Untangling the Latino hypertension paradox: a mixed-methods study of Latino hypertension management in new and established Latino destination states

Despite rapid growth and growing recognition, US Latinos have poorer hypertension management, lower treatment adherence, and are less likely to achieve hypertension control than Whites. Though current evidence suggests that social, contextual, and environmental factors have a significant influence on individuals’ cardiovascular disease outcomes, their association with Latinos’ hypertension management has been rarely explored. In this dissertation, using a combination of nationally representative data (BRFSS) and semi-structured interviews, I sought to identify the contributions of individual, social, contextual, and environmental factors that may explain Latinos’ hypertension management and how these varied by place of residence (i.e., established vs new Latino destination states). Findings indicate that hypertension management is a complex phenomenon being influenced by factors at each level of the ecological model and that for some factors, place of residence may matter. Specifically, healthcare access and history of diabetes were associated with higher odds of treated hypertension. Conversely, residence in new Latino destination states or in established destination states that expanded Medicaid in 2017, was associated with lower odds of treated hypertension. In addition, participants’ narratives highlighted how the impact of culture and immigration related stressors were more salient depending on place of residence. This work contributes to the emerging body of literature on Latino health disparities in established and new destination states. The findings of this dissertation have significant implications for public health interventions, as it highlights the need for interventions targeting multiple variables at different ecological levels to address well documented hypertension disparities in the Latino community.