Trauma and cultural values in the health of recently immigrated families

Abstract

This study examined Ruiz et al.’s sociocultural model of Hispanic health resilience by assessing trauma exposure and symptoms and Hispanic cultural values in relation to the physical health of 97 Central American immigrant families, within 24 hours of arrival to the United States. Increased posttraumatic stress symptoms, but not exposure, were associated with increased physical health concerns for parents and children. Hispanic cultural values moderated trauma-health relations for adult health only. Identifying posttraumatic stress symptoms as a significant correlate of physical health in Latino immigrant parents and children is critical to identifying vulnerabilities in need of future research and interventions.

Keywords

culture health immigration trauma well-being

The physical health of Hispanics in the United States is a matter of critical importance, given that they account for 17 percent of the total US population (U.S. Census Bureau, 2010). Moreover, roughly 39.9 million immigrants currently reside in the United States, of which one-third is from Mexico and 55 percent originate from Latin America (U.S. Census Bureau, 2010). According to the US Department of Health and Human Services Office of Minority Health, health in Latino groups is often shaped by factors such as language/cultural barriers, lack of access to preventive care, and the lack of health insurance. In addition, the Centers for Disease Control and Prevention has cited some of the leading causes of illness and death among Hispanics, which include heart disease, cancer, unintentional injuries (accidents), stroke, and diabetes. Nonetheless, despite the leading causes of illness and health risk factors present in Latino groups, Latinos are generally healthier and live longer than non-Hispanic populations (Ruiz et al., 2016).

The Hispanic Health Paradox refers to an existing literature base showing that, despite elevated health risk (e.g. low socioeconomic status, limited access to healthcare, and insurance), Hispanics in the United States generally report greater health than non-Hispanic Whites (Ruiz et al., 2016). This Hispanic health advantage is evident in life expectancy (Heron, 2015), infant mortality (Collins et al., 2013), cardiovascular disease (Mozaffarian et al., 2015), and cancer (Ruiz et al., 2016). The advantage is most pronounced among Hispanic immigrants (i.e. foreign born; Singh et al., 2013) and erodes with increasing time and generations in the United States, as Hispanic acculturation to US culture increases (Kondo et al., 2016).

This Hispanic health advantage was initially identified three decades ago (Markides and Coreil, 1986), and much of the health data collected predate unprecedented increases in violence in Central America—particularly El Salvador, Guatemala, and Honduras. This shift is recent, with Honduras reporting the highest homicide rate globally in 2011, 2013 marking the end of a truce between major gang powers in El Salvador, and crime victimization cited as a major reason for Central American migration in 2014 (Hiskey et al., 2016). As the socio-political climate of Central America has changed, so have patterns of Hispanic immigration to the United States. Indeed, between 2015 and 2016 alone, there was a 122 percent increase in the number of children and families crossing the Southwestern border of the United States, reflecting large numbers of families seeking “humanitarian protection” (U.S. Customs Border Patrol, Southwest Border Sectors, 2016). The unprecedented danger in Central America has been cited as a “humanitarian emergency” by former President Obama, with children and families needing “special attention” (The White House, 2010). Dramatic increases in rates of violence in Central America have corresponded to dramatic increases in reports of trauma and posttraumatic stress (PTS) symptoms among recent waves of Hispanic immigrants (US Conference on Catholic Bishops, 2015). No prior research has considered the role of trauma on the Hispanic health advantage, though very high rates of trauma have been noted in recent immigrants (Venta and Mercado, 2018). Extensive literature now documents that trauma exposure and PTS symptoms have broad, systemic effects on the body with very serious consequences for physical and mental health. Indeed, the literature reviewed by Gill et al. (2009), Gill and Szanton (2011) cites elevations in systemic inflammation following trauma exposure, which subsequently increase risk for persistent, impairing PTS symptoms as well as medical morbidity and mortality. Thus, examining the role of trauma exposure and PTS symptoms in the context of the Hispanic health advantage is a timely and necessary contribution to the literature.

The conceptual model underlying this study was put forth by Ruiz et al. (2016). This model posits that the Hispanic health advantage, characterized by decreased susceptibility to disease and increased survival, is driven by sociocultural resilience factors that promote positive health. Specifically, the authors posit that collectivist values including “family (familismo), interpersonal harmony (simpatía), and valuing of elder community members (respeto)” (Ruiz et al., 2016: 467) are responsible for the Hispanic health advantage but note that existing research rarely assesses these sociocultural values directly, limiting empirical support for their model. Instead, studies have linked “proxies of Latino culture” (Ruiz et al., 2016) like higher neighborhood ethnic density (Shaw and Pickett, 2013), foreign nativity (Holmes et al., 2015), and low US acculturation (Kondo et al., 2016) to positive health, and assumed that increased endorsement of Hispanic cultural values drives the observed relations. A need to directly assess relations between proposed sociocultural resilience factors and health remains and has dominated recent calls for research (e.g. Ruiz et al., 2016). Moreover, examinations of this conceptual model to date have not considered the role of trauma exposure or symptoms—despite high rates of traumatic exposure in modern waves of Hispanic immigrants and evidence that trauma has a deleterious effect on health in other groups.

Against this background, the overarching goal of this study was to examine Ruiz et al.’s (2016) sociocultural model of Hispanic health resilience by assessing trauma (exposure and symptoms) in relation to the physical health of Central American immigrant parents and their children. We also sought to uncover how these variables interact with Hispanic cultural values. A notable innovation of this study is that the data were collected within 24 hours of arrival in the United States and, thus, having low acculturation to the United States. The first aim of the proposed study was to examine the role of trauma exposure and symptoms as putative risk factors for lower levels of self-reported physical health among immigrant adults along with the parent-reported health of their children. We hypothesized the following: (a) higher levels of exposure to trauma and PTS symptoms reported by adults would be associated with lower levels of self-reported physical health; (b) higher levels of trauma exposure and symptoms reported by parents would be associated with lower levels of parent-reported physical health of their children; and (c) higher levels of parent-reports of their children’s exposure to trauma and PTS symptoms would be associated with lower levels of parent-reported physical health in children. As such, this study makes a significant contribution to the literature: it is the first to include trauma in a sociocultural model of the Hispanic Health Paradox, providing first data on how worsening conditions in Central America may thwart the Hispanic health advantage through psychological mechanisms.

The second aim of this study was to address a critical gap in the existing literature by examining the sociocultural resilience factors of familismo, simpatia, and respeto in relation to the self-reported physical health of Central American immigrant adults and their children. We hypothesized that higher levels of familismo, simpatia, and respeto would be associated with lower levels of parents’ own physical health concerns as well as lower levels of health concerns in their children, controlling for relevant demographic variables. Furthermore, we assessed the extent to which relations between trauma and PTS symptoms and self-reports of parents’ own health along with their reports on the health of their children were buffered by these cultural values. We hypothesized significant interaction effects such that relations between trauma/PTS symptoms and health would be significantly lower in the presence of higher levels of familismo, simpatia, and respeto.

The study makes four novel contributions to the Hispanic health literature. First, Hispanic sociocultural values were assessed directly, rather than assuming their presence through unreliable proxies. Second, this is the first study to identify whether these sociocultural values are associated with a health advantage in immigrant children. Third, participants were assessed within 24 hours of entering the United States, removing a significant confound of much of the current literature base, that of varied acculturation. Fourth, use of self-report data eliminated several critiques of Hispanic health research including ethnic misclassification, under-reporting health problems due to reliance on medical records that are influenced by legal and insurance status, and concerns of positive biases driven by selective registration for national studies.

To date, there is little research assessing the relation between Hispanic sociocultural factors and physical health in recent immigrants. Without such data, resilience models of the Hispanic Health Paradox fail to identify sociocultural values that may be targets for public health intervention. Moreover, models describing sociocultural factors in relation to Hispanic immigrant health have failed to consider trauma, despite tremendous increases in violence and related suffering in much of Central America. Identifying factors that relate both positively and negatively to the physical health of Hispanic immigrant parents and children is critical to identifying vulnerabilities in need of future research and ultimately intervention, as well as protective factors warranting public health attention for health promotion.

Methods

Participants

Data were collected in one sitting, from parents who voluntarily arrived at a humanitarian respite center for recently arrived immigrants after being processed by US immigration officials for seeking asylum (i.e. those who have spent less than 24 hours within the borders of the United States) in a border community of South Texas. This location is an entry point for many Latin-American immigrants, documented and undocumented. The respite center provides immigrants with basic needs and medical resources, short-term housing, and information regarding the bus transportation system. The families arrive as single parents with their children. In many cases, their husbands or wives remain in the home country or are already settled in the United States. Inclusion criteria for the parent participants included voluntary arrival at the respite center, age 18+, and Spanish fluency. Parents were excluded from this study if they reported having previously lived in the United States. For the purpose of simplicity, questionnaires focused on the eldest child traveling with the parent.

The total number of participants included 97, with 43 males and 54 females ranging from 20 to 57 years of age (M = 34.44, SD = 7.53) and their children (newborn–17 years), with an average age of 8.22 and SD = 5.29. The countries of origin for the participants were Guatemala, Honduras, El Salvador, and Mexico, with the majority of participants originating from Honduras (43.3%) and El Salvador (43.3%). Participant’s education ranged from no education (6%), elementary (37%), middle school (28%), and high school (27%).

Measures

Physical health

The Spanish version of the 36-item Short Form 36 Health Survey (Ware and Sherbourne, 1992) was used to broadly assess parental physical health. The self-report survey measures patient health-related quality of life in eight distinct areas: (a) limitations in physical activities, (b) limitations in social activities, (c) limitations in usual role activities, (d) bodily pain, (e) general mental health, (f) limitations in usual role activities, (g) vitality, and (h) general health perceptions. A meta-analysis revealed that reliability estimated for all dimensions of this scale were found to be higher than 0.7 (Vilagut et al., 2005). The SF 36 also demonstrated good internal consistency in this study (α = 0.80).

The Spanish version of the 28-item Child Health Questionnaire (CHQ; Landgraf et al., 1996) was used to assess the physical and psychosocial health of children based on the parent-report. The CHQ is a parent-reported outcome measures that assesses the health-related quality of life for children and adolescents from 5 to 18 years of age and measures 14 unique physical and psychosocial concepts. Reliability estimates for the Spanish and English versions range from 0.62 to 0.83 (Landgraf et al., 1996). In this study, sample-specific reliability estimates showed acceptable internal consistency (α = 0.74).

Hispanic cultural values

Familismo and respeto were assessed using the Mexican American Cultural Values Scale (MACVS) (Knight et al., 2010), which has been expanded for use among various Hispanic immigrant groups since its development. This measure included 50 items focusing on Mexican American cultural values, in which item response ranged from 1 (not at all) to 5 (completely) via a Likert Scale. Reliability estimates for the Mexican American value subscales scale range from 0.84 to 0.89 (Knight et al., 2010) and in this study also showed good internal consistency (α = 0.85).

Simpatia was assessed using a 10-item version of the Simpatia Scale (Griffith et al., 1998), which has been previously translated into Spanish and subject to construct validity research (Sotomayor-Peterson et al., 2012, 2013). Griffith et al. (1998) report a coefficient alpha of 0.77 for the Hispanic group in their sample. The Simpatia is a 10-item scale in which participants are asked how important this cultural value is to them, such as 0 (not important) to 4 (extremely important). This measure demonstrated good internal consistency (α = 0.81).

Trauma exposure and symptoms

Parental exposure to traumatic events was assessed using the Trauma History Questionnaire (Heilemann et al., 2005), a 24-item checklist that asks parents whether they have experienced 24 possibly traumatic events. Participants answer yes or no and prompts for how many times those specific events occurred in their lifetime and how old they were. Stability coefficients for specific events ranged from 0.47 to 0.91 (Hooper et al., 2011).

In addition, parents completed the 22-item Impact of Events Scale (Báguena et al., 2001) in order to assess symptoms of posttraumatic stress disorder (PTSD). The 22-items identified symptoms of PTSD via a Likert-type scale ranging from 1 (never) to 5 (always). Reliability estimates of the total scale ranged from 0.91 to 0.95 (Báguena et al., 2001). Study-specific internal consistency noted an excellent range of α = 0.91.

The caregiver-report UCLA PTSD Index Trauma Screen (Pynoos et al., 1998) and Child PTSD Symptoms Scale (Foa et al., 2001) were used to assess the child’s exposure to traumatic events and current PTS symptoms via the parent-report. The Trauma Screen asks the parent to identify whether the child has been exposed to 13 different potentially traumatic events. If a potentially traumatic event is endorsed, the 17-item Child PTSD Symptoms Scale is administered. The measure includes 17 symptoms of PTSD responded to on a frequency scale from 0 (not at all) to 3 (5 or more times a week). Seven subsequent items probe impairment with regard to saying prayers, doing chores, friendships, hobbies, schoolwork, family relationships, and general happiness. Reliability estimates for the English and Spanish version of the Child PTSD Symptoms Scale range from 0.91 to 0.92 (Gudiño and Rindlaub, 2014) and sample-specific alpha coefficient included 0.90, noting excellent internal consistency.

Procedures

The Institutional Review Board and respite center approvals were sought prior to data collection. Informed consent from parents was secured in Spanish. All attempts to eliminate coercion and harm were employed. All data were collected at one time point, in person, from parents through questionnaire-based measures administered in Spanish. Participants were compensated for their time and given a US$20.00 gift card. Data collection began in February 2017 and the families included in this study were not affected by government-imposed family separations.

Analytic plan

The first aim of this study was to examine the role of psychological trauma in relation to self-reported physical health among Central American immigrant parents and the parent-reported health of their children. Relations were examined concurrently using multivariate regression analysis to test the hypothesis that increased trauma is associated with increased physical health concerns for parents and children. The second aim was to examine the proposed protective factors of familismo, simpatia, and respeto in relation to the self-reported physical health of Central American immigrant parents and the parent-reported health of their children. Relations between Hispanic cultural values and physical health were examined concurrently using multivariate regression to test the hypothesis that increased familismo, simpatia, and respeto are associated with reduced self-reported physical health concerns for parents and reduced mother-reported physical health concerns for children. Finally, we used multivariate regression to assess the extent to which Hispanic cultural values moderated trauma-health relations. Significant interaction effects were supplemented with analyses examining moderated regression using the Process macro (Hayes, 2013), as implemented in the statistical software SPSS. Child sex and age were included as covariates in all models due to the potential significance of the developmental effects of these demographic variables on the outcome variables. Given the uniqueness of the sample, the relatively small sample size, and the cost associated with ignoring Type II error in this early line of research, we interpret both marginal findings (p < 0.10), along with the traditional alpha level of p < 0.05. The analyses were guided by Ruiz et al. (2016) sociocultural model of the Hispanic Health Paradox.

Results

Preliminary analyses

Almost without exception, the participants faced some type of traumatic event, with the majority of participants experiencing crime-related trauma (70%) and almost half experiencing physical or sexual trauma (46%). These responses are common as many immigrants are fleeing home countries due to pre-migratory trauma in the home country and many experience trauma during migratory journey, and post-migration. These very high rates of exposure and PTS symptoms were also found in Venta and Mercado (2018). In accordance with the journal’s guidelines on table usage, a table of means and standard deviations for each of the measures investigated is included as supplementary material.

Associations between trauma and self-reported health

Multivariate regression was used to test the hypothesis that increased trauma exposure and symptoms are associated with increased physical health concerns for parents and children, separately, with the latter adjusted for child sex and age. In the first model, parental health variables (Short Form-36 Health Survey-SF36) served as the dependent variables and associations with trauma exposure (Child Health Questionnaire-CHQ) and PTS symptoms (Impact of Events Scale-ERIE) were assessed. The results indicated a significant multivariate effect of PTS symptoms on health (F_{(7, 80)} = 6.69, p < 0.001, η² = 0.37), but no such effect of trauma exposure (F_{(7, 80)} = 0.75, p = 0.633, η² = 0.06). All significant effects were in the hypothesized direction. Univariate effects for the influence of trauma exposure and symptoms are displayed in Table 1.

Table 1.

Multivariate summary table of associations between trauma exposure and trauma symptoms with parent-reported health.

Trauma exposure
Dependent variable	F _{(1, 86)}	p	η²
SF-36 Physical Functioning Scale	10.37	0.002	0.11
SF-36 Role Limitations due to Physical Health Scale	13.78	<0.001	0.14
SF-36 Role Limitations due to Emotional Problems Scale	13.46	<0.001	0.14
SF-36 Energy/Fatigue Scale	23.30	<0.001	0.21
SF-36 Emotional Well-Being Scale	36.29	<0.001	0.30
SF-36 Social Functioning Scale	30.24	<0.001	0.26
SF-36 Pain Scale	20.15	<0.001	0.19
Trauma symptoms
Dependent variable	F _{(1, 86)}	p	η²
SF-36 Physical Functioning Scale	0.01	0.91	<0.01
SF-36 Role Limitations due to Physical Health Scale	0.05	0.83	<0.01
SF-36 Role Limitations due to Emotional Problems Scale	1.96	0.17	0.02
SF-36 Energy/Fatigue Scale	0.28	0.60	<0.01
SF-36 Emotional Well-Being Scale	1.96	0.17	0.02
SF-36 Social Functioning Scale	0.04	0.85	<0.01
SF-36 Pain Scale	0.16	0.69	<0.01

Associations between trauma and parent-reported child health

In the second model, child health variables (CHQ) served as the dependent variables with both UCLA Trauma Screening for child trauma exposure (TS) and Child PTSD Symptom Scale (CPSS) serving as predictor variables and child sex and age as covariates. The results indicated a significant multivariate effect of PTS symptoms on health (F_{(14, 53)} = 3.50, p < 0.001, η² = 0.48), but no such effect of trauma exposure (F_{(14, 53)} = 1.52, p = 0.138, η² = 0.29). All the significant effects were in the hypothesized direction. Univariate effects regarding the relation between child PTS symptoms and exposure and mother-reported child health are reported in Table 2.

Table 2.

Multivariate summary table of associations between trauma symptoms and trauma exposure with parent’s report of child’s health.

Trauma symptoms
Dependent variable	F _{(1, 66)}	P	η²
CHQ Physical Functioning Scale Score	5.29	0.025	0.07
CHQ Role/Social Limitations due to Emotional/ Behavioral Difficulties Scale Score	6.18	0.015	0.09
CHQ Role/Social Limitations due to Physical Health Scale Score	4.01	0.050	0.06
CHQ Bodily Pain and Discomfort Scale Score	15.09	<0.001	0.19
CHQ Behavior Scale Score	23.20	<0.001	0.26
CHQ Global Behavior Scale Score	12.60	0.001	0.16
CHQ Mental Health Scale Score	13.15	0.001	0.17
CHQ Self-Esteem Scale Score	4.17	0.045	0.06
CHQ General Health Perceptions Scale Score	1.06	0.306	0.02
CHQ Change in Health Scale Score	0.67	0.798	<0.01
CHQ Emotional Health Scale Score	3.02	0.087	0.04
CHQ Time Impact on Parent Scale Score	0.19	0.67	<0.01
CHQ Family Activities Scale Score	5.95	0.017	0.08
CHQ Family Cohesion Scale Score	0.83	0.365	0.01
Trauma exposure
Dependent variable	F _{(1, 66)}	p	η²
CHQ Physical Functioning Scale Score	0.01	0.91	<0.01
CHQ Role/Social Limitations due to Emotional/ Behavioral Difficulties Scale Score	0.20	0.65	<0.01
CHQ Role/Social Limitations due to Physical Health Scale Score	4.19	0.05	0.06
CHQ Bodily Pain and Discomfort Scale Score	0.20	0.65	<0.01
CHQ Behavior Scale Score	1.56	0.22	0.02
CHQ Global Behavior Scale Score	2.88	0.10	0.04
CHQ Mental Health Scale Score	0.03	0.87	<0.01
CHQ Self-Esteem Scale Score	2.32	0.13	0.03
CHQ General Health Perceptions Scale Score	0.37	0.55	0.01
CHQ Change in Health Scale Score	0.11	0.74	<0.01
CHQ Emotional Health Scale Score	<0.01	>0.99	<0.01
CHQ Time Impact on Parent Scale Score	1.19	0.28	0.02
CHQ Family Activities Scale Score	1.01	0.32	0.02
CHQ Family Cohesion Scale Score	0.98	0.33	0.02

Associations between Mexican American cultural values and self-reported health

Next, we examined the influence of cultural values on self-reported adult health as well as their influence on parent-reported child health. Again, child age and sex were included as covariates. To assess cultural values, we used a composite Mexican American Values (MAV) Scale from the MACVS along with a measure assessing simpatia, which was not included in the MACVS. For parent health, neither MAV, F_{(7, 73)} = 1.75, p = 0.111, η² = 0.14, nor simpatia was significant, F_{(7, 73)} = 1.16, p = 0.336, η² = 0.10. Nor were there significant relations for child health for either measure: MAV, F_{(14, 55)} = 0.83, p = 0.634, η² = 0.17; simpatia, F_{(14, 55)} = 1.07, p = 0.405, η² = 0.21. Univariate relations for each of the variables are included in a table with supplementary material.

Mexican American cultural value moderator effects

Finally, we used multivariate regression to assess the interaction between cultural values and PTS symptoms on self-reported health and parent-reported child health. Multivariate interaction effects were marginal for adult self-report (F_{(7, 72)} = 2.05, p = 0.06, η² = 0.17). Univariate effects subsumed in the marginal multivariate effect for maternal health are displayed in a table with supplementary material (Figure 1, panels 1, 2, and 3). Simple linear regressions conducted using the PROCESS procedure were not significant for these effects (role limitations: b = 0.32, Standard Error (SE) = 0.21, t = 1.51, p = 0.133; Energy/Fatigue: b = 0.15, SE = 0.15, t = 0.98, p = 0.331; Emotional Well-being: b = 0.09, SE = 0.18, t = 0.46, p = 0.644). Please note that these tests differ from the univariate effects reported in the table (supplementary material), in that they do not take into account interrelations between the predictors and the criterion variables other than the effect in question.

Figure 1.

Trauma symptoms on health variables at mean and ± 1 standard deviation of Mexican American Values (panel 1 = Role Limitations Due to Emotional Problems; panel 2 = Fatigue, panel 3 = Emotional Well-being).

Interaction effects for parent-report of child health were not significant (F_{(14, 51)} = 1.58, p = 0.118, η² = 0.30). Likewise, interactions were not significant when simpatia was used as the measure of cultural values (adult self-report: F_{(7, 72)} = 1.30, p = 0.265, η² = 0.11; parent-report of child: F_{(11, 49)} = 1.13, p = 0.351, η² = 0.24).

Discussion

The overarching goal of this study was to examine Ruiz et al.’s (2016) sociocultural model of Hispanic health resilience by assessing trauma (exposure and symptoms) and Hispanic cultural values in relation to the physical health of Central American immigrant parents and children within 24 hours of arrival in the United States. Critically, the proposed study was the first to directly test the sociocultural model of Hispanic health in a group of recently immigrated parents and children. Moreover, the proposed study provided the first data on relations between these cultural values and child health, and it is the first to include trauma, a psychosocial experience of increasing prevalence in Central America, in a model of the Hispanic health advantage.

First, the results provided support regarding the importance of PTS symptoms for Hispanic immigrant health. Regarding adult physical health, evidence of a large, significant effect of PTS symptoms on health was noted with large effects of PTS symptoms on each domain of health assessed. No such effect was noted for trauma exposure. These findings were echoed in the parent-report of child trauma exposure and health as well—with a large, significant effect of PTS symptoms on health and no such effect exerted by trauma exposure. Again, PTS symptoms demonstrated moderate to large effects on each domain of child health assessed. These findings support previous research noting that PTS symptoms are directly related to health risk factors such as cardiovascular disease (Kibler et al., 2009), cholesterol problems (Eisenman et al., 2008; Maia et al., 2008), and being overweight (Vieweg et al., 2007). Eisenman et al. (2008) specifically explored PTS symptoms and health in Latinos and also noted that patients reported increased somaticized symptoms. The absence of evidence for a significant link between trauma exposure and health outcomes stands in contrast to prior research documenting such a link in diverse patient populations and, in this study, is likely a factor of restricted range. Indeed, trauma exposure was nearly universal in this sample and, thus, the effects of exposure alone could not be detected.

The sociocultural resilience factors of familismo, simpatia, and respeto were also examined in relation to the self-reported physical health of Central American immigrant adults and the parent-reported physical health of their children. Previous studies have postulated that increased Latino cultural values are associated with reduced physical health concerns and reduced health risk (Cardoso and Thompson, 2010; Ruiz et al., 2016). However, in this study no evidence of a main effect of Latino cultural values on physical health was noted, contrary to previous studies that highlight the role of culture serving as a protective factor in Latino communities (Ruiz et al., 2016). However, regarding the possible moderating role of cultural values, a large, marginally significant interaction effect was noted for adult self-report (with no such effect noted for the parent-report of child health). Specifically, univariate effects indicated moderate to large, significant interaction effects with the following dependent variables: role limitations due to emotional problems, energy/fatigue, and emotional well-being. Regarding role limitations and energy/fatigue, increased PTS symptoms were associated with poorer outcomes (i.e. more role limitations, more fatigue) with individuals high in cultural values demonstrating better outcomes (i.e. less role limitations, less fatigue). In this context, higher cultural values appeared to exert a buffering effect such that role limitations and chronic fatigue do not occur to adults, even in the presence of high PTS symptoms. It is no surprise that, among parents, high endorsement of familismo is associated with low self-reported fatigue and role limitations, as parents, even those with elevated PTS symptoms, are more likely to let their obligations to family supersede the otherwise deleterious effects of PTS symptoms exerted on parents with less endorsement of traditional cultural values.

The results regarding emotional well-being as an outcome variable are somewhat less intuitive. Specifically, increased PTS symptoms were associated with worse outcomes (i.e. poorer emotional well-being) with no apparent buffering effect of cultural values. On the contrary, in the presence of low PTS symptoms, individuals high in cultural values reported lower emotional well-being than those with moderate or low levels. Previous research has identified familismo of having significant protective factors, yet risk factors have also been investigated. For instance, Calzada et al. (2012) found that mothers struggled with the behavioral expectations and norms of familismo resulting in emotional and financial costs. Thus, familismo may have an emotional toll, which was reflected in these findings.

The findings show significant interaction of PTS symptoms and culture for mental health; however, when further probed for directionality of the effects using PROCESS, the results are not significant. Nonetheless, given the importance of the suggestive nature of the original interaction effects, they are worth reporting and thus in need of replication. This study is limited to cross-sectional data, precluding longitudinal testing of the hypothesized integrated model. Furthermore, the design of the study (i.e. data collected at one time point, very shortly after migration) does not allow examination of long-term stressors, including those related to acculturation, that immigrant families will likely face for years after the snapshot captured in this study. This study cannot comment on the impact of these long-term stressors on immigrant health. Relatedly, the collection of data during the migration process means that acute stress associated with migration or very recent catalysts for migration may have affected questionnaire responses about both physical and mental health. Collateral medical and biological data are not available and, as such, the study’s findings rely upon self-report—though this is also a strength in that it excludes the confounding effects of access to medical services. This study assesses families outside of their typical social context (i.e. during migration) and, thus, cannot assess the relation between sociocultural resilience factors and actual social engagement, as is posited by Ruiz et al. (2016). Finally, this study uses a moderate sample size that is relatively homogeneous (e.g. participants from only a few countries of origin). These facts limit the generalizability of our findings. Indeed, there is substantial cultural variability both within the Hispanic community and in the immigrant community more broadly. Future research must seek a large sample size in order to examine the impact of cultural values on health within specific cultural groups in the Hispanic community and undertake similar research in non-Hispanic immigrant groups. Taken together, these areas for development suggest the need for a large-scale longitudinal study. Still, the importance of this study should not be discounted, particularly in the context of this unique, difficult to recruit sample. Identifying factors that relate to the physical health of Latino immigrant women and children is critical to identifying vulnerabilities in need of future research and intervention. This study has implications for the large number of Latino immigrants that continue crossing the Southwestern US border each day—primarily by drawing attention to the public health consequences of PTS symptoms in this group and the need for intervention resources. Furthermore, this is one of the few studies to consider both cultural and psychological variables in a conceptual model of physical health that may serve as a model for future research addressing the physical health of other immigrant groups, a pressing need in light of current global crises of migration to the United States.

Supplemental Material

Supplementary_Table_1 – Supplemental material for Trauma and cultural values in the health of recently immigrated families

Supplemental material, Supplementary_Table_1 for Trauma and cultural values in the health of recently immigrated families by Alfonso Mercado, Amanda Venta, Craig Henderson and Norma Pimentel in Journal of Health Psychology

Supplemental Material

Supplementary_Table_2_(2) – Supplemental material for Trauma and cultural values in the health of recently immigrated families

Supplemental material, Supplementary_Table_2_(2) for Trauma and cultural values in the health of recently immigrated families by Alfonso Mercado, Amanda Venta, Craig Henderson and Norma Pimentel in Journal of Health Psychology

Footnotes

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: This study was funded by the Office of Global Engagement at the University of Texas-Rio Grande Valley.

Supplemental material

Supplemental material for this article is available online.

ORCID iD

Alfonso Mercado

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