1. 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

2. 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.

3. 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

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

5. 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

6. 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

7. 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

8. 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

9. “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%)

10. 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

11. 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

12. 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

13. 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)

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

15. 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

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

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

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

19. 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

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

21. 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

22. 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

23. Thank You