US Caribbean-born Adults: The State of Mental Health and Substance Abuse Research and Treatment Nakia C. Brown, PhD Rhonda R. Waller, PhD Nycal Anthony-Townsend, MHS

Purpose 1.Provide context for discussing issues and needs of Caribbean-born populations. 2.Identify risk and protective factors for mental health (MH) and substance abuse (SA) among Caribbean- born adults living in the US 3.Discuss MH/SA interventions targeting or serving Caribbean-born adults. 4.Discuss next steps in meeting MH/SA prevention and treatment for Caribbean-born adults.

Overview 3 rd largest immigrant group Colluded MH/SA survey data MH/SA Evidence-based interventions Organizations serve or target communities with large Caribbean-born populations Little has been known about this growing segment of the increasingly diverse U.S. Black population

Contextual Factors Acculturative and Psychosocial Stress –Social Isolation –Discrimination –Language Barriers

Demographics US Census Data Native-born: –Born in AK, DC, HI or 48 other states –Puerto Rico: (Spanish language) –St. John, St. Thomas, or St. Croix (US VI) Foreign-born: –Any other country or territory Includes Caribbean islands/countries

Who’s Who in the US Race and ethnicity are treated as separate concepts in the US Caribbean-populations are included as “Black” unless they say otherwise

US Census Options White: origins in Europe, Middle East, or North Africa Black/African American: origins in African racial group Native Hawaiian/Other Pacific Islander : Hawaii, Guam (a US Territory), or Samoa Hispanic or Latino: Origins in Cuba, Mexico, Puerto Rican (US Territory), South or Central America regardless of race Other race/ethnicity not captured

Official Language of Caribbean Islands-Countries English (n=13) –Anguilla, Antigua and Barbuda, Bahamas, Barbados, Bermuda, Cayman Islands, Dominica, Grenada, Guyana, Jamaica, Saint Kitts and Nevis, Saint Lucia, Trinidad and Tobago, Turks and Caicos and US VI* Non-English (n=11) –Argentina, Aruba, Brazil, Colombia, Cuba, Dominican Republic, Guadeloupe, Haiti, Honduras, Martinique, Puerto Rico, and Saint Barthélemy, and Saint Maarten

“Blacks” in the United States Caribbean-born Haiti, Jamaica, Trinidad & Tobago (42%)Other Caribbean island/countries (58%) Foreign-Born Non-Caribbean-born (46%)Caribbean-born (54%) Black Native (92%)Foreign-born (8%) US Population Non-Black (88%)Black (12%)

Mental Health Research: Caribbean-born Adults Compared to Blacks born in US –Higher lifetime depression rates –Lower treatment rates –Similar past-year rates Williams et al., 2007

Substance Abuse Research: Caribbean-born Adults Limited published research Failure to distinguish from Blacks Gender differences in prevalence –African American women > Caribbean women Broman et al., 2008

Top 5 States: Caribbean-born Residents Florida New York –Caribbean-born comprise nearly 25% of Black population in New York City New Jersey Massachusetts California

Number of MH/SA Facilities ( within a 5-mile Radius) New York City Boroughs –Bronx (n=76) –Brooklyn (n=86) –Manhattan (n=144) –Queens (n=43)

MH/SA Intervention and Treatment Large Caribbean-born population Plethora of MH/SA agencies Best practices in MH/SA

SAMHSA’S National Registry of Evidence- Based Programs and Practices Searchable registry of 160+ interventions Connect public with intervention developers to help implement approaches Minimum Requirements –Positive behavioral outcomes –Experimental/quasi-experimental design –Peer-reviewed publication –Public use-ready

NRREP Search Criterion Age (18 years and older) Black (or African American) Non-US population Urban In-patient or Outpatient Setting

Standards for Federal Data on Race and Ethnicity Race and Ethnicity Immigration Status (optional) –Cuba and Dominican Republic CPS, NHIS, and NHANES

Fundamental Issue Caribbean-born populations that we are discussing traverse multiple categories, but are not adequately captured in any.

Current State of Affairs Limited MH/SA Research No US-based MH/SA EBIs for Caribbean-born populations Lack of EBI evaluation on Caribbean-born populations

Points to Consider Heterogeneity among “Blacks” Heterogeneity among Caribbean Variation in MH/SA risk profiles Impact of culture and contextual factors on treatment outcomes

Points of Emphasis Important to understand health disparities in the US not just in terms of race/ethnicity, but also by culture In US, there exists axes of diversity not only among native-born, but also among foreign-born

Recommendations Increase self-select identification categories Use stakeholders to inform survey designs Incorporate qualitative data collection to enhance research quantitative findings Conduct longitudinal studies of Caribbean- born immigrants to assess the impact of immigration on MH/SA outcomes over time

Thank You