Navigating health care: brokerage and access for undocumented Latino immigrants under the 2010 Affordable Care Act

ABSTRACT

Brokerage is a prominent mechanism that explains access for Latino immigrants to many American institutions. However, few studies examine the dual nature of brokerage in answering questions on access to health care for undocumented Latino immigrants. The growing importance of Federally Qualified Health Centers (FQHCs) and ethnic navigators connecting immigrants to health care under the 2010 Affordable Care Act calls attention to the duality of brokers and its role in access. The study draws from 44 in-depth interviews with providers, clinic directors, navigators, and immigrant patients and two years of fieldwork in FQHCs in California’s San Francisco Bay Area (2011–2013). Results show that brokers enable access through coaching and myth-busting but they also hinder it through scrutiny and bureaucratic filtering. The widespread dependence on brokerage, I argue, leads to ersatz brokerage, such as when providers navigate the health-care system for the undocumented without the appropriate linguistic resources or coordination. Furthermore, the study shows that the duality in brokerage generates misinformation, churning, and alienation. Understanding the relational processes that both include and exclude vulnerable populations from needed services enhances theories of immigrant integration and can help design more efficient policies and address inequalities related to documentation status.     

Household Debt and Adult Depressive Symptoms in the United States

This study used data from Waves 1 (1987–1989) and 2 (1992–1994) of the National Survey of Families and Households in the United States and a series of regression models, some of which included individual-specific fixed effects, to estimate associations of particular types and levels of debt with adult depressive symptoms. Results suggest that household debt is positively associated with greater depressive symptoms. However, this association appears to be driven by short-term (unsecured) debt; we found little evidence of associations with depressive symptoms for mid- or long-term debt. The link between short-term debt and depressive symptoms persisted with alternative estimation strategies, including defining debt in absolute and relative terms. Furthermore, this association was particularly concentrated among 51–64 year-old adults, those with a high school education or less, and those who were not stably married throughout the observation period. These findings suggest that short-term debt may have an adverse influence on psychological wellbeing, particularly for those who are less educated, approaching retirement age, or unmarried.     

Food in a row: urban trees offer valuable floral resources to pollinating insects

Urbanization affects the availability and diversity of floral resources (pollen and/or nectar) for wild pollinating insects. For example, urban green areas are characterized by an abundance of ornamental plant species. Increasingly, trees are planted to improve the aesthetics of urban streets and parks. These urban trees might offer important floral resources to pollinating insects. To examine the suitability of urban trees as resources for pollinating insects, we investigated the chemical composition of pollen and nectar as well as the amount of nectar produced by the nine major insect-pollinated tree species planted in cities of Western Europe, namely Acer pseudoplatanus, Aesculus carnea, A. hippocastanum, Robinia pseudoacacia, Tilia cordata, T. x euchlora, T. x europaea, T. platyphyllos and T. tomentosa. The analyses revealed that globally the Tilia trees provide pollen with lower contents of polypeptides, amino acids and phytosterols compared with the other species. Urban tree flowers offer abundant nectar with relatively high sugar contents (0.16–1.28 mg/flower); sucrose was the predominant sugar in all nectars. The investigated tree species could therefore be considered in future city plantings.     

Developmental Outcomes of School Attachment Among Students of Mexican Origin

We used a longitudinal community study of 674 grade school children (Grades 5, 6, 7, and 8; 337 males, 337 females) of Mexican origin to examine outcomes of school attachment. Attachment to school is important in this population given the high level of school dropout rates of Mexican‐origin students. Results indicated that, on average, school attachment from fifth to sixth grade remains stable, but declines from sixth to eighth grade. Boys had lower levels of school attachment at fifth grade but followed similar patterns of change as girls did. Attachment to teachers, peer competence, school aspirations and expectations, and substance‐use cognitions emerged as longitudinal outcomes of level or changes in school attachment. Gender moderated associations of school attachment.     

Transforming the Way We Live Together: A Model to Move Communities From Policy to Implementation

Most cities, counties, and neighborhoods are not designed for an aging population. By providing a range of services to all residents, Lifelong Communities allow individuals to age in place. Although the Lifelong Communities Initiative is based on established guiding principles, little information exists regarding the realities of moving from policy to implementation. The Atlanta Regional Commission conducted a case study in Mableton, Georgia, and found successful implementation requires a combination of support from local citizen groups and government. The Atlanta Regional Commission is replicating these best practices in other communities and providing support to those aspiring to launch or expand Lifelong Communities.     

Developmental Patterns in Marital Satisfaction: Another Look at Covenant Marriage

This study investigated differences in the trajectory of marital satisfaction in the first 7 years between couples in covenant versus standard marriages. The authors analyzed data on 707 Louisiana marriages from the Marriage Matters Panel Survey of Newlywed Couples, 1998–2004, using multivariate longitudinal growth modeling. When the sample was restricted to couples who remained married over the duration of the study, a marginal benefit of covenant status was found for husbands. This effect was largely accounted for by covenant husbands' more extensive exposure to premarital counseling. The linear decline in marital satisfaction over time that obtained for both husbands and wives was not, however, any different for covenant marriages versus standard marriages. Couples characterized by more traditional attitudes toward gender roles were significantly less satisfied than others. High premarital risk factors, initial uncertainty about marrying the spouse, and the presence of preschool‐age children in the household were all corrosive of marital satisfaction at any given time.     

Relational rurals: Some thoughts on relating things and theory in rural studies

This paper considers how shifts within the social sciences towards conceptualising spatiality in relational terms have unfolded in rural studies in particular ways over the past decade or so. A period in which networks, connections, flows and mobility have all established themselves as compelling conceptual frames for research, the rural has increasingly been recast in relational terms as a multi-authored and multi-faceted space, constituted through local-global interconnections and their place specific, sometimes contested, manifestations. In this way, the multiple meanings of the rural continues to be a focus of critical concern, as are the implications ‘of’ and ‘in’ rural spaces for some of the major issues currently being faced by governments and citizens around the world; including climate change and food security. Apprehending the complexity of the rural in these terms, we argue, requires not only thinking space relationally, but at the same time being epistemologically relational or theoretically pluralist. That is, recognising the co-constituent production of rural space through material and discursive phenomenon, processes and practices, and thus the value of existing theoretical resources (social constructionism, political and economic materialism) in relation with the critical and rigorous appraisal of ‘new’ concepts and ideas to better comprehend rural space in its multidimensional complexity and particularity. To this end, we identify Cindi Katz's notion of ‘countertopography’ as a promising conceptual and methodological addition to the rural scholar's toolkit insofar as it attends to a politics of location and differentation in relation to global processes. We conclude our discussion by sketching out possible objects of countertopographical analysis for understanding ongoing processes of change in rural space(s).