1 University of California, Riverside School of Pu

1
University of California, Riverside
School of Public Policy
Course Syllabus
Winter 2021
Name and Number of Course: PBPL 190 Special Studies:
Immigrant Health and Wellbeing
Instructor Information: Cecilia Ayón, MSW, PhD
[email protected] | 951.827.5577
Office Hours: T/TH 1-1:45PM and by appointment
Course Description:
Informed by the social determinants of health framework,
students gain an in-depth understanding on
the significant role that physical, social, and policy
environments play on immigrants’ health. Students
will examine factors that strain immigrants’ health and restrict
their access to care as well as factors that
protect immigrants’ health. Students examine the health and
wellbeing of vulnerable immigrant groups

including older adults, children, undocumented, and mixed
status families.
Learning Objectives:
This course is focused on the circumstances, conditions, and
health experiences of immigrants, who are
a marginalized group in the United States, particularly around
legality, race/ethnicity, and
socioeconomic status. Specific learning outcomes include:
1. Become familiarized with and provide a critical analysis of
current theories on immigrant health,
risk, and wellbeing.
2. Apply a comprehensive and holistic model of health that
includes structural and social
determinants of health, to the understanding of immigrant
health.
3. Critically examine various domains of health in immigrant
communities, such as physical health,
mental health, and resilience.
4. Understand various determinants of health in immigrant
communities, such as health promoting
behaviors, and family, community, and social contexts and
policy, and recognize ways in which

discrimination is embedded in policies and contexts.
5. Critically examine how immigration and healthcare policy
currently promote or hinder the
health of immigrant communities, and examine how inequities
in health are inextricably linked
to inequities in immigration policy.
6. Develop/enhance analytical skills and written communication
skills in public policy.
Course Format
Class format will include seminar discussions around course
readings, individual and small group work
activities. Course readings address multiple topics on
immigrants’ health such as mental health, physical
health, risk and protective factors, and access to health care.
This class assumes students will be
prepared for class and actively engage in class discussion.
mailto:[email protected]
2
Assignments and Evaluative Procedures

The table below lists the assignments, due dates, and the points
allocated to each assignment. A
separate handout, also on ilearn, details each assignment and
provides grading criteria.
Assignment Due Date Points
1. Response Papers TBD; Throughout the quarter 50
2a. Immigrant health paper – part 1 Week 5 20
2b. Immigrant health paper – part 2 Week 9 20
3. Participation Throughout the quarter 10
Total 100
1. Response papers (50 points total): Students will synthesize
the week’s readings. Five response
papers will be completed during the quarter, each worth 10
points. A sign-up sheet will be made
available online. Every effort will be made to accommodate
students’ preferences, but it will be
based on a first come first serve basis. The response papers
should be completed in essay format
with an intro and conclusion. The body of the essay should
address the prompt (all parts). Papers
should be two pages in length (double-spaced). See rubric for
additional details. Select one of the

following writing prompts:
a. Critique the articles: What are the limitations and strengths
of the articles? What gaps
remain in the research?
b. What are two prevalent themes in the week’s readings?
Support your response with
examples from the readings.
c. What are the major findings in the articles? What are the
implications for policy?
Note: Response papers should reflect a critical analysis of the
readings. Summaries of papers will not
receive credit.
2. Immigrant Health Paper (40 points total): This assignment
will integrate course material on
different aspects of immigrant health. There are two parts to
this assignment; each part is worth 20
points. The two parts will be integrated to form a final research
paper due at the end of the quarter;
for a total of 10 pages - double-spaced with one inch margin,
and 12-point font. Essays should draw
from course readings, supplemental readings, and other
material. Each essay should include

references and be formatted according to the American
psychological Association’s (APA) style
guide. Students may consult the following resources regarding
APA style: Purdue University’s Online
Writing Lab
(https://owl.purdue.edu/owl/research_and_citation/apa_style/apa
_formatting_and_style_guide/ge
neral_format.html).
a. Part 1: Students will select an immigrant group to focus on
(e.g., older adults, children of
immigrants, undocumented youth, undocumented adults, Mixed
status families, can also
focus on an ethnic group – i.e., Latinx mixed status families, or
Japanese immigrants, etc).
Students will also select a domain of health, such as a
physical/medical condition, a mental
health condition, or an area of wellness and daily living (e.g.,
physical health among
Japanese immigrants or mental health among children of
immigrants). Students will focus
on multiple determinants of health and use the conceptual model
discussed in class to link
multiple determinants using literature (from class or external;
focus on empirical studies).

https://owl.purdue.edu/owl/research_and_citation/apa_style/apa
_formatting_and_style_guide/general_format.html
https://owl.purdue.edu/owl/research_and_citation/apa_style/apa
_formatting_and_style_guide/general_format.html
3
The first part of the assignment will address, for the immigrant
group and domain of health
selected:
i. What are the characteristics of the immigrant group (i.e., a
demographic profile)? (1
page) Include a description of the population in the U.S. (could
address, but not
limited to: number of individuals in the U.S., regions were they
primarily reside,
average age, gender, info about family structure, average
income etc.)
ii. Brief history of immigration in the U.S. (1 page). What is
known about the selected
groups history of migration to the U.S., what is their general
experience in the U.S.
(barriers, challenges, resilience), what is known about the
documentation status
among the immigrant group?

iii. What are the primary explanations/determinants for their
health? (4-5 pages)
Provide an overview of the what is known about the condition
that you are
addressing. Present evidence on the determinants of health or
factors that influence
how immigrants experience the condition you have identified.
Use the SDH
framework to organize the information. Address all domain of
the SDH framework.
In addition, address if and how immigrant’s status and/or
immigration policy and
enforcement plays a role on the populations health, as it related
to your selected
group and topic.
b. Part 2: Students will integrate the sections from the first part
of the assignment,
incorporating professor feedback, and will expand by discussing
implications for policy,
practice, and research. Part 2 of the assignment should be 3
pages. Include part 1 with
revisions and part 2 when submitting the paper. Implications
should be grounded in your

findings from part 1.
i. What policy changes are needed to address the health needs of
immigrants? Why
are these changes needed?
ii. How can practice models or access to care be improved for
this community?
Practice implications could range from direct practice
(interactions with medical
providers) to community based efforts (e.g., to improve access,
advocate etc.).
iii. What gaps remain in the research? What additional research
is needed to better
understand the health and wellbeing of the immigrant group?
3. Participation (10 points). The instructor may utilize multiple
methods for evaluating students’ class
participation, including asking students to post comments on
ilearn (e.g., discussion board posts)
and/or administering pop quizzes related to the readings.
Evaluation/Grading
Grading System:
90-100 = A
80-89 = B
70-79 = C

60-69 = D
59 and below= F
An A grade at the undergraduate level means that a student is
doing outstanding or excellent work. The
student attends class regularly, hands in all of the course
assignments and demonstrates a thorough grasp
of the material. To receive an A grade a student must go well
above and beyond the basic expectations
for the course.
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A B grade at the undergraduate level means that a student is
doing above average work. The student
attends class regularly, hands in all of the course assignments
and demonstrates (at the very least) a strong
grasp of the material.
A C grade at the undergraduate level means that a student is
doing at least satisfactory work, and meeting
the minimum requirements for the course. The student attends
class regularly, hands in all of the course
assignments, and demonstrates a basic level of understanding of
the course concepts.
A D or an F at the undergraduate level means that a student is
doing unacceptable work, demonstrating
a complete lack of understanding of course concepts.
Required Textbook and Readings

• A text book is not required for this course. All required
readings will be available on ilearn.
Instructor Responsibilities
It is the responsibility of the instructor to (1) be well -prepared
for each class, (2) be available to
students as needed for responding to questions and comments
about this course, (3) provide
constructive feedback as needed on student assignments, and (4)
do their part to provide a
space that is intellectually and personally challenging and safe
for discussing and critiquing
controversial issues and ideas.
Student Responsibilities
General Expectations. Please adhere to the follow ing:
• It is the responsibility of each individual student to ensure that
their assignments are turned in
on time and are received by the instructor. Assignments must be
submitted through ilearn:
assignments attached to emails will not be opened or graded,
unless previously arranged with
the instructor.
• Be sure that all written assignments are in one’s own words
except where otherwise cited. All
direct quotes must appear either in quotation marks or indented,
and must include the source,
date, and page number(s). Material taken from other authors
that is paraphrased must also
include source information. Noncompliance with these
requirements constitutes plagiarism and

is grounds for a failing grade.
• Students are expected to keep a copy of each assignment until
the end of the quarter in the
event that an assignment is not received.
• Students are expected to complete all assignments, participate
in discussion boards, and engage
fully in the learning process. If at any time an emergency ar ises
that compromises a student’s
ability to complete the course requirements, it is expected that
the student will contact the
instructor to discuss options for course completion.
• It is the responsibility of the student to ensure receipt of
announcements and email messages
through ilearn. Course changes and reminders will be sent via
announcements and emails; thus,
students should check their email regularly. If you email the
professor, she will respond within
48 hours (excluding weekend), if a response is not received
within that timeframe then it is the
student’s responsibility to follow up by with the instructor.
• Do not hesitate to contact the instructor to get additional help
with course content or
assignments. Students are encouraged to visit office hours for
additional support.
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Course Outline

Date Content
Assignment/
Task Due
Week 1
Week of
January 4
Introduction to course content and logistics
Objectives:
• Review the purpose of the course.
• Understand the course requirements.
• Examine immigrant demographics in the U.S. and CA
Required Readings:
• Syllabus
Week 2
Week of
January 11
Topic: The Immigrant Paradox
Objectives:
• Examine the immigrant health paradox.

a. What is the immigrant health paradox?
b. What are the limitations and strengths of this
concept?
c. Does this concept apply to all immigrant groups?
Required Readings:
• Teruya, S.A. & Bazargan-Hejazi, S. (2013). The immigrant
and Hispanic Paradoxes: A systematic review of their
predictors and effects. Hispanic Journal of Behavioral
Sciences, 35(4), 486-509. doi:10.1177/0739986313499004.
• Alegría, M., Canino, G., Shrout, P., Woo, M., Duan, N., Vila,
D., Torrest, M., Chen, C., & Meng, X. (2008). Prevalence of
mental illness in immigrant and non-immigrant U.S. Latino
groups. American Journal of Psychiatry, 165, 359-369.
• Ayón, C., Marsiglia, F.F., Bermudez, M. (2010). Latino
family mental health: Exploring the role of discrimination
and familismo. Journal of Community Psychology, 38(6),
742-756. Doi: 10.1002/jcop.20392
• John, A.D., Castro, A.B., Martin, D.P., Duran, & Takeuchi, D.
(2012). Does an immigrant paradox exist among Asian
Americans? Associations of nativity and occupational cl ass
with self-rated health and mental disorders. Social Science
Medice, 75(12), 2085-2098. Doi:
10.1016/j.socscimed.2012.01.035.
Activities:
• View video: Unnatural Causes Video (Becoming American)

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Week 3
Week of
Jan 18
Topic: Social Determinants of Health Model
Objectives:
• Examine and discuss the social determinants of health model.
• Assess health disparities among immigrant groups.
Required Reading:
• For an Overview on Social Determinants of Health
o Healthy People 2020. Social Determinants of health.
Retrieved from:
https://www.healthypeople.gov/2020/topics-
objectives/topic/social-determinants-of-health
o Artiga, S. & Hinton, E.(2018). Beyond health care: The role
of social determinants in promoting health and health

equity. Retrieved from:
http://files.kff.org/attachment/issue-brief-beyond-health-
care
o CDC Health Disparities and Inequalities Report – U.S. 2013
Activities:
• Identify a research article that identifies one of the social
determinants of health and its relation to health outcomes
among
immigrants. Prepare a short summary statement in preparation
for class and post on the discussion board before class (1/2 page
single spaced).
Due on Th
(1/21): see
activities, post
on discussion
board
Extra Credit
Opportunity
Week 4
Week of
Jan 25
Topic: Immigration as a social determinant of health
Objectives:
• Analyze immigration as a social determinant of health.

• Understand evidence used to position immigration as a social
determinant of health.
• Critique the notion ‘immigration policy as health policy.’
Required Readings
• Castañeda, H., Holmes, S., Madrigal, D.S., DeTrinidad Young,
M.,
Beyeler, N., & Quesada, J. (2015). Immigration as a social
determinant of health. Annual Review of Public Health, 36,
375-
392.
• Ayón, C., Nieri, T., & Gurrola, M. (2020). Latinx immigrant
health
and mental health. Encyclopedia of Social Work. [READ pages
x-x
ONLY]
• Cabral, J., & Cuevas, A.G. (2020). Health inequities among
Latinos/Hispanics: Documentation status as a determinant of
health. Journal of Racial and Ethnic Health Disparities.
https://doi.org/10.1007/s40615-020-00710-0
Activities:
• Small group discussion
Due Response
paper

http://files.kff.org/attachment/issue-brief-beyond-health-care
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Week 5
Week of
Feb 1
Topic: Policies and Access to health care for immigrants
Objectives:
• Appraise the social and health policies that impact upon
immigrant’s health.
• Examine promising practices to support immigrant’s accesses
to
care.
Required Reading (Select four of the following articles):
• Kaiser Family Foundation (2018). Key facts about the
uninsured
population. Retrieved from https://www.kff.org/uninsured/fac t-
sheet/key-facts-about-the-uninsured-population/
• Wallace SP, Torres J, Sadegh-Nobari T, Pourat N, Brown RE.
Undocumented immigrants and healthcare reform. UCLA Center
for Health Policy. [Online]. Retrieved from

http://healthpolicy.ucla.edu/publications/Documents/PDF/undoc
umentedreport-aug2013.pdf [Read executive summary]
Activities:
• Film: CoverAge
DUE, Immigrant
Health Paper,
Part 1
Week 6
Week of
Feb 8
Topic: Older immigrant adults and health [and end of life
issues]
Objectives:
• Examine health needs and barriers experienced by
undocumented older adults.
Required reading: [Select three]
• Cervantes, L., Fischer, S., Berlinger, N., Zabalaga, M.,
Camacho, C., Linas, S., & Ortega, D. (2017). The illness
experience of undocumented immigrants with end -stage
renal disease. JAMA Internal Medicine, 177(4), 529-535. DOI:
10.1001/jamainternalmed.2016.8865
• Ayón, C., Santiago-Ramos, J., & Lopez Torres, A.S. (accepted
12.20.2019). Latino Undocumented Older Adults, Health
Needs and Access to Healthcare. Journal of Immigrant and

Minority Health. DOI 10.1007/s10903-019-00966-7
• Gray, N.A., Boucher, N.A., Kuchibhtla, M., & Johnson, K.S.
(2017). Hospice access for undocumented immigrants. JAMA
Internal Medicine, 177(4), 579-580. DOI:
0.1001/jamainternmed.2016.8870
• Rodriguez, N., Parades, C.L, & Hagan, J. (2017). Fear of
immigration enforcement among older Latino immigrants in
the United Stated. Journal of Agin and Health 29(6), 986-
1014.
Activities:
Due Response
paper
https://www.kff.org/uninsured/fact-sheet/key-facts-about-the-
uninsured-population/
https://www.kff.org/uninsured/fact-sheet/key-facts-about-the-
umentedreport-aug2013.pdf
umentedreport-aug2013.pdf
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Week 7
Week of

Feb 15
Topic: Undocumented youth and health
Objectives:
• Examine health needs and barriers experienced by
undocumented youth.
Required reading:
• Gonzales, R. G., Suárez-Orozco, C., & Dedios-Sanguineti, M.
C.
(2013). No place to belong: Contextualizing concepts of mental
health among undocumented immigrant youth in the United
States. American Behavioral Scientist, 57(8) 1174–1199.
• Enriquez, L.E., Hernandez, M.M., Ro., A. (2018).
Deconstructing
immigrant illegality: A mixed methods investigation of stress
and
health among undocumented college students. Race and Social
Problems,10, 193-208. doi: 10.1007/s12552-018-9242-4
• Cha, B.S., Enriquez, L.A., Ro, A. (2019). Beyond access:
Psychosocial barriers to undocumented students’ use of mental
health services. Social Science and Medicine, 233, 193-200.
Doi:
10.1016/j.socscimed.2019.06.003
• [Optional] Terriquez, V. (2015) Dreams delayed: Barriers to
degree completion among undocumented community college
students. Journal of Ethnic and Migration Studies,41(8), 1302-
1323. doi: 10.1080/1369183X.2014.968534

Activities:
Due Response
paper
Week 8
Week of
Feb 22
Topic: Children of immigrants and health
Objectives:
• Examine health needs and barriers experienced by children of
immigrants.
Required reading:
• Ezlemazi, B., Fahey, C.A., Kogut, K., et al., (2019).
Association
of perceived immigration policy vulnerability with mental and
physical health among US-Born Latino adolescents in
California. JAMA Pediatrics, 173(8), 744-753. Doi:
10.1001/jamapediatrics.2019.1475
• Kim, S.Y., Schwartz, S.J., Perreira, K.M., & Juang, L.P.
(2018).
Culture’s influence on stressors, parental socialization, and
developmental processes, in the mental health of children of
immigrants. Annual Review of Clinical Psychology, 14, 373-
370. DOI: 10.1146/annurev-clinpsy-050817-084925.

• Mendoza, M. M., Dmitrieva, J., Perreira, K. M., Hurwich-
Reiss,
E., & Watamura, S. E. (2017). The effects of economic and
sociocultural stressors on the well-being of children of Latino
immigrants living in poverty. Cultural Diversity and Ethnic
Minority Psychology, 23(1), 15–26.
Due Response
paper
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https://doi.org/10.1037/cdp0000111
• [Optional]Landale, N.S., Hardie, J.H., Oropesa, R.S., &
Hillemeier, M.M (2015). Behavioral functioning among
Mexican-Origin children: Does parental leagal status matter?
Journal of Health and Social Behavior, 56(1), 2-18.
• [Optional] Yoshikawa, H. & Kalil, A. (2011). The effects of
parental undocumented status on the developmental context
of young children in immigrant families, Child Development
Perspectives, 5(4), 291-297.
Activities:
Week 9
Week of
March 1

Topic: Immigrant health: Protective factors and resilience
Objectives:
• To examine factors that are protect immigrants’ health.
Required reading:
• Ayón, C., & *Bou Ghosn, M. (2013). Latino immigrant
families’ social support networks: Strengths and limitations
during a time of stringent immigration legislation and
economic insecurity. Journal of Community Psychology, 41(3),
359-377. doi: 10.1002/jcop.21542
• Mikell, M., Snethen, J., & Kelber, S. (2020). Exploring factors
associated with physical activity in Latino immigrants.
Western Journal of Nursing Research. DOI:
10.1177/0193945919897547
• Cardoso, J.B., & Thompson, S.J. (2010). Common themes of
resilience among Latino immigrant families. A systematic
review of the literature. Families in Society: The journal of
contemporary social services, 91(3), 257-265. Doi:
10.1016/1044-3894.4003.
Activities:
Due Response
paper
Due Immigrant
Health Paper
(part 1
revisions, and

part 2)
Week 10
Week of
March 8
Topic: Immigrant health: Implications for practice
Objectives:
• To examine practice models used to support immigrants’
health.
Required reading: [Select three]
• Crosnoe, R. et al., (2012). Promising practices for increasing
immigrant’s access to health and human services. Retrieved
from:
https://aspe.hhs.gov/system/files/pdf/76466/rb.pdf
• Hawkins, J.M., Posadas, L., Manale, A., & Bean, R.A. (2020):
Culturally competent therapy with Latinxs: Addressing
isolation.
The American Journal of Family Therapy, DOI:
10.1080/01926187.2020.1777912
• Martinez Tyson, D., Arriola, N.B., & Corvin, J. (2016).
Perceptions
Due Response
paper
https://psycnet.apa.org/doi/10.1037/cdp0000111
https://aspe.hhs.gov/system/files/pdf/76466/rb.pdf

10
of depression and access to mental health care among Latino
immigrants: Looking beyond one size fits all. Qualitative Health
Research, 26(9). 1289-1302. DOI: 10.1177/1049732315588499
• Falgas-Bague, I., Wang, Y., Banerjee, S., Ali, N., DiMarzio,
K., Vidal,
D.P., & Alegria, M. (2019). Predictors of adherence to
treatment
in behavioral health therapy for Latino immigrants: The
importance of trust. Frontiers in Psyschiatry, 10, 1-11. DOI:
10.3389/fpsyt.2019.00817
• Doshi, M., Lopez, W.D., Mesa, H., et al (2019). Barriers and
facilitators to healthcare and social services among
undocumented Latino(a)/Latinx immigrant clients: Perspectives
from frontline service providers in Southeast Michigan.
PLoSONE
15(6):e023383
• Bloemraad, I. & Terriquez, V. (2016). Cultures of
engagement: The
organizational foundations of advancing health in immigrant
and
low—income communities of color. Social Science and
Medicine,
165, 214-222.
Activities:
Finals Week

March
13-19
Topic VIII: Skin/Soft Tissue and Urinary Tract Infections
Introduction
This topic will discuss two additional infectious disease topics,
skin/soft tissue infections and urinary tract infections. Both
kinds of infections are very common in both the outpatient and
inpatient settings. Be sure to follow the same infectious disease
concepts regarding antimicrobial selection as were discussed in
the previous topic.
SSTIs
Skin and soft tissue infections encompass a variety of infections
such as: impetigo, folliculitis, furuncles, carbuncles,
erysipelas, diabetic foot infections and cellulitis. Our focus
will be primarily on cellulitis and diabetic foot infections. It is
important with any infectious disease to keep up to date with
local resistance patterns and emerging resistant organisms such
as methicillin resistant staphylococcus aureus (MRSA), to aid in
your decision making.
Appropriate wound care, as well as preventative measures for
subsequent infections, is important for many types of SSTIs.
The most common organisms involved in cellulitis are
staphylococcus aureus and B-hemolytic streptococci.
Community-acquired methicillin resistant staphylococcus
aureus (CA-MRSA) should be considered in patients with risk
factors or in an area with increasing prevalence of organism.
(Table 73-3)
Diabetic foot infections are often polymicrobial and can involve
gram +, gram - and anaerobic bacteria. Often resistant
organisms (especially if recurrent infection) may be of concern.

Broad spectrum empiric coverage is essential here. (Table 73-
6)
UTIs
Urinary tract infections are classified both my location (upper
and lower) as well as causation (complicated or uncomplicated).
The treatment choices, dose, as well as treatment duration vary
greatly dependent on the classification of the infection. Local
resistance patterns and urine cultures are helpful in
appropriately managing UTIs.
Bacteriuria does not always indicate an infection. Be familiar
with the diagnostic criteria for significant bacteriuria (Table 79-
1) and understand when treatment is necessary.
Escherichia coli is the causative agent in up to 85% of
uncomplicated UTIs.
Treatment of urinary tract infections varies greatly in terms of
medication, dose and treatment duration depending on the
location of the UTI as well as the cause (complicated or
uncomplicated). (Table 79-2 and Table 79-3)
Be cautious of resistant organisms in patients with recurrent
UTIs.
Special considerations for treatment are necessary for pregnant
women, patients with catheters and UTIs in men.
Objectives
At the completion of this module the student will be able to:
Skin and Soft Tissue Infections:understand the common
organisms involved in various skin and soft tissue
infections.recognize the common adverse effects, drug
interactions and monitoring parameters for medications used for
skin and soft tissue infections.create a treatment plan for
patients with cellulitis.
Urinary Tract Infections (UTI):recognize the symptoms of upper
(pyelonephritis) and lower (bladder) urinary tract infections.
identify the common organisms involved in UTIs.create a
treatment plan for a patient with both complicated and
uncomplicated urinary tract infections.appropriately monitor a

patient taking antibiotics for a urinary tract infection.
Readings Pharmacotherapy Principles and PracticeChapter 73:
Skin and Soft Tissue InfectionsChapter 79: Urinary Tract
Infections
Dynamed Summaries:
Cellulitis -
https://wilkes.idm.oclc.org/login?url=http://www.dynamed.com/
topics/dmp~AN~T116794/Methicillin Resistant Staphylococcus
Aureus -
topics/dmp~AN~T189788/Uncomplicated UTI -
topics/dmp~AN~T116894/
Complicated UTI -
topics/dmp~AN~T114928/
VideosUrinary tract infection
animation: https://youtu.be/lY2bZjggc08
Urinary Tract Infection - Overview (signs and symptoms,
pathophysiology, causes and
treatment): https://youtu.be/1vIHTAnBmuU
Module VIIIDiscussions & Assignments Discussion
Often infections have several treatment possibilities, depending
on both patient specific and disease specific characteristics.
Below is a very short case, and I want you as a class to compare
and contrast the listed treatment options. The focus will be on
safety and efficacy of the regimens, all considered possible
choices by the Infectious Disease Society of America's
treatment guidelines for Acute Uncomplicated Cystitis.
HT is a 31 year old female with acute, uncomplicated cystitis
and no known drug allergies. She has no significant PMH or
medications. Her urine culture shows a susceptible E. coli

(susceptible to all treatments listed below). Please compare the
safety and efficacy of the following options. What would make
you choose one over another?
1. nitrofurantoin 100 mg po BID x 7 days
2. TMP/SMX DS (160 mg/800 mg) po BID x 3 days
3. levofloxacin 250 mg po daily x 3 days
4. cephalexin 500 mg po q12hrs x 7-14 days
I want you all to discuss and add to or dispute each other's
thoughts and ideas.
Post your initial response by Wednesday at midnight. Respond
to one student by Sunday at midnight. Both responses should
be a minimum of 150 words, scholarly written, APA formatted,
and referenced. A minimum of 2 references are required (other
than your text). Refer to the Grading Rubric for Online
Discussion in the Course Resource section.
Module VIII: Skin and Soft Tissue/UTI Discussion
Assignments
Exam 2: Somatic Disorders and Infectious Disease
Post your initial response by Wednesday at midnight. Respond
to one student by Sunday at midnight. Both responses should
be a minimum of 150 words, scholarly written, APA formatted,
and referenced. A minimum of 2 references are required (other
than your text). Refer to the Grading Rubric for Online
Discussion in the Course Resource section.
Special Guidance on APA formatting in Discussion Posts
APA formatting is required in discussion posts with the
following two exceptions (due to limitations with the text editor
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Wilkes University - The Office of Technology for Teaching &
Learning
Panahi-Pour
Japanese Immigrant Mental Health and Wellbeing
Yasha Panahi-Pour
UCR
Professor Ayón
February 3, 2021
1
Panahi-Pour
Immigrants encounter significant barriers when it comes to
accessing mental health. They
face discrimination, economic problems, and hostile
immigration policies preventing them from

accessing better mental health care services (Teruya &
Bazargan-Hejazi, 2013). In the United
States, mental health is a significant issue among Japanese
immigrants mainly because of racial
discrimination, economic challenges, and health services
accessibility challenges. Besides, several
social determinants of health influence how the Japanese
immigrants experience mental health in
the U.S. Some of these social determinants of health include
economic stability, neighborhood and
physical environment, education, food, community and
social context, and health care system
(Cabral & Cuevas, 2020). The immigration status of the
Japanese Americans also plays a
substantial role in this group's mental health. The social
determinants of health, including
economic stability, neighborhood and physical environment,
education, food, community and
social context, and health care system influence the Japanese
immigrants' mental health experience
in the United States.
Section 1: Characteristics of Immigrant Group
The immigrant group under consideration in this assignment is
the Japanese immigrants.

The Japanese immigrants comprise an ethnic group that falls
under the Asian Americans category.
It is regarded as one of the oldest groups of Asian origin to
have moved to the United States. The
first Japanese immigrants arrived in the U.S. in the 1880s
during the Meiji period (Torimoto,
2017). They first settled in Hawaii islands before moving to the
mainland in the late 1890s to early
1900s. Most researchers have pointed out that the home
country's challenges and the desire to seek
a better future motivated the early Japanese immigrants to shift
to the United States. Although they
initially worked as laborers in the sugar plantations in Hawaii,
the Chinese Exclusion Act of 1888
2
Cecilia Ayon
Cecilia Ayon
Panahi-Pour
paved the way for Japanese immigrants to get other better jobs
in mainland America, increasing

their population.
Today, Japanese immigrants reside mostly reside in California,
Washington, and Oregon
states. According to the 2010 census, there were 1.3 million
Japanese immigrants in the U.S. with
272,528 living in California, 185,502 in Hawaii, 37,780 in New
York, and 35,008 in Washington
(Torimoto, 2017). The metropolitan areas occupied by the
Japanese immigrants include Honolulu,
Los Angeles, and San Francisco. The median age among
Japanese immigrants is 40 years. There
are more women Japanese immigrants than men with 52% and
48%, respectively. The average
household income is $60,000, and only 7% of the Japanese
immigrant population does not have
health insurance health cover (Orgera & Tolbert, 2020).
Concerning the family structure, Japanese
families are patriarchal, with the father as the breadwinner and
must be accorded utmost respect.
However, there have been recent changes in gender roles
as women among the Japanese
immigrants receive equal educational and employment
opportunities.
Section 2: Brief History of Immigration in the U.S.

As noted in the first section above, the first Japanese
immigrants arrived in the United
States in the 1880s. At this time, this group comprised less than
1000 individuals. They first settled
in Hawaii, working mainly as farm laborers in sugar plantations.
By 1900, the number of Japanese
immigrants reached 25, 000 and apart from being farm laborers,
these individuals also worked in
mining and mills camps (Torimoto, 2017). After a few
years, the Japanese immigrants started
forming small communities within small towns and
established restaurants, general stores, and
small hotels. By 1925, many Japanese immigrants flocked i nto
the United States, comprising over
100,000 individuals. During this time, the Japanese
immigrants established many of its
foundational institutions.
3
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Panahi-Pour

Although many newcomers found their employment in
migratory labor working in mines,
farms, and railroads, some became active in labor activism.
Following constant agitation efforts,
many Japanese immigrants founded their businesses, such as
restaurants and shops serving the
community needs. They also established cooperative societies
that provided financial support to
farmers and businesses. By 1920, Japanese immigrant farmers
owned about 450,000 acres of land
in California and generated about 10% of the total crop
revenue (Torimoto, 2017). However,
despite the Japanese immigrant progress in the 19th century,
this success story did not come on a
silver plate. The group encountered significant challenges and
policy barriers. For instance, they
were excluded from employment, and most of them only worked
as laborers regardless of their
qualifications. Several campaigns by the English-language
press called for the exclusion of
Japanese immigrants from American life in the early 1990s.
The press labeled the Japanese as the enemies of the American
workers and corrupt agents.
This influenced the Alien Land Law's passing in 1913 in

California that barred all Asian
Americans from owning land. The policy aimed to discriminate
Japanese immigrants from owning
property and competing with the natives. In 1924, the federal
government enacted the Immigrant
Act of 1924 that ended Japanese immigration (Torimoto,
2017). Despite these challenges, the
Japanese demonstrated resilience through sticking together and
speaking in one voice as a family.
They also learned to manure the restrictive system; for
instance, the Japanese immigrants
registered their lands using European names following the Alien
Land Law of 1913 enactment.
Section 3: Determinants of Health
Mental health is essential in every stage of individuals' lives
beginning from childhood,
adolescence, through adulthood to older adulthood. Healthy
People (2021) defined mental health
4
Cecilia Ayon
Revisit some of the sequencing of this section. This paragraph
ends with info from 1924, but earlier you stated that in 1925 the
Japanese population increase significantly.

Panahi-Pour
as the emotional, psychological, and social well-being of a
person. It often impacts how people
feel, thinks, and behave. A compromised mental health status
entails a situation where individuals'
emotions, psychology, and overall social well-being are not
good or unstable. In other words, the
person has a poor mental status, feels terrible, and cannot think
properly. Mental health problems
can result from genetics, such as a history of mental illness
running in the family, chronic medical
conditions, financial/economic situations (lacking money),
and death or loss of loved ones.
Examples of mental health concerns include depression, stress,
anxiety, sleep disorders, bipolar
disorder, and personality disorder.
In the United States, mental health illness is a massive problem.
Current studies show that
about 20.6% of the U.S. adults experienced mental illness in
2019, constituting approximately one
in five adults. More females (49.7%) experienced mental
health concerns than males (36.8%).

Apart from mental illness affects virtually everyone in the
United States, several factors
impact/influence how immigrants (Japanese immigrants)
experience this condition. These factors
are often known as the social determinants of health. Healthy
People (2021) defined the social
determinants of health as situations in which individuals are
born, live, play, worship, work, or
learn that impact people's and community's health outcomes and
quality of life. Such conditions
include economic stability, neighborhood and physical
environment, education, food, community
and social context, and health care system.
Economic Stability
According to the Healthy People 2020 campaign, economic
stability comprises the pillar of
the social determinants of health. One of the significant
indicators in the economic stability domain
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Panahi-Pour
is employment. Employment is directly linked to an
individual’s health outcomes (Teruya &
Bazargan-Hejazi, 2013). For instance, employed individuals can
earn income to consume healthy
foods, access better healthcare, and live in better housing. In
the case of Japanese immigrants,
employment influences mental health among this group
negatively.
Recent statistics show that about 58% of Japanese immigrants
are employed, and about
39% are out of the labor force. Although 58% seems like a
considerable number, a significant
percentage of Japanese immigrants are still out of the
labor force or doing less paying jobs.
Lacking employment makes many of them go through financial
difficulties compared to the whites
with similar qualifications, therefore subjected to an array of
mental health problems. Assari and
Kumar (2018) stated that most Japanese immigrants have mental
illness due to poor or low paying
jobs. Due to a lack of employment, most Japanese
immigrants cannot access or afford better

mental health care services, worsening their conditions.
Neighborhood and Physical Environment
The neighborhoods and physical environment where individuals
live tend to impact their
health outcomes and overall well-being directly. For instance,
people can live in communities with
high violence rates and unsafe water and air, which negatively
affects their physical and mental
health. Most Japanese immigrants live in New York and
Honolulu, which are among cities with
the highest violence rate, thus harming their mental health.
Research by John et al. (2012)
established that immigrants living in places with high
crime/violence rates are likely to experience
mental health illness such as stress, anxiety, and depression for
fear of being mugged, killed, or
robbed. Another study by Cabral and Cuevas (2020) also
indicated that most immigrants live in
areas with high safety and health risks because of their minority
status, which harms their mental
health.
6

Cecilia Ayon
Include a reference here
Panahi-Pour
Education
Education is a major social health determinant because it
enables individuals to make
informed decisions about their health and maneuver the
healthcare system (John et al., 2012). For
instance, highly educated people can prioritize diagnosis or
know which facility to visit before a
health condition worsens. According to recent reports, about
32% of the Japanese immigrants have
attained a bachelor’s degree. This number is still low and means
that a considerable percentage of
the population only has basic education. Because of the massive
population of individuals without
tertiary education, most do not have the appropriate health
literacy to seek mental health treatment.
Alegría et al. (2008) pointed out that most immigrants have low
education levels to make informed
decisions about their health. Some even die without
knowing their ailments due to a lack of

information for a diagnosis or treatment. The author suggested
that improving education and health
literacy among immigrants can help boost health outcomes since
these groups will make informed
health decisions, preventing specific health conditions.
Food
Typically, food is linked to economic stability indicators
like employment and income
(John et al., 2012). As noted earlier, a significant
percentage of Japanese immigrants are
unemployed, thus lack money to access nutritious food, which
affects their health outcomes. For
example, due to a lack of healthy and adequate food, most
Japanese immigrants are often forced to
starve and subjected to mental illness such as stress and
depression. A study by Castañeda et al.
(2012) showed that immigrant parents who cannot provide
enough food to their children or family
are likely to suffer from various mental health problems
such as depression, panic disorders,
personality disorders, and eating disorders.
Community and Social Context
7

Panahi-Pour
The community and social context domains comprise
indicators like social support
networks and resources (Artiga & Hinton, 2019). These domains
can influence health outcomes
positively or negatively. Japanese immigrants entail one of
the most socially knit ethnic
communities in the United States. Their culture is defined by
living together, helping each other,
and visiting one another frequently. Because of this,
Japanese immigrants have robust
social/family support networks that release the impacts of
mental illness. Those with mental health
concerns receive adequate family support, speeding their
recoveries. An article by Butkus et al.
(2020) established that Japanese immigrants have a culture that
embraces togetherness, ensuring
that individuals with mental illness, especially among the
elderly population, receive sufficient
social support. This influences better health outcomes.
Health Care Systems

Health care systems and policies comprise significant
health determinants since they
impact the type and health care available to an individual
or community (John et al., 2012).
Generally, the U.S. health care system is expensive compared to
other developed nations. In 2019,
the U.S. government spent about $3.8 trillion or 17.7% of the
GDP on health care. Because of the
enormous health care costs and the high unemployment rate
among Japanese immigrants, most of
them cannot access better health care services, affecting the
health outcomes negatively. Teruya
and Bazargan-Hejazi (2013) pointed out that the costly health
care system of the United States is a
massive problem to many immigrants’ health since they cannot
afford better health care services.
This is why the Healthy People 2020 campaigns suggest
reducing care costs and expanding
insurance coverage to ensure health equity in the United States.
Immigration as a Social Determinant of Health
8
Cecilia Ayon

Since you include indicators that create barriers/exacerbate
health issues and indicators that are protective - in your intro
you should indicate that you will address SDH factors that
facilitate and hinder health.
Cecilia Ayon
Meygan Maciel
elaborate
Panahi-Pour
Immigration status and policy plays a significant role in the
health of Japanese immigrants.
For instance, in states with restrictive immigrant policies such
as Arizona, access to employment
and health services for mental health concerns affects
immigrants' health outcomes adversely
(Castañeda et al., 2012). In other words, the restrictive
regulations prevent Japanese immigrants
from accessing better mental health care services,
jeopardizing the health outcomes (Teruya &
Bazargan-Hejazi, 2013). Also, most immigrants encounter
discrimination in employment,
education, social support, and health care access, which
influences their mental health outcomes
negatively because of the immigration status. For instance, due

to constant racial discrimination,
immigrants can experience anxiety, stress, or depressive
disorders, reducing the quality of life or
well-being.
Japanese immigrants moved to the United States as early as the
1880s. They have since
settled to become among the powerful communities of Asian
origin. The group faced significant
challenges but demonstrated resilience to become what they are
today. Besides, mental health is a
massive concern among Japanese immigrants, and this condition
is influenced by several social
determinants of health including economic stability,
neighborhood and physical environment,
education, food, community and social context, and health care
system. The factors have positive
and negative effects on the mental health outcomes of
Japanese immigrants. Lastly, the
immigration status and policies also impact the health outcomes
of this ethnic group negatively.
References
9

Cecilia Ayon
This is good - hinting at a historical application of immigration
as a SDH or even historical trauma experienced by this
population.
Panahi-Pour
Alegría, M., Canino, G., Shrout, P. E., Woo, M., Duan,
N., Vila, D., & Meng, X. L. (2008).
Prevalence of mental illness in immigrant and non-immigrant
US Latino groups. American
Journal of psychiatry, 165(3), 359-369.
Artiga, S., & Hinton, E. (2019). Beyond health care: the role of
social determinants in promoting
health and health equity. Health, 20(10), 1-13.
http://files.kff.org/attachment/issue-brief-
beyond-health-care
Assari, S., & Kumar, A. (2018). Social determinants of
physical self-rated health among Asian
Americans; comparison of six ethnic groups. Societies, 8(2), 24.
Butkus, R., Rapp, K., Cooney, T. G., & Engel, L. S. (2020).
Envisioning a better US Health Care
System for all: reducing barriers to care and addressing
social determinants of

health. Annals of internal medicine, 172(2_Supplement), S50-
S59.
Cabral, J., & Cuevas, A. G. (2020). Health inequities
among latinos/hispanics: documentation
status as a determinant of health. Journal of racial and ethnic
health disparities, 1-6.
Castañeda, H., Holmes, S. M., Madrigal, D. S., Young, M. E.
D., Beyeler, N., & Quesada, J.
(2015). Immigration as a social determinant of health. Annual
review of public health, 36,
375-392.
Healthy People (2021). Social Determinants of Health.
John, D. A., De Castro, A. B., Martin, D. P., Duran, B.,
& Takeuchi, D. T. (2012). Does an
immigrant health paradox exist among Asian Americans?
Associations of nativity and
occupational class with self-rated health and mental
disorders. Social science &
medicine, 75(12), 2085-2098.
10

Panahi-Pour
Orgera, K., & Tolbert, J. (2020). Key Facts about the
Uninsured Population.
https://www.kff.org/uninsured/issue-brief/key-facts-about-the-
Teruya, S. A., & Bazargan-Hejazi, S. (2013). The
immigrant and Hispanic paradoxes: A
systematic review of their predictions and effects. Hispanic
journal of behavioral
sciences, 35(4), 486-509.
Torimoto, I. (2017). Okina Kyūin and the Politics of Early
Japanese Immigration to the United
States, 1868-1924. McFarland.
11
https://www.kff.org/uninsured/issue-brief/key-facts-about-the-

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