammation [49, 50]. ELO, discrimination, familism, and potential covariates of
age, alcohol use, TV, and pain level (Table 3).
For interview brevity, items were drawn from a larger
assessment battery consisting of culturally-specific and Relationships among nearly all significant predictors of
standardized instruments described elsewhere [25, 51]. AL (p \ .05) were further examined using ordinal logistic
Independent variables included self-reported indicators of regression (OLR) models (Table 4). For reasons of power,
annual household income (1 B$1,000 to 13 C$35,000), age was chosen in lieu of age upon arrival and years in the
highest level of education completed (1 B3rd grade to US as all variables were significantly correlated for women
10 = graduate degree), English language orientation and men (p \ .01), and as past studies of AL have focused
(ELO), time in US residence (TR), age upon arrival, per- on age.
ceived discrimination, and items reflecting two dimensions
of Hispanic familism (or feelings of loyalty, reciprocity, For OLR models, all variables were made categorical or
and solidarity among family members [54]): perceived dichotomous. We created three-part variables for AL, re-
family support and family as attitudinal and behavioral versing the scale for easier interpretation (2 = 0; 1 = 1–2;
referents (Table 2). The ELO factor score was created from
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J Immigrant Minority Health (2015) 17:1518–1525 1521
Table 2 Mean differences in Variables Range x (SD)
allostatic load,
sociodemographic, lifestyle, and Women Men Women in White Women in
health measures (for women and (n = 84) (n = 42) majority Mexican
men) and place (for communities enclave
women only) (n = 50) (n = 34)
AL, Allostatic load; Income, AL 0–5 1.5 (1.4) 1.5 (1.5) 1.3 (1.3) 1.7 (1.5)
annual household income as
reported by head of household; Sociodemographic 35.9 (11.7) 38.9 (13.5) 33.8 (10.5)* 38.9 (13.0)
Insured, whether have health 25.1 (11.1) 23.1 (9.7) 25.5 (11.9) 24.6 (10.0)
insurance; TR, time in Age (years) 18–73 9.7 (6.9)** 14.1 (9.6)
residency; ELO, English 15,724 (2,454) 16,857 (2,105) 7.9 (5.8)** 12.2 (7.5)
language engagement; Support, Arrival age 2–63 15,724 (2,004) 15,724 (3,325)
family support; Decision, family (years) 0.2 (0.4) 0.4 (0.5)
decision-making; Food, food 0.2 (0.4) 0.2 (0.4)
security; SBP, systolic blood TR (years) 0.2–36 0.01 (1.1) -0.1 (0.8)
pressure; DBP, diastolic blood 1.8 (1.3) 1.8 (1.3) 0.1 (1.3) -0.2 (1.0)
pressure; WC, waist Income ($) \1,000 to 1.8 (1.2) 1.6 (1.0)
circumference; TC, total [35,000 2.8 (1.4) 2.6 (1.4) 2.0 (1.3)* 1.5 (1.2)
cholesterol; CRP, C-reactive 1.7 (0.7) 1.6 (0.6) 1.9 (1.1) 1.7 (1.4)
protein Education 0.1 (0.5)*** 1.2 (1.8)
Student’s t tests are statistically 2.7 (1.4) 2.8 (1.5)
significant at p \ .10; Insured 0–1 0.02 (0.2)* 0.2 (0.4) 1.8 (0.8)
* p \ .05; ** p \ .01; 3.7 (1.3) 3.6 (1.4) 1.5 (0.7)
*** p \ .001 Lifestyle 6.0 (2.6) 6.6 (1.8) 0.2 (0.7)
0.1 (0.2)
ELO -1.2 to 112.5 (15.4)* 118.6 (12.4) 0.02 (0.1)
4.9 73.8 (9.3) 72.5 (9.0) 3.5 (1.3) 0.03 (0.2)
90.5 (13.7) 93.0 (12.6) 3.9 (1.2)
Inferior 1–5 85.4 (21.6) 84.2 (18.3) 6.0 (2.3)
6.0 (3.1)
Support 1–5 148.3 (31.6) 149.8 (34.6) 110.1 (15.8)
(5 = hi) 1.6 (1.5) 1.2 (1.3) 72.8 (9.4) 116.1 (14.5)
89.6 (14.0) 75.2 (9.1)
Decision 1–5 82.6 (16.7) 91.7 (13.3)
(5 = hi) 86.9 (20.6)
147.0 (26.4)
Food security 1–3 1.6 (1.7) 150.2 (38.7)
(3 = hunger) 1.6 (1.0)
Days drank 0–8
alcohol in past
month
Ever smoked 0–1
Daily TV 1–7
(hours)
Pain level 0–10
Health
SBP (mmHg) 89.5–165
DBP (mmHg) 44.5–102
WC (cm) 63–133
Glucose 57–174
(mg/dL)
TC (mg/dL) 100–261
CRP (mg/l) 0.06–4.3
0 = 3–6 for women and 3–4 for men). We computed di- Finally, to explore potential differences by locale, we
chotomous variables for age (1 = 35–72 years; conducted OLR analyses for each site; as the small sample
2 = 18–34 years; note: we reversed this variable to sim- of men limited our power, we investigated relationships
plify interpretation of odds ratios), family support among women only (model B, Table 4). Pearson’s Good-
(1 = 1–2; 2 = 3–5), and alcohol use (1 = no use; 2 = any ness-of-Fit statistics showed that the models for each site
use in the past month). Pearson’s Goodness-of-Fit statistics (White dominant = .77; Mexican enclave = .09) were
showed that the models for women (.76) and men (.65) acceptable. Tests of proportional odds assumption con-
were acceptable. Tests of proportional odds assumption ducted separately by site for women were non-significant.
were non-significant for each of the models for women and Model B showed similar results when all four independent
men. variables versus the two significant ones in model A
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1522 J Immigrant Minority Health (2015) 17:1518–1525
Table 3 Correlation table for allostatic load for women and men, Results
independent variables, and key covariates
Average AL levels were 1.5 for women and 1.5 for men
Variables Women’s AL Men’s AL (Table 2), indicating no significant sex differences. Among
women, older age, more time in the US, and lower family
Income 0.21 0.09 support were significantly correlated with elevated AL
Education -0.07 -0.28 (Table 3). Among men, older age, older age at time of
Age (years) arrival in the US, and lower alcohol consumption were
Arrival age (years) 0.25* 0.46** associated with higher AL (Table 3). Older age upon ar-
TR (years) 0.20 0.36* rival in the US among women, and less education and
ELO 0.24* 0.15 lower family decision-making among men showed trends
Inferior -0.02 0.02 in relation to higher AL. AL did not significantly correlate
Support 0.02 0.05 with women or men’s income, ELO, discrimination, food
Decision -0.25* -0.03 security, TV viewing, or pain levels. T tests revealed no
Alcohol -0.02 -0.30 significant differences in AL between individuals with and
TV viewing -0.02 -0.35* without health care access, and smokers versus non-
Food security -0.09 0.04 smokers (data not shown). T test comparisons by site of
Pain level -0.14 -0.06 women’s AL scores and independent variables indicated
0.02 0.21 that women in the Mexican enclave were significantly
older (38.9 vs. 33.8 years; p \ .05), had lived in the US
AL, allostatic load; TR, time in residency; ELO, English language longer (12.2 vs. 8.7 years; p \ .01), and reported lower
engagement; Support, family support; Decision, family decision- discrimination stress (scores of 1.5 vs. 2.0; p \ .05) than
making women residing in White dominant sites. Women’s AL
scores did not significantly differ by site.
Correlations are statistically significant at p \ .10; * p \ .05;
** p \ .01; *** p \ .001 Results from OLR models indicated that women with
low family support were more than 4 times more likely to
Table 4 Ordinal logistic regression models for prediction of (a) al- have higher AL scores than women with high support;
lostatic load for women and men, and (b) women in two distinct similarly, older women were 2.7 times more likely to have
community contexts higher AL than younger women (Table 4). Older men and
men who reported consuming some alcohol were nearly 4
Measure and variables OR 95 % CI Pseudo r2 times more likely to have higher AL scores than younger
(Nagelkerke) men and men who reported consuming no alcohol, re-
spectively (Table 4). When OLR models were run
A. Allostatic load—women .18** separately by site, only outside of the Mexican enclave
were women with low support more than 8 times more
Age 2.67 1.13–6.31* likely to have higher AL than women with high support
(Table 4). For women residing within the enclave, no
Alcohol 1.26 .31–5.20 significant predictors of AL emerged.
Support 4.17 1.50–11.54** Discussion
Allostatic load—men .20* The current study’s findings, like those of previous studies,
suggest that Latino immigrant men and women’s cumula-
Age 3.62 1.05–12.51* tive experiences in the US significantly compromise their
health [19, 56]. Results also suggest that AL studies based
Alcohol 3.71 1.07–12.91* on national samples may mask important differences by
place in the predictors of AL. The finding that low family
Support .47 .11–2.04 support was a significant predictor of women’s AL outside
of the ethnic enclave only, suggests the local nature of
B. Allostatic load—women in .26** certain patterns of health and disease. As in other studies,
White majority communities we failed to identify links between AL and common
Age 2.04 .66–6.30
Support 8.23 2.06–32.92**
Allostatic load—women in .09
Mexican enclave
Age 3.19 .78–13.10
Support 1.74 .35–8.53
OR, Odds radio; CI, confidence interval; Support, family support
* p \ .05; ** p \ .01; *** p \ .001
(women) were included. Thus, the final model B incorpo-
rates only two predictor variables for parsimony. All ana-
lyses were performed using SPSS 21.0.
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J Immigrant Minority Health (2015) 17:1518–1525 1523
acculturation-related stressors (e.g., discrimination, as- sociocultural worlds. Future studies should assess nutrition
similation) [22, 56]. and exercise, as well as caregiving, financial, and work
strain-related stressors [22, 44], which interrelate with
Prospective studies have shown the impact of low social physiological stress and chronic disease risk, and are in-
support on life expectancy to be as large as cigarette creasingly incorporated into AL research [67].
smoking, hypertension, obesity, and lack of physical ac-
tivity [57]. Social isolation is generally less prevalent in New Contribution to the Literature
non-industrialized societies; once in the US, individuals
whose social ties have been attenuated through immigra- This study adds to the literature through its novel iden-
tion may have smaller social networks—family may pro- tification of family support and place as important to
vide the main or only support—and experience increased Mexican immigrants’ AL. Growing evidence documents
psychosocial stress as a result [58]. Loneliness can the interrelationships among individual susceptibility (re-
chronically activate the stress response, leading to im- lated to genetic and early developmental influences), in-
munosuppression and greater disease risk [59–61]. dividual and community level psychosocial factors, and
biologically relevant components of the human environ-
Despite the widespread recognition that moderate ment that can determine health outcomes [67]. Further
drinking can protect cardiovascular health [62, 63], our study is clearly required to identify those elements—from
finding that more days of consuming alcohol related to social networks to social contextual stressors to environ-
men’s lowered AL was surprising given the very modest mental toxins—that may vary by locale in their intensity
drinking rates reported in this study. Previous researchers and impact on immigrants’ experiences of aging with
have attributed these effects to enhanced insulin sensitivity effects for AL. Also of future utility is the identification
and reduced inflammation [22, 64], markers incorporated of factors such as family support, and potentially other
in our AL construct. forms of social support, that may protect against immi-
grants’ higher AL and serve as a target of disease
The finding that family support and AL were sig- prevention.
nificantly associated only for women living outside the
enclave raises questions of whether women are more so- Acknowledgments We thank study assessors and participants,
cially isolated in those communities and thus family sup- Felicia Madimenos for biomarker training assistance, and Lynn
port becomes even more salient as a protective factor. This Stephen and Frances White for discussions of the project. Support
finding also raises questions of whether the enclave and its for this project was provided by Grant Nos. R01 DA017937 and
institutions and networks may buffer otherwise potentially R01 DA01965 (Charles R. Martinez, Jr., Principal Investigator) from
corrosive effects of life in Oregon communities that have the National Institute on Drug Abuse, US PHS. Support also was
few bicultural supports and potentially more intense provided by the University of Oregon’s Center for Latino/a and
stressors [44, 45]. Latin American Studies (CLLAS). We also appreciate the support of
the Oregon Social Learning Center Scientists’ Council, Northwest-
This study’s findings must be seen in light of its ern University, and the University of Oregon (UO), including the
limitations. The small sample size precluded the ex- UO chapter of Movimiento Estudiantil Chicano de Aztla´n
amination of site differences among men, and findings (MEChA).
among both women and men should be replicated with a
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SSM -Population Health 2 (2016) 416–424
Contents lists available at ScienceDirect
SSM -Population Health
journal homepage: www.elsevier.com/locate/ssmph
Article
Nativity differences in allostatic load by age, sex, and Hispanic
background from the Hispanic Community Health Study/Study
of Latinos
Christian R. Salazar a,n, Garrett Strizich a, Teresa E. Seeman b, Carmen R. Isasi a,
Linda C. Gallo c, Larissa M. Avilés-Santa d, Jianwen Cai e, Frank J. Penedo f,
William Arguelles g, Anne E. Sanders h, Richard B. Lipton a,i, Robert C. Kaplan a
a Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
b Departments of Epidemiology and Medicine, University of California, Los Angeles, USA
c Department of Psychology, San Diego State University, San Diego, CA, USA
d National Heart, Lung, and Blood Institute at the National Institutes of Health, USA
e University of North Carolina Gillings School of Global Public Health, Department of Biostatistics, Chapel Hill, NC, USA
f Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
g Department of Psychology, University of Miami, Miami, FL, USA
h Department of Dental Ecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
i Departments of Neurology, Psychiatry, and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
article info abstract
Article history: Allostatic load (AL), an index of biological “wear and tear” on the body from cumulative exposure to
Received 2 December 2015 stress, has been little studied in US Hispanics/Latinos. We investigated AL accumulation patterns by age,
Received in revised form sex, and nativity in the Hispanic Community Health Study/Study of Latinos. We studied 15,830 Hispanic/
9 May 2016 Latinos of Mexican, Cuban, Dominican, Puerto Rican, Central and South American descent aged 18–74
Accepted 9 May 2016 years, 77% of whom were foreign-born. Consistent with the conceptualization of AL, we developed an
index based upon 16 physiological markers that spanned the cardiometabolic, parasympathetic, and
Keywords: inflammatory systems. We computed mean adjusted AL scores using log-linear models across age-groups
Allostatic load (18–44, 45–54, 55–74 years), by sex and nativity status. Among foreign-born individuals, differences in AL
Physiological dysregulation by duration of residence in the US (o 10, Z10 years) and age at migration ( o 24, Z 24 years) were also
Hispanic ethnicity examined. In persons younger than 55 years old, after controlling for socioeconomic and behavioral
Nativity factors, AL was highest among US-born individuals, intermediate in foreign-born Hispanics/Latinos with
Age patterns longer duration in the US (Z 10 years), and lowest among those with shorter duration in the US ( o10
years) (P o0.0001 for increasing trend). Similarly, AL increased among the foreign-born with earlier age
at immigration. These trends were less pronounced among individuals Z 55 years of age. Similar pat-
terns were observed across all Hispanic/Latino heritage groups (P for interaction ¼0.5). Our findings
support both a “healthy immigrant” pattern and a loss of health advantage over time among US His-
panics/Latinos of diverse heritages.
& 2016 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND
license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Introduction useful construct in conceptualizing how chronic adversity imposes
“wear and tear” on biological systems, increasing morbidity and
Exposure to stressors over the life course is thought to accel- mortality over the life course (McEwen & Seeman, 1999), and
erate biological aging by promoting physiological dysregulation contributing to health disparities in the US (Geronimus, Hicken,
and influencing disease trajectories (Masoro, 1997). Allostatic load Keene, & Bound, 2006). Studies suggest that AL increases with age
(AL) is an index of physiological dysfunction from a failure to adapt (Crimmins, Johnston, Hayward, & Seeman, 2003) and can vary by
to chronic and repeated exposure to stressors (Ben-Shlomo & Kuh, sex (Goldman et al., 2004; Yang & Kozloski, 2011). While some
2002). As a multisystem model of biological risk, AL has been a available evidence links AL with cardiovascular disease (CVD) risk
factors in Hispanics/Latinos in the US (Mattei, Demissie, Falcon,
n Corresponding author. Ordovas, & Tucker, 2010), there has been a scarcity of studies ex-
E-mail address: [email protected] (C.R. Salazar). amining patterns of AL accumulation by age and sex in this
http://dx.doi.org/10.1016/j.ssmph.2016.05.003
2352-8273/& 2016 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Created for free by https://foxyutils.com
C.R. Salazar et al. / SSM -Population Health 2 (2016) 416–424 417
vulnerable population. A greater understanding of the accumula- and two-hour oral glucose tolerance test was obtained with clin-
tion of biological mediators of risk may help to explain the in- ical chemistry panels conducted by a core study laboratory.
creased burden of disease among US Hispanics/Latinos. Standardized questionnaires were administered by bilingual in-
terviewers in English or Spanish according to the participant’s
Emerging evidence suggests that place of birth (nativity) has an preference (Sorlie et al., 2010). Other measurements included se-
influence on AL. Data from the National Health and Nutrition Ex- ated blood pressure, resting electrocardiogram, pulmonary func-
amination Surveys (NHANES 1999–2002) showed that while His- tion testing and anthropometry (Sorlie et al., 2010).
panics/Latinos tend to have CVD risk factor values at high risk
levels than do non-Hispanic whites, US-born Hispanics/Latinos Allostatic load markers
(who were predominantly of Mexican origin) had higher levels of
AL than foreign-born Hispanics/Latinos (Crimmins, Kim, Alley, We defined AL based upon values of 16 available biomarkers
Karlamangla, & Seeman, 2007). Similar results from a cross-sec- collected using standardized protocols during the baseline clinical
tional study of Mexican adults residing in Texas City, TX, showed examination. Measures that comprised the AL index were de-
differences across groups that persisted after controlling for so- signed to capture (a) cardiometabolic risk: body mass index (BMI),
cioeconomic status, smoking, and physical activity (Peek et al., waist-to-hip ratio (WHR), serum triglycerides, and fasting levels of
2010). These findings may suggest an “unhealthy assimilation” ef- high- and low-density lipoprotein cholesterol (HDL-c and LDL-c);
fect where increased stress from discrimination (Paradies, 2006), (b) glucose metabolism: fasting plasma glucose (FPG), blood gly-
worsening dietary habits (Akresh, 2007), physical inactivity (Ham, cosylated hemoglobin (HbA1c), and homeostatic model assess-
Yore, Kruger, Heath, & Moeti, 2007), and adoption of unhealthy ment of insulin resistance (HOMA-IR); (c) cardiopulmonary func-
behaviors such smoking and drinking (Eitle, Wahl, & Aranda, tioning: systolic blood pressure (SBP), resting pulse pressure,
2009; Leung, 2014) confer a physiological toll and a deterioration resting heart rate, and lung function (% FEV1/FVC);
in health with time spent in the US (Antecol & Bedard, 2006). (d) parasympathetic functioning using two ultra-short time do-
Because each major Hispanic/Latino group living in the US has a main measures of heart rate variability (HRV), including the square
distinct history and culture, it is informative to investigate het- root of the mean squared difference of successive NN intervals and
erogeneity in the relationship between nativity, duration in the US, the standard deviation of NN intervals; and (e) inflammation:
age at immigration and AL across Hispanic heritage backgrounds. high-sensitivity C-reactive protein (hs-CRP) and total white blood
Moreover, the few studies that have investigated these relation- cell count (WBC). These biomarkers span a wide selection of reg-
ships have had limited age ranges and modest sample sizes, pre- ulatory systems theorized to be involved in adaptive processes
cluding the study of AL across age groups. related to life stresses and linked to health outcomes later in life
(Gruenewald et al., 2012; Juster, McEwen, & Lupien, 2010; Seeman,
The objective of this study is to examine differences in AL by Epel, Gruenewald, Karlamangla, & McEwen, 2010). We excluded
age and sex patterns of AL in a diverse, representative sample of participants who had o 8 h of fasting prior to blood draw (n ¼294,
Hispanic/Latino adults in the US, and to investigate the influence o2%) and those who had 42 missing biomarkers of AL (n ¼230,
of nativity status and Hispanic heritage on these observed o 2%).
patterns.
Details of laboratory methods for AL markers in HCHS/SOL are
Methods described on the study website (www2.cscc.unc.edu/hchs/).
Briefly, BMI was computed as weight in kilograms divided by
Sample and procedures height in meters squared. Plasma glucose was measured using a
hexokinase enzymatic method (Roche Diagnostics). HbA1c was
The Hispanic Community Health Study/Study of Latinos is a measured using a Tosoh G7 Automated HPLC Analyzer (Tosoh
community based prospective cohort study of 16,415 Hispanic/ Bioscience). Fasting insulin was measured using two commercial
Latino persons of diverse Hispanic heritages (Mexican, Puerto Ri- immunoassays (ELISA, Mercodia AB, Uppsala, Sweden; and sand-
can, Cuban, Dominican, Central and South American) aged 18–74 wich immunoassay on a Roche Elecsys 2010 Analyzer, Roche Di-
recruited from four U.S. field centers (Chicago, IL; Miami, FL, Bronx, agnostics, Indianapolis, IN; early measures conducted with the
NY; San Diego, CA), with baseline measurements conducted during Mercodia assay were calibrated, and values were equivalent to the
2008–2011. Detailed information regarding the sampling design Roche method (Qi et al., 2015). HOMA-IR was calculated using the
and cohort selection is available elsewhere (Lavange et al., 2010). following equation: fasting glucose  fasting insulin/405 (Mat-
Briefly, a stratified two-stage area probability sampling approach thews et al., 1985). The two measures of heart rate variability were
was used to select households in each of the four field centers. For assessed through ECG recordings read by the Central ECG Reading
the first stage, census block groups were randomly selected with Center (EPICARE) using GEMSIT MAC1200 portable electro-
stratification on the basis of Hispanic/Latino concentrations and cardiograph while participants were in a fasting state. Serum hs-
proportions of high and low socioeconomic status. For the second CRP was assayed in blood with a RocheModular P Chemistry
stage, households were randomly selected with stratification on Analyzer using an immunoturbidimetric method (Roche Diag-
the basis of whether the occupant had a Hispanic surname from nostics). Inter-assay coefficient of variation was o2.5%, and intra-
US Postal Service registries that covered the census block groups assay coefficient of variation was o4.7%. White blood counts were
selected. At each stage, strata were oversampled to increase like- measured in EDTA whole blood using a Sysmex XE-2100 instru-
lihood of selecting a Hispanic/Latino household. Additionally, ment, (Sysmex America, Inc., Mundelein, IL). White blood counts
Hispanic/Latino participants aged 45–74 were oversampled to fa- were measured in EDTA whole blood using a Sysmex XE-2100
cilitate an analyses of cardiovascular disease outcomes. The In- instrument, (Sysmex America, Inc., Mundelein, IL).
stitutional Review Boards at each participating institution ap-
proved this study and all subjects gave written informed consent. Operationalization of allostatic load
Study visits We created a count-based summary measure of AL following
the approach developed by Seeman and colleagues (Seeman,
At the time of enrollment, all participants attended a clinical Singer, Rowe, Horwitz, & McEwen, 1997). Each marker was as-
examination at a local field center. Fasting morning blood draw signed a score of one if its value reached a high-risk quartile;
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418 C.R. Salazar et al. / SSM -Population Health 2 (2016) 416–424
lowest quartile for HDL, FEV1/FVC, and HRV, and highest quartile summed to obtain a total AHEI-2010 score, which ranges from 0 to
for all other markers. Participants taking medications designed to 110, with a higher score representing a better quality diet.
lower values of specific markers were considered “high-risk” re-
gardless of biomarker value; specifically, these included: (a) FPG Statistical analyses
and HbA1c for anti-diabetic medications, (b) SBP for anti-hy-
To estimate age patterns of AL scores, we computed predicted
pertensive medications, (c) heart rate for β-blockers, (d) serum marginal means from log-linear models (Bieler, Brown, Williams,
& Brogan, 2010), with 95% confidence intervals based on Taylor
triglycerides for fibrates, and (e) LDL-c for statins, cholesterol ab- series linearization to account for the complex sampling scheme of
sorption inhibitors, niacin, and/or bile acid sequestrants. For each HCHS/SOL (Lavange et al., 2010). We grouped individuals into
participant, we summed all 16-indicator variables to compute a young, middle-aged, and older adults (18–39, 40–54, 55–74 years,
final AL summary score with a potential range of 0–16. respectively); for each age group, we examined whether nativity
status was associated with allostatic load (main effect) after ad-
To examine whether our results were robust to other ap- justment for covariates. Using established methods for multiple
proaches of operationalizing AL, we developed several additional imputation (Little & Rubin, 2002) with 20 imputed data sets, key
AL summary measures in sensitivity analyses, including count- social and behavioral covariates were imputed for 1665 (10.5%)
based scores that used clinical or sex-specific cut-points, and a participants who were missing annual household income
measure that summed across standardized z-scores (Box & Cox, (n ¼1374), educational attainment (n ¼ 27), insurance status
1964; Seplaki, Goldman, Glei, & Weinstein, 2005). Clinically-de- (n ¼216), and smoking status (n ¼74). Complete case analyses re-
fined high-risk cut-points for selected markers were determined vealed similar results. To further test whether the nativity-allo-
upon established criteria (Alberti & Zimmet, 1998; Chobanian static load association differed by sex and Hispanic heritage
et al., 2003; Cleeman et al., 2001; Pauwels et al., 2001; Ridker, background, we added (sex*nativity) and (Hispanic heritage
2003). background group*nativity) interaction terms in separate models.
Nativity, years in the US, and age at immigration All reported values were non-response adjusted, trimmed, and
calibrated by age, sex, and Hispanic heritage background to the
We include information on self-reported nativity status (US- characteristics of each field center's target population from the
born, foreign-born), with US born defined as birthplace within the 2010 U.S. Census. All analyses account for cluster sampling and the
50 states or Washington, DC. Foreign-born individuals were fur- use of stratification in the sample selection, and were performed
ther stratified into categories of duration in the US and age at using SAS 9.3 (Cary, NC) and SUDAAN 11.0 (Research Triangle Park,
immigration with cut-points at the median ( o10, Z10 years and NC). All tests were two-sided and the level of significance was 5%.
o24, Z24 years, respectively). Age at immigration was computed
as the number of years of residence in the U.S subtracted from the Results
age at interview. We excluded participants who had missing in-
formation on nativity status or Hispanic background (n ¼61, o1%). Table 1 depicts the continuous distributions of each physiolo-
gical marker in the AL index stratified by sex. Mean age was 40
Covariate measures years in men and 42 years in women. On average, men had higher
levels of WHR, LDL-c, triglycerides, fasting glucose, SBP, and pulse
Covariates assessed included household income, educational pressure than women, whereas women had higher mean levels of
attainment, health insurance status, Hispanic background, and BMI, HDL-c, resting heart rate, HRV, lung function, CRP and WBC
field center site. Health behaviors included self-reported smoking than men (all P values o0.0001).
status (current, former, never) and current usual alcohol con-
sumption, with at-risk drinkers defined as Z7 drinks/week for Table 2 shows age-adjusted, sex and age-stratified mean AL
women and Z14 drinks/week for men according to the National scores across socio-demographic and behavioral characteristics.
Institute on Alcohol Abuse and Alcoholism. To ascertain physical We found differences by Hispanic heritage backgrounds
activity, we administered a modified World Health Organization (P o0.0001), such that South Americans had the lowest and Puerto
Global Physical Activity Questionnaire (Bull, Maslin, & Armstrong, Ricans had the highest mean AL scores in both men and women. A
2009) to obtain estimates of moderate/vigorous levels; physically notable exception was for Hispanic/Latino men at the oldest age
active was defined as Z150 min/week of moderate-intensity, group (55–74 years), where Cubans exhibited the highest levels.
Z75 min/week of vigorous-intensity, or an equivalent combina- When we considered socioeconomic factors, lower income and
tion of both, as recommended by the 2008 US physical activity education levels were associated with higher mean AL scores at all
guidelines for adults (Pate, 2009). Diet quality was assessed from age categories in women (all P values o 0.01 for increasing trend in
two 24-h dietary recalls collected during the baseline visit and AL across lower income and education categories). However, no
operationalized using the Alternative Healthy Eating Index 2010 associations between income or education with AL were observed
(AHEI-2010). The AHEI-2010 is a summary score of 11 component in men. With regard to health behaviors, mean AL scores increased
foods and nutrients; namely, servings/day of: (1) vegetables linearly across categories of never, former, and current smoking
without potatoes, (2) whole fruits, (3) whole grains, (4) sugar amongst young (adj means: 2.11, 2.38, 2.64 respectively, P ¼0.007)
sweetened beverages and fruit juice, (5) nuts and legumes, (6) red/ and middle-aged women (adj means: 3.61, 4.13, 4.28 respectively,
processed meat; total mg/day of: (7) long chain omega-3 fats P¼ 0.0007). We found differences in the relationship of alcohol
(docosahexaenoic acid and eicosapentaenoic acid), and (8) so- consumption with AL between men and women. In men aged 18–
dium; percent (%) energy of: (9) trans-fats and (10) poly- 54, individuals who were classified as low-risk drinkers had the
unsaturated fatty acids; and number of drinks/day of (11) alcohol. lowest and at-risk drinkers had the highest mean AL scores;
Scores for each individual component were computed using the whereas amongst women aged 40–74, at-risk drinkers had the
National Cancer Institute method to estimate usual dietary intakes lowest but never drinkers had the highest scores. When dietary
of foods and nutrients obtained from the dietary recalls (Chiuve habits were considered, we found that mean AL scores decreased
et al., 2012). Each component was given a minimal score of 0 and a with better diet quality in both men and women, but only at
maximal score of 10, with intermediate values scored pro- younger (18–39) and older (55–74) ages. Lastly, AL scores were
portionally, and has the potential to contribute 0–10 points to the
total score (McCullough et al., 2002). All component scores were
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C.R. Salazar et al. / SSM -Population Health 2 (2016) 416–424 419
Table 1
Distribution of allostatic load markersa and high risk cut-points in the study population by men and women.
Allostatic load markers by Men (n¼ 6332) Women (n¼ 9498) High-risk Clinical cut-
systems cut-pointb point
Weighted means (95% Weighted medians Weighted means (95% Weighted medians
CI) (IQR) CI) (IQR)
Lipid metabolism 0.94 (0.94, 0.95) 0.94 (0.90, 0.99) 0.89 (0.89, 0.90) 0.90 (0.84, 0.94) Z 0.97 Z 0.85, 0.90c
Waist-to-hip circumference 28.9 (28.7, 29.1) 28.3 (25.3, 31.8) 29.8 (29.5, 30.1) 28.8 (25.2, 33.4) Z 32.9 Z 30
45 (44, 45) 43 (37, 50) 52 (51, 52) 50 (42, 59) r 40 o 40, 50c
ratio
Body mass index (kg/m2) 121 (120, 123) 119 (95, 144) 119 (117, 120) 114 (93, 140) Z 145 Z 160
High-density lipoprotein cho- 147 (143, 151) 117 (79, 176) 119 (117, 121) 101 (70, 146) Z 166 Z 200
lesterol (mg/dL)
Low-density lipoprotein cho-
lesterol (mg/dL)d
Serum triglycerides (mg/dL)d
Glucose metabolism 104 (103, 105) 96 (90, 103) 100 (99, 101) 92 (86, 99) Z 104 Z 126
Fasting glucose (mg/dL) 5.7 (5.7, 5.8) 5.4 (5.2, 5.7) 5.7 (5.7, 5.8) 5.4 (5.2, 5.8) Z6 Z7
Blood glycosylated hemoglo-
bin (%) 3.4 (3.3, 3.5) 2.5 (1.5, 4.1) 3.4 (3.3, 3.5) 2.4 (1.6, 4.0) Z 4.2
Homeostasis model assessed
insulin resistance
Cardiopulmonary 123 (123, 124) 121 (113, 130) 117 (116, 117) 112 (103, 125) Z 132 Z 140
Systolic blood pressure 50 (50, 50) 48 (42, 54) 46 (45, 46) 42 (37, 50) Z 55 Z 90
(mmHg)d r 70
64 (64, 65) 63 (57, 70) 67 (66, 67) 66 (60, 72) Z 72
Resting pulse pressure 80.3 (80, 80.6) 81.3 (76.5, 84.9) 81.9 (81.7, 82.1) 82.5 (78.6, 86.0) r 77.1
(mmHg)
Resting heart rate (bpm)d
Lung function (%FEV1/FVC)
Parasympathetic (heart rate 32.6 (31.5, 33.7) 25.5 (16.1, 40.8) 33.2 (32.3, 34) 26.8 (17.1, 41.5) r 14.8
variability) 38.6 (37.1, 40.1) 29.3 (17.4, 49.3) 41.4 (40.2, 42.6) 32.4 (19.5, 51.6) r 16.5
R–R interval standard devia-
tion (ms)
Root mean square successive
differences (ms)
Inflammation 2.9 (2.8, 3.1) 1.6 (0.7, 3.1) 4.6 (4.3, 4.9) 2.5 (1.0, 5.3) Z 4.5 Z3
Serum C-reactive protein (pg/ 6.4 (6.3, 6.5) 6.2 (5.2, 7.3) 6.7 (6.6, 6.8) 6.5 (5.4, 7.8) Z 7.6
ml)
Total white blood cell count
(per mL)
a Individuals with 1 or 2 missing markers were included in analyses; missing values were imputed at the mean. The distribution of missing markers were as follows:
waist-to-hip circumference ratio (n ¼39, 0.2%), body mass index (n¼ 36, 0.2%), high-density lipoprotein cholesterol (n¼ 1,o 0.1%), low-density lipoprotein cholesterol
(n¼ 303, 2%), fasting glucose (n¼ 5, o 0.1%), glycosylated hemoglobin (n ¼48, 0.3%), homeostasis model assessed insulin resistance (n¼ 43, 0.3%), pulse pressure (n¼ 8,
o 0.1%), resting heart rate (n ¼7, o 0.1%), vital capacity (n ¼760, 5%), heart rate variability (n¼ 684, 4%), c-reactive protein (n ¼4, o0.1%), and total white blood cell count
(n¼ 962, 6%).
b High-risk cut-points derived from the bottom 25th percentile for: high-density lipoprotein cholesterol, lung function, heart rate variability measures; top 75th per-
centile for all other markers.
c Sex-specific cut-points for women (first value) and men (second value).
d Scored as high-risk if on medications that were prescribed to lower these markers, even if the measured marker was below the “high risk” cut point.
lower amongst individuals who met criteria for being physically scores by nativity status were observed when the data were fur-
active as compared to those who did not, irrespective of sex and ther stratified by sex (P ¼0.36 and 0.13 for interaction of sex*-
age. nativity in 18–54 year olds and Z 55 years, respectively; Fig. 2b,c).
However, nativity differences were more pronounced in younger
Nativity differences in allostatic load by age and sex Hispanic/Latino women compared with men.
While scores were higher for the older age groups overall, men Stratified results
exhibited higher mean levels than women at all ages, reaching a
peak sex difference in AL scores at 35–44 years (Fig. 1; P ¼0.02 for When foreign-born individuals were further stratified by years
interaction of age-group*sex). When we plotted age patterns by living in the US, we observed the lowest mean AL scores in for-
nativity status, US-born individuals exhibited higher mean scores eign-born persons with o10 years of living in the US (adj.
than their foreign-born counterparts at each age category up to 54 means ¼3.47, 95% confidence interval [CI]: 3.34–3.61), inter-
years (Fig. 2a); beyond age 54 years, these differences were no mediate AL in those living in the US Z10 years (adj. means ¼3.78,
longer apparent. It should be noted, however, that the proportion 95% CI: 3.68–3.88), and the highest AL scores in US-born in-
of foreign-born Hispanic/Latino adults (Z55 years) was appreci- dividuals (adj. means ¼4.23, 95% CI: 4.03–4.42), after adjustment
ably higher among older adults than that of their younger coun- for age (Fig. 3a; Po 0.0001 for trend). These results changed little
terparts (94% versus 78%, respectively). Similar age patterns of AL whether or not adjustment was made for Hispanic background,
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420 C.R. Salazar et al. / SSM -Population Health 2 (2016) 416–424
Table 2
Age-adjusted means (95% CI) of allostatic load scores across participant characteristics stratified by age and sex.
Men Women
n 18–39 yr (n¼ 2180) 40–54 yr (n¼2426) 55–74 yr (n¼ 1726) n 18–39 yr (n¼ 2726) 40–54 yr (n¼ 3914) 55–74 yr (n¼ 2858)
Overall 6332 2.77 (2.65, 2.88) 4.53 (4.38, 4.68) 6.58 (6.39, 6.77) 9498 2.23 (2.11, 2.35) 3.82 (3.66, 3.97) 5.86 (5.68, 6.03)
National background 489 2.76 (2.33, 3.20) 4.22 (3.72, 4.73) 6.22 (5.75, 6.68) 929 2.19 (1.88, 2.49) 3.39 (3.10, 3.69) 5.77 (5.39, 6.14)
Dominican 1079 3.02 (2.70, 3.35) 5.04 (4.68, 5.40) 6.55 (6.13, 6.98) 1512 2.86 (2.53, 3.18) 4.53 (4.10, 4.95) 6.23 (5.90, 6.56)
Puerto Rican 1069 2.48 (2.20, 2.75) 4.55 (4.26, 4.84) 6.93 (6.57, 7.28) 1213 1.89 (1.66, 2.13) 3.71 (3.47, 3.96) 5.97 (5.65, 6.29)
Cuban 2398 2.86 (2.67, 3.06) 4.36 (4.12, 4.59) 6.49 (6.10, 6.88) 3938 2.27 (2.08, 2.45) 3.76 (3.50, 4.02) 5.58 (5.22, 5.95)
Mexican 660 2.51 (2.26, 2.76) 4.60 (3.99, 5.22) 6.41 (5.91, 6.90) 1026 2.11 (1.86, 2.37) 3.72 (3.31, 4.12) 6.14 (5.66, 6.62)
Central American 417 2.21 (1.72, 2.69) 3.96 (3.51, 4.40) 5.61 (5.02, 6.20) 1.52 (1.17, 1.87) 3.00 (2.67, 3.33) 5.20 (4.61, 5.78)
South American 220 2.92 (2.37, 3.47) 4.85 (3.93, 5.78) 6.13 (5.24, 7.02) 619 2.11 (1.67, 2.55) 4.82 (3.20, 6.45) 6.06 (4.82, 7.30)
Other/more than 1 0.0045 0.0056 0.0036 261 o 0.0001 o 0.0001 0.0316
P group difference*
Annual household income
o $10,000 709 2.96 (2.53, 3.40) 4.57 (4.14, 5.01) 6.63 (6.22, 7.03) 1519 2.73 (2.41, 3.05) 4.17 (3.80, 4.55) 5.96 (5.65, 6.27)
2.78 (2.54, 3.03) 4.64 (4.38, 4.90) 6.70 (6.39, 7.01) 2937 2.40 (2.22, 2.58) 3.96 (3.72, 4.21) 6.12 (5.84, 6.39)
$10,001–$20,000 1768 2.82 (2.61, 3.02) 4.62 (4.38, 4.86) 6.79 (6.43, 7.15) 2799 2.19 (2.00, 2.38) 3.71 (3.45, 3.98) 5.66 (5.33, 5.98)
2.95 (2.66, 3.23) 4.24 (3.95, 4.54) 6.24 (5.78, 6.70) 1000 1.98 (1.70, 2.27) 3.38 (2.93, 3.83) 5.47 (5.03, 5.90)
$20,001–$40,000 2124 2.57 (2.11, 3.03) 4.29 (3.62, 4.97) 5.97 (5.07, 6.87) 1.56 (1.15, 1.97) 2.91 (2.13, 3.69) 4.15 (2.79, 5.51)
0.651 0.1666 0.1572 278 o 0.0001 0.0002 0.0043
$40,001–$75,000 964
4 $75,000 358
P trenda
Highest educational attainment
o9th grade 1351 2.79 (2.48, 3.09) 4.61 (4.26, 4.97) 6.73 (6.40, 7.05) 2368 2.42 (2.10, 2.74) 4.15 (3.85, 4.44) 6.11 (5.78, 6.44)
5.00 (4.65, 5.35) 6.79 (6.27, 7.30) 1264 2.59 (2.30, 2.87) 4.23 (3.89, 4.58) 6.11 (5.67, 6.56)
9th grade– oHS 990 2.79 (2.51, 3.07) 4.47 (4.22, 4.73) 6.39 (5.93, 6.85) 2276 2.28 (2.08, 2.48) 4.21 (3.89, 4.53) 5.82 (5.48, 6.15)
4.39 (4.15, 4.63) 6.49 (6.20, 6.78) 3569 2.00 (1.85, 2.16) 3.30 (3.12, 3.49) 5.53 (5.29, 5.77)
HS or equivalent 1770 2.78 (2.58, 2.99) 0.0734 0.2069 0.0001 o 0.0001 0.0033
4 HS 2215 2.73 (2.54, 2.92)
P trenda 0.6647
Has health insurance 3258 2.72 (2.58, 2.87) 4.54 (4.35, 4.73) 6.50 (6.17, 6.84) 4479 2.21 (2.07, 2.34) 3.77 (3.59, 3.94) 5.68 (5.41, 5.95)
No 2990 2.81 (2.58, 3.05) 4.53 (4.29, 4.77) 6.60 (6.38, 6.83) 4887 2.22 (2.04, 2.39) 3.87 (3.62, 4.12) 5.94 (5.70, 6.19)
Yes 0.9606 0.6213 0.4966 0.1732
P value 0.555 0.9372
Smoking status 3054 2.69 (2.53, 2.85) 4.31 (4.11, 4.52) 6.42 (6.13, 6.72) 6567 2.11 (1.99, 2.23) 3.61 (3.42, 3.80) 5.71 (5.50, 5.92)
Never 1649 2.88 (2.54, 3.22) 4.73 (4.43, 5.03) 6.78 (6.47, 7.09) 1480 2.38 (2.00, 2.75) 4.13 (3.76, 4.51) 6.16 (5.83, 6.50)
Former 1614 2.86 (2.61, 3.10) 4.74 (4.47, 5.01) 6.50 (6.12, 6.88) 1435 2.64 (2.29, 3.00) 4.28 (3.99, 4.56) 6.11 (5.72, 6.50)
Current 0.3794 0.1049 0.6247 0.0073 0.0007 0.1651
P group difference*
Alcohol consumptionb 2407 2.82 (2.61, 3.02) 4.70 (4.48, 4.91) 6.54 (6.24, 6.84) 5900 2.29 (2.14, 2.43) 4.05 (3.85, 4.24) 6.06 (5.88, 6.24)
Not current drinker 3391 2.63 (2.48, 2.78) 4.30 (4.10, 4.50) 6.70 (6.45, 6.96) 3315 2.16 (1.98, 2.35) 3.40 (3.20, 3.60) 5.33 (4.97, 5.70)
Low-risk drinker 527 3.32 (2.81, 3.84) 5.36 (4.84, 5.89) 6.11 (5.57, 6.65) 268 2.18 (1.58, 2.79) 3.84 (3.26, 4.42) 5.48 (4.57, 6.38)
At-risk drinker 0.03 0.0002 0.1437 0.5446 o 0.0001 0.0011
P group difference*
Meets physical activity guidelinesc
No 1634 3.21 (2.88, 3.55) 5.06 (4.80, 5.33) 6.88 (6.55, 7.21) 4066 2.37 (2.17, 2.57) 4.10 (3.87, 4.32) 6.12 (5.87, 6.37)
4.33 (4.17, 4.49) 6.37 (6.15, 6.59) 5406 2.16 (2.02, 2.30) 3.61 (3.43, 3.79) 5.56 (5.34, 5.78)
Yes 4650 2.68 (2.55, 2.80) o 0.0001 0.0122 0.0004 0.0006
0.0822
P value 0.0039 2.30 (2.13, 2.46) 4.16 (3.90, 4.41) 2.72 (2.55, 2.90) 4.97 (4.69, 5.26)
2.11 (1.91, 2.30) 3.81 (3.57, 4.05) 2.87 (2.65, 3.08) 4.32 (4.08, 4.57)
AHEI-2010 scoresd 3410 3.76 (3.63, 3.88) 2.27 (1.97, 2.58) 3.27 (3.02, 3.52) 1771 4.15 (4.02, 4.28) 2.70 (2.46, 2.93) 4.31 (4.06, 4.55)
Bottom tertile 3159 3.41 (3.27, 3.56) 0.4017 o 0.0001 2085 4.06 (3.91, 4.21) 0.8919 0.0004
Middle tertile 2849 3.27 (3.10, 3.45) 2402 3.86 (3.71, 4.00)
Highest tertile o 0.0001 0.0044
P trenda
* P-values for group difference based on Wald F-statistic from age-adjusted models.
a P-values for test of linear trend with the variable treated as ordinal.
b At-risk drinking defined as 7þ drinks per week in women and 14þ drinks per week in men.
c According to self-report using the Global Physical Activity Questionnaire, which recommends at least 150 min/week of moderate-intensity, 75 min/week of vigorous
intensity, or an equivalent combination.
d Alternative Healthy Eating Index-2010 (AHEI-2010) is a measure of diet quality is a summary score of 11 component foods and nutrients; servings/day of vegetables
without potatoes, whole fruits, whole grains, sugar sweetened beverages and fruit juice, nuts and legumes, red/processed meat; total mg/day of long chain omega-3 fats
(docosahexaenoic acid and eicosapentaenoic acid), and sodium; percent (%) energy from trans-fats and polyunsaturated fatty acids; and number of drinks/day of alcohol.
Scores for each individual component were computed using the National Cancer Institute method to estimate usual dietary intakes of foods and nutrients obtained from two
24-hr dietary recalls, with each component given a minimal score of 0 and a maximal score of 10, and intermediate values scored proportionally. All the component scores
were summed to obtain a total AHEI-2010 score, which ranged from 0 to 110, with higher scores representing better quality diet. The score was categorized into tertiles.
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C.R. Salazar et al. / SSM -Population Health 2 (2016) 416–424 421
Fig. 1. Age–specific mean allostatic load scores stratified by sex in the overall HCHS/SOL target population (unweighted n¼ 15,830).
Fig. 2. Age–specific mean allostatic load scores stratified by nativity status in the overall population (panel A; P¼ 0.36 and 0.13 for interaction of sex*nativity in 18–54 year
olds and Z 55 years, respectively), in men only (panel B), and in women only (panel C).
field center, socioeconomic position, insurance status, smoking, years in the US with AL by Hispanic background in multivariable
alcohol consumption, physical activity, and diet quality. Age-stra- analysis (P ¼0.50 for interaction). While US-born Central and
tified models restricted to women showed that this increasing South Americans exhibited similar or lower AL scores than their
trend in AL scores across categories of nativity/duration was more foreign-born counterparts, their numbers were relatively small
apparent in persons aged 18–54 years than in those of older age. In (n ¼76 and 43, respectively; o5% of total sample). Because AL is
men, however, the trend persisted across every age group (P known to be associated with socioeconomic status, we also tested
values o 0.01 for trend). Fig. 3b illustrates that similar patterns for interaction by income and education. We found no effect
were observed in analyses in which foreign-born individuals were modification by socioeconomic status.
stratified by age at immigration rather than duration of US re-
sidence. Overall, persons who were US born had the highest scores Sensitivity analyses
(adj. means ¼ 4.26, 95% CI: 4.06–4.46), those who migrated to the
US at younger ages (o24 years of age) had intermediate mean AL To assess the robustness of the nativity association, we per-
scores (adj. means ¼3.75, 95% CI: 3.63–3.87), and persons who formed several sensitivity analyses using alternate summary
migrated at older ages (Z 24 years of age) had the lowest mean AL measures of AL that included clinical cut-points, sex-specific cut-
scores (adj. means ¼3.52, 95% CI: 3.52–3.74, P o0.0001 for trend). points, and standardized z-scores. For each alternate measure of
AL, we observed similar nativity differences when we plotted
We observed similar associations of birthplace and length of mean levels of each AL measure across age groups (Supplementary
time in the US with AL when we further stratified the analyses by Fig. 1). In addition, we adjusted our models for medication use
Hispanic background (Fig. 3c). There was no interaction of nativity/
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422 C.R. Salazar et al. / SSM -Population Health 2 (2016) 416–424
Fig. 3. Adjusted‡ mean allostatic load scores by nativity/duration of US residence (panel A), nativity/age at immigration (panel B), and nativity/duration of US residence
further stratified by Hispanic background (panel C), n ¼15,830. *P for trend o0.01, **P for trend o 0.001, ***P for trend o0.0001, ‡Adjusted for age (continuous), field center
(Miami, San Diego, Bronx, Chicago), income ( o $10,000, $10,001–$20,000, $20,001–$40,000, $40,001–$75,000, 4$75,000), education (o 9th grade, 9th grade– o HS, HS or
equivalent, 4HS), health insurance (yes, no), smoking (current, former, never), alcohol consumption (not current drinker, low risk drinker, at-risk drinker), meets physical
activity guidelines (yes, no), and diet quality (tertile scores).
rather than assigning participants into a “high-risk” group and we association persisted in both men and women, across all Hispanic
found that the results were similar. backgrounds, and was independent of selected social factors and
health behaviors. The robustness of this finding is further con-
Discussion firmed by the fact that the nativity differences remained un-
changed with other measures of AL and was similar across His-
In a sample of individuals drawn from four urban centers with panic backgrounds. Among the foreign-born, we found that
large numbers of Hispanics/Latinos, we found that US-born in- greater duration of US residence and younger ages at immigration
dividuals had higher scores of AL than their foreign-born coun- were related to higher levels of AL. Results from this large popu-
terparts, with differences less pronounced at ages 55 or older. The lation-based study are consistent with those among Mexican
Americans (Crimmins et al., 2007; Kaestner, Pearson, Keene, &
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C.R. Salazar et al. / SSM -Population Health 2 (2016) 416–424 423
Geronimus, 2009; Peek et al., 2010), and extends these findings to Hispanic/Latino immigrants to their countries of origin (Turra &
US Hispanic/Latinos of other heritage backgrounds. Elo, 2008). However, our data show differences in AL by nativity/
duration in US among Cuban Americans, who would not have
Our data support the healthy immigrant effect, a widely docu- easily returned to their country of origin (Abraido-Lanza, Doh-
mented and well-established phenomenon in which recent im- renwend, Ng-Mak, & Turner, 1999). More studies are thus neces-
migrants demonstrate health advantages over demographically si- sary to identify risk and resilience mechanisms that may explain
milar native-born individuals (Lara, Gamboa, Kahramanian, Morales, these differences at older ages.
& Bautista, 2005). While our data showed that unhealthy behaviors
such as cigarette smoking and physical activity were associated with We found that men had higher levels of AL scores than women
high scores of allostatic load, nativity differences persisted after ad- across every age category, a novel finding among US Hispanics/
justment for these factors, consistent with prior studies (Crimmins Latinos of diverse backgrounds. In analyses of specific AL compo-
et al., 2007; Kaestner et al., 2009). Proposed alternative explanations nents, metabolic markers were generally higher in men and in-
for the healthy immigrant effect include selective migration, whereby flammatory markers were higher in women. Sex differences in
the healthiest individuals of their respective countries of origin self- components of AL have been previously reported in other cohorts.
select to migrate to a remote and unfamiliar labor market (Bostean, For instance, results from the Social Environment and Biomarkers
2013). Given that data on potential emigrants and non-emigrants of Aging Study in Taiwan, the Wisconsin Longitudinal Survey, and
from participants’ countries of origin are not available in the present the MacArthur studies of successful aging demonstrated that men
study, selective migration cannot be ruled out. had higher cardiovascular/ metabolic markers whereas women
had a disadvantage in markers of sympathetic nervous system
Consistent with the notion that newer immigrants’ health ad- (SNS) and HPA axis functioning (Goldman et al., 2004). Findings
vantages erode over time, we observed higher AL scores with from NHANES (1998–2006) showed a higher overall cumulative
longer duration in the US and with younger age at immigration. burden of inflammation in women than in men, which tended to
Findings from NHANES (1988–1994) similarly showed a health decline with age (Yang & Kozloski, 2011). Similarly, in the Boston
advantage among Mexican Americans who immigrated at older Puerto Rican Study, women exhibited higher levels of in-
ages (Kaestner et al., 2009). Moreover, higher AL among those with flammatory markers than men (Mattei et al., 2010). It's unclear to
longer time spent in the US is supported by a large study of what extent sex differences in AL and its components are driven
Mexican Americans living in Texas that found nativity differences by genetic, hormonal, or contextual influences. There is, however,
even after adjusting for social factors and health behaviors (Peek some empirical evidence from the Texas City Stress and Health
et al., 2010). Among immigrants, longer duration of US residence Study to show that sex modifies the relationship between duration
(4 10 years) has been associated with obesity and obesity-related of residence in a stressful environment and AL (Mair, Cutchin, &
conditions (Goel, McCarthy, Phillips, & Wee, 2004). Exposure to Kristen Peek, 2011), suggesting that men and women may man-
severe challenges and stressors associated with migration and the ifest stressors differently. Additional work is necessary to further
adoption of a new culture could lead to chronic dysregulation of understand the complex inter-relationships between sex, stres-
hypothalamic-pituitary-adrenal axis activity (Mangold, Mintz, Ja- sors, AL and its components in Hispanics/Latinos.
vors, & Marino, 2012; Sapolsky, 2004), with downstream effects on
multiple physiological systems. Our study had several limitations. The cross-sectional design
precludes any inferences of a causal effect. Related to this is the
US-born Hispanics/Latinos consistently had the highest AL possibility that the differences in AL across groups might be in-
scores. Assuming that newer immigrants come with a health ad- fluenced, in part, by age and period effects such as shifts in im-
vantage and lose that advantage through a process of acculturation migration policies. For instance, a rise in late-age immigration due
to levels comparable of the native born population, it's conceivable to US admission policies since 1981 (Carr & Tienda, 2013) may
that individuals who have already adopted the host culture (US create imbalances in the cohort related to family reunification/
born) would no longer exhibit such health advantage. This is cohesion and lead to health consequences. Disentangling age,
consistent with previous reports using NHANES data (Kaestner period, and cohort effects on AL and subsequent health outcomes
et al., 2009; Peek et al., 2010). However, exposure to stressors is a target of future study in HCHS/SOL when longitudinal data are
associated with acculturation might not be the only factor that made available. Secondly, we did not have neuroendocrine mar-
drives our associations. In addition, the process of acculturation is kers available for analyses, which have been previously included in
complex and may be different for each of the Hispanic groups from studies of AL. This reduces the ability to compare our findings with
different countries of origin. Longitudinal studies will be needed to some prior studies that included a different set of markers of AL.
address these questions, which we plan to conduct in future stu-
dies using the HCHS/SOL cohort. In summary, the current study is the first to examine AL patterns
in a diverse Hispanic/Latino population in the US. We found nativity
The nativity-AL relationship was, however, less pronounced at differences in age patterns of AL, showed sex-related differences, and
older ages. This may also reflect an unfavorable influence of in- conclude that these patterns are consistent across major Hispanic/
creasing acculturation to the US over time among migrants Latino backgrounds. Future work should focus on identifying risk and
(Antecol & Bedard, 2006), or could also be explained by differences resiliency factors that might explain these differences, as well as find
between younger and older individuals in the burden of health additional biological markers such as epigenetic changes that can
conditions and use of medical care. Older individuals are more measure response to stressors. Identification of key determinants of
likely to receive health benefits from the health care system, and AL patterns among Hispanics/Latinos is an important first step in
the US-born are more likely to take advantage. This may confer a developing tailored interventions to reduce health disparities. A
variety of benefits to older US-born Hispanic/Latino persons or major strength is the prospective design of HCHS/SOL, which will
among those who have longstanding residence in the US and who enable us to monitor the impact of acculturation on AL over time and
therefore have better access to medical and social services. On the examine the effects of behavior on these processes.
other hand, selective survival of older Hispanics with lower AL
may offer a competing explanation. Additionally, older individuals Funding
with lower levels of AL might have self-selected for inclusion in
this study preferentially due to a more favorable health status The Hispanic Community Health Study/Study of Latinos (HCHS/
relative to their similarly aged peers with higher levels of detri- SOL) was performed as a collaborative study supported by
mental markers. Another contributory selection factor often cited
is the “salmon effect”, the selective return of less healthier older
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424 C.R. Salazar et al. / SSM -Population Health 2 (2016) 416–424
contracts from the National Heart, Lung, and Blood Institute (2004). Sex differentials in biological risk factors for chronic disease: Estimates
(NHLBI) to the University of North Carolina (N01-HC65233), Uni- from population-based surveys. Journal of Women's Health (Larchmont), 13,
versity of Miami (N01-HC65234), Albert Einstein College of Med- 393–403.
icine (N01-HC65235), Northwestern University (N01-HC65236), Gruenewald, T. L., Karlamangla, A. S., Hu, P., Stein-Merkin, S., Crandall, C., Koretz, B.,
and San Diego State University (N01-HC65237). The following In- et al. (2012). History of socioeconomic disadvantage and allostatic load in later
stitutes/Centers/Offices contribute to the HCHS/SOL through a life. Social Science and Medicine, 74, 75–83.
transfer of funds to the NHLBI: National Institute on Minority Ham, S. A., Yore, M. M., Kruger, J., Heath, G. W., & Moeti, R. (2007). Physical activity
Health and Health Disparities, National Institute on Deafness and patterns among Latinos in the United States: Putting the pieces together. Pre-
Other Communication Disorders, National Institute of Dental and venting Chronic Disease, 4, A92.
Craniofacial Research, National Institute of Diabetes and Digestive Juster, R. P., McEwen, B. S., & Lupien, S. J. (2010). Allostatic load biomarkers of
and Kidney Diseases, National Institute of Neurological Disorders chronic stress and impact on health and cognition. Neuroscience and Biobeha-
and Stroke, National Institutes of Health Institution-Office of vioral Reviews, 35, 2–16.
Dietary Supplements. This research was supported by an NHLBI Kaestner, R., Pearson, J. A., Keene, D., & Geronimus, A. T. (2009). Stress, allostatic
supplement award to Christian R. Salazar. load and health of Mexican immigrants. Social Science Quarterly, 90, 1089–1111.
Lara, M., Gamboa, C., Kahramanian, M. I., Morales, L. S., & Bautista, D. E. (2005).
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Tuggle et al. Journal of Physiological Anthropology (2018) 37:28
https://doi.org/10.1186/s40101-018-0188-4
ORIGINAL ARTICLE Open Access
Stress, migration, and allostatic load: a
model based on Mexican migrants in
Columbus, Ohio
Alexandra C. Tuggle1* , Jeffrey H. Cohen1 and Douglas E. Crews1,2
Abstract
Background: Immigration is a disruptive event with multiple implications for health. Stressors, including family
separation, acculturation, job insecurity, restricted mobility, sojourns, dangerous border crossings, stigmatization, and
marginalization, shape immigrant health in ways we are only beginning to untangle. Around the world, there are over
200 million international migrants. In 2015, there were 43.2 million immigrants living in the US, 26.8% of whom were
born in Mexico. Investigating how stress affects health among migrants facilitates better understanding of their
experiences.
Methods: Here, we review existing research on stress and how allostatic load varies among migrants with specific
attention to Mexican migrants in the US. Next, we explore research incorporating biomarkers of allostasis and narratives of
migration and settlement to examine disease risks of Mexican migrants residing in Columbus, Ohio. This mixed-methods
approach allowed us to examine how social stressors may influence self-reports of health differentially from associations
with assessed discrimination and physiological biomarkers of health.
Results: These data sources are not significantly associated. Neither narratives nor self-reports of health provide significant
proxies for participants’ physiological health.
Conclusions: We propose, the pairing of objectively assessed health profiles with narratives of migration better
illustrate risks migrants face, while allowing us to discern pathways through which future health challenges may arise.
Immigration and acculturation to a new nation are biologically and culturally embedded processes, as are stress and
allostatic responses. To understand how the former covary with the latter requires a mixed-methods bioethnographic
approach. Differences across multiple social and physiological systems, affect individual health over time. We propose
incorporating physiological biomarkers and allostatic load with migrants’ narratives of their migration to unravel
complex relationships between acculturation and health.
Keywords: Acculturation, Biomarkers, Health, Immigration, Stressors
Background effect on health. As such, all organisms have evolved in
The deterioration of immigrant health following migra- some way to halt and delay stressors long enough to
tion is closely intertwined with stressors they experience reproduce [1]. Allostasis theory was developed to help ex-
before, during, and after their journeys. Transitioning plain this general mammalian life history trait, allocating
into a new society and the social adjustment that follows energy for physiological stress responses to limit somatic
produce unique stressors for migrants. For all species, wear and increase an organism’s survival and reproduction
their environment is a significant stressor, and any [2]. In their original conception, Sterling and Eyer [2]
change in that environment may have a corresponding defined allostasis as “stability through change,” highlight-
ing the dynamic character of internal mammalian physio-
* Correspondence: [email protected] logical systems evolved to react to their continuously
1Department of Anthropology, Ohio State University, 4034 Smith Laboratory, fluctuating activity levels and environmental conditions
174 W. 18th Avenue, Columbus, OH 43210, USA (p. 636). Although dynamic short-term physiological
Full list of author information is available at the end of the article
© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
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