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US Caribbean-born Adults: The State of Mental Health and Substance Abuse Research and Treatment. Nakia C. Brown, PhD Rhonda R. Waller, PhD Nycal Anthony-Townsend, MHS. Purpose. Provide context for discussing issues and needs of Caribbean-born populations.
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US Caribbean-born Adults: The State of Mental Health and Substance Abuse Research and Treatment Nakia C. Brown, PhD Rhonda R. Waller, PhD Nycal Anthony-Townsend, MHS
Purpose • Provide context for discussing issues and needs of Caribbean-born populations. • Identify risk and protective factors for mental health (MH) and substance abuse (SA) among Caribbean-born adults living in the US • Discuss MH/SA interventions targeting or serving Caribbean-born adults. • Discuss next steps in meeting MH/SA prevention and treatment for Caribbean-born adults.
Overview • 3rd largest immigrant group • Colluded MH/SA survey data • MH/SA Evidence-based interventions • Organizations serve or target communities with large Caribbean-born populations • Little has been known about this growing segment of the increasingly diverse U.S. Black population
Contextual Factors • Acculturative and Psychosocial Stress • Social Isolation • Discrimination • Language Barriers
Demographics • US Census Data • Native-born: • Born in AK, DC, HI or 48 other states • Puerto Rico: (Spanish language) • St. John, St. Thomas, or St. Croix (US VI) • Foreign-born: • Any other country or territory • Includes Caribbean islands/countries
Who’s Who in the US • Race and ethnicity are treated as separate concepts in the US • Caribbean-populations are included as “Black” unless they say otherwise
US Census Options • White: origins in Europe, Middle East, or North Africa • Black/African American: origins in African racial group • Native Hawaiian/Other Pacific Islander : Hawaii, Guam (a US Territory), or Samoa • Hispanic or Latino: Origins in Cuba, Mexico, Puerto Rican (US Territory), South or Central America regardless of race • Otherrace/ethnicity not captured
Official Language of Caribbean Islands-Countries • English (n=13) • Anguilla, Antigua and Barbuda, Bahamas, Barbados, Bermuda, Cayman Islands, Dominica, Grenada, Guyana, Jamaica, Saint Kitts and Nevis, Saint Lucia, Trinidad and Tobago, Turks and Caicos and US VI* • Non-English (n=11) • Argentina, Aruba, Brazil, Colombia, Cuba, Dominican Republic, Guadeloupe, Haiti, Honduras, Martinique, Puerto Rico, and Saint Barthélemy, and Saint Maarten
Mental Health Research: Caribbean-born Adults • Compared to Blacks born in US • Higher lifetime depression rates • Lower treatment rates • Similar past-year ratesWilliams et al., 2007
Substance Abuse Research: Caribbean-born Adults • Limited published research • Failure to distinguish from Blacks • Gender differences in prevalence • African American women > Caribbean women Broman et al., 2008
Top 5 States: Caribbean-born Residents • Florida • New York • Caribbean-born comprise nearly 25% of Black population in New York City • New Jersey • Massachusetts • California
Number of MH/SA Facilities ( within a 5-mile Radius) • New York City Boroughs • Bronx (n=76) • Brooklyn (n=86) • Manhattan (n=144) • Queens (n=43)
MH/SA Intervention and Treatment • Large Caribbean-born population • Plethora of MH/SA agencies • Best practices in MH/SA
SAMHSA’S National Registry of Evidence-Based Programs and Practices • Searchable registry of 160+ interventions • Connect public with intervention developers to help implement approaches • Minimum Requirements • Positive behavioral outcomes • Experimental/quasi-experimental design • Peer-reviewed publication • Public use-ready
NRREP Search Criterion • Age (18 years and older) • Black (or African American) • Non-US population • Urban • In-patient or Outpatient Setting
Standards for Federal Data on Race and Ethnicity • Race and Ethnicity • Immigration Status (optional) • Cuba and Dominican Republic • CPS, NHIS, and NHANES
Fundamental Issue Caribbean-born populations that we are discussing traverse multiple categories, but are not adequately captured in any.
Current State of Affairs • Limited MH/SA Research • No US-based MH/SA EBIs for Caribbean-born populations • Lack of EBI evaluation on Caribbean-born populations
Points to Consider • Heterogeneity among “Blacks” • Heterogeneity among Caribbean • Variation in MH/SA risk profiles • Impact of culture and contextual factors on treatment outcomes
Points of Emphasis • Important to understand health disparities in the US not just in terms of race/ethnicity, but also by culture • In US, there exists axes of diversity not only among native-born, but also among foreign-born
Recommendations • Increase self-select identification categories • Use stakeholders to inform survey designs • Incorporate qualitative data collection to enhance research quantitative findings • Conduct longitudinal studies of Caribbean-born immigrants to assess the impact of immigration on MH/SA outcomes over time