La vida en la frontera: protocol for a prospective study exploring stress and health resiliencies among Mexican-origin individuals living in a US-Mexico border community

Abstract

Background Mexican-origin adults living near the U.S.-Mexico border experience unique and pervasive social and ecological stressors, including poverty, perceived discrimination, and environmental hazards, potentially contributing to the high burden of chronic disease. However, there is also evidence that residents in high-density Mexican-origin neighborhoods exhibit lower prevalence rates of disease and related mortality than those living in other areas. Understanding the factors that contribute to health resiliencies at the community scale is essential to informing the effective design of health promotion strategies. Methods La Vida en la Frontera is a mixed-methods participatory study linking a multi-disciplinary University of Arizona research team with Campesinos Sin Fronteras, a community-based organization founded by community health workers in San Luis, Arizona. This paper describes the current protocol for aims 2 and 3 of this multi-faceted investigation. In aim 2 a cohort of N≈300 will be recruited using door-to-door sampling of neighborhoods in San Luis and Somerton, AZ. Participants will be surveyed and undergo biomarker assessments for indicators of health and chronic stress at three time points across a year length. A subset of this cohort will be invited to participate in aim 3 where they will be interviewed to further understand mechanisms of resilience and wellbeing. Discussion This study examines objective and subjective mechanisms of the relationship between stress and health in an ecologically diverse rural community over an extended timeframe and illuminates health disparities affecting residents of this medically underserved community. Findings from this investigation directly impact the participants and community through deepening our understanding of the linkages between individual and community level stress and chronic disease risk. This innovative study utilizes a comprehensive methodology to investigate pathways of stress and chronic disease risk present at individual and community levels. We address multiple public health issues including chronic disease and mental illness risk, health related disparities among Mexican-origin people, and health protective mechanisms and behaviors.

Risk Factors Associated with Diabetes among Mexican-Origin Adults in Southern Arizona

“…That is, a low level of educational attainment affects health literacy and English proficiency in Mexican-origin people with diabetes, leading to distress and poorer diabetes self-care [ 37 ]. In addition to the impact of education and income, Mexican-origin individuals have the lowest rates of healthcare utilization among different groups in the US, primarily due to barriers that hinder access to care [ 38 ]. Therefore, promoting CHWs interventions is crucial as they facilitate education and communication regarding healthcare, enabling patients to better understand the healthcare system and receive the necessary support and services they require [ 31 ].…”

“…In general, depression and anxiety are often not diagnosed or underdiagnosed among Latine adults with diabetes due to cultural and linguistic barriers between health professionals and patients [ 24 , 39 ]. Thus, emotional well-being is critical to diabetes control [ 38 , 44 ], and these findings point toward the need to screen for depression and anxiety specifically among Mexican-origin individuals with diabetes during regular office visits [ 19 ].…”

The Use of Qualitative Methods to Guide the Development of the Border Resilience Scale in a Participatory Research Study

“…As such, the study included a qualitative explanatory phase designed to elucidate the potential protective factors articulated by the SRM, followed by a longitudinal study of the identified factors and their relationship to health outcomes among a cohort of border residents. We developed the BRS within the context of the qualitative phase of the study (see Duenas et al 2022 for a detailed description of the study protocol) [26].…”

“…In the parent study, CSF community health workers recruit participants through door-to-door randomized community-based sampling in two U.S. border communities. Eligible individuals complete a longitudinal survey in the home setting with an interview-style approach [26]. With the exception of question six, the nine-item BRS follows a 4-point Likert scale from 1 to 4 (1 = Completely disagree, 2 = Disagree, 3 = Agree, 4 = Completely Agree).…”