Through the lens of the Hispanic Paradox, this thesis examines healthy and unhealthy life expectancy changes occurring from 1997 to 2015 among Hispanics, non-Hispanic blacks, and non-Hispanic whites in the United States. The goal is to determine how Hispanics –disaggregated by nativity status– fare relative to other racial-ethnic groups in regard to changes in the percentage of total life expectancy that is lived in a healthy state (i.e. compression and expansion of morbidity). Using the Sullivan method, multi-state life tables were created with functional limitation prevalence data from the National Health Interview Survey. Results indicate that most subpopulation groups experienced periods of both morbidity compression and expansion from 1997 to 2015, though patterns of change varied by race-ethnicity and gender. Partial support was found for the Hispanic paradox given that similar trends in the percentage of total life expectancy lived disabilityree existed between non-Hispanic whites and foreign-born Hispanics.

The Hispanic Paradox is the finding that Hispanic immigrants living in the United States have better health than Anglo Americans despite being socioeconomically disadvantaged (Crespo et al., 1996; Stern et al., 1999; Sundquist et al., 1999; Dixon et al, 2000; Lariscy et al., 2015; Overton et al., 2015; Thomson et al., 2013). The literature surrounding the Hispanic Paradox has studied these effects primarily in Mexican-American Immigrant populations (Sundquist et al., 1999; Dixon et al, 2000; Lariscy et al.); however, additional research has found similar findings for various other Hispanic countries such as Cuba and Puerto Rico (Abraido-Lanza, A F. et al., 1999). It is not known if there is a Hispanic Paradox advantage during the menopausal transition. This study compared the health outcomes of 90 Mexican immigrant women between the ages of 40-60 living in the Utah to 78 Anglo American women of the same age in order to test the hypothesis that Mexican immigrant women are healthier than their Anglo-counterparts during the menopausal transition. We compared the health of the two groups of women across various health outcomes including blood pressure, C-reactive protein, BMI, fasting glucose, and cholesterol. Contrary to our hypotheses, Anglo Americans had better health across the board on all health outcome variables (BMI; F (1)= 3.63, p =.050; C-Reactive Protein; F (1)= 9.05, p =.003; Cholesterol; F (1)= 43.51, p =.000; Blood Pressure; F (1)= 43.32, p =.000; Fasting Glucose; F (1)= 12.25, p =.001). We speculate that our findings are not consistent with Hispanic Paradox theory because of the religious culture in Utah that lends itself to healthier individuals who refrain from cigarette smoke and alcohol consumption.

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The current paper examines the relationship between social support, perceived social status and health in the context of the Hispanic Paradox. It was hypothesized that social support will predict perceived social status which, in turn, is an important factor in predicting physical health among Mexican immigrants. The current paper also hypothesized that stress mediates the relationship between perceived social status and health. Three hundred and twenty male and female Mexican immigrants (ages 18-79) completed questionnaires, wore ambulatory blood pressure monitors for 24 hours, and submitted blood samples. Results supported some, but not most hypotheses. Greater social support was related to higher perceived social status (p = 0.01) and stress mediated two indirect relationships between perceived social status and health outcomes. Specifically, as perceived social status increased calories consumed decreased (p = 0.01) and self-reported health improved (p = 0.02). Still, there were no direct relationships between perceived social status and health outcomes and only two stress mediated relationships. Implications of the results and future directions are addressed. The paper discusses the possibility that higher education and possible variations in degree of acculturation among study participants might have resulted in a unique relationship between perceived social status and health. The paper also addresses the role that a high LDS affiliation among participants might play in the relationship between perceived social status and health of Hispanic immigrants. Finally, the relationship between perceived social status and self-reported health as the study's most consistent finding is discussed.

INTRODUCTION: Racial disparities exist in both healthcare access and outcomes. Despite high poverty rates, less education, and worse access to healthcare, the Hispanic population as a whole experiences equal, if not better outcomes compared to their non- Hispanic White counterparts. We sought to determine if race was significantly associated with the development of serious post-operative complications (POC) among patients undergoing intra-abdominal general surgical procedures. METHODS: We performed a retrospective cohort study of patients undergoing appendectomy, cholecystectomy, or colectomy at a single healthcare system over a 12 month period. Medical records were reviewed for patient demographics, co-morbidities, operative variables, and the occurrence of selected post-operative complications. Variables found to be significantly associated with the development of a POC on univariate analysis were entered into a multivariate logistic regression model to determine the effect of Hispanic race on POC. Additionally, we constructed a propensity score adjusted logistic regression model as a confirmation of our findings. RESULTS: Among 456 patients, 48 (10.5%) developed a POC. Hispanic race, age, tobacco use, selected co-morbidities, surgical procedure and surgical approach were all associated with POC on univariate analysis. On multivariate logistic regression analysis, after adjusting for confounders, Hispanic race, age, tobacco use, and surgical approach were all significantly associated with POC. Hispanic race was the strongest independent predictor, and was found to be protective against the development of a POC (adjusted OR= 0.22, p-value=0.048). The propensity score adjusted regression model provided a similar estimate of the effect of Hispanic race on POC (adjusted OR= 0.20, p-value=0.03). CONCLUSIONS: We have demonstrated that Hispanic patients undergoing common intra-abdominal surgical procedures have lower rates of serious post-operative complications, even after adjusting for patient demographics, co-morbidities, and operative variables. This, and other existing data, suggests that Hispanic patients may incur some type of overall health advantage despite the socioeconomic hardships they often face. / Clinical Research and Translational Medicine

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