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This paper proposes a theoretical framework and an empirical example of the relationship between the civic stratification of immigrants in the United States, and their access to healthcare. We use the 2007 Pew Hispanic Center/Robert Wood Johnson Foundation Hispanic Healthcare Survey, a nationally representative survey of U.S. Latinos (N = 2,783 foreign-born respondents) and find that immigrants who are not citizens or legal permanent residents are significantly more likely to be excluded from care in both the United States and across borders. Legal-status differences in cross-border care utilization persisted after controlling for health status, insurance coverage, and other potential demographic and socioeconomic predictors of care. Exclusion from care on both sides of the border was associated with reduced rates of receiving timely preventive services. Civic stratification, and political determinants broadly speaking, should be considered alongside social determinants of population health and health care. [ABSTRACT FROM AUTHOR]

"Reefer madness," a spurious psychiatric affliction that was widely promulgated in the United States during the 1930s, is rarely mentioned today as a possible sequela of acute cannabis consumption. Because reefer madness (RM) was questioned and generally dismissed in the West by the 1940s, I was surprised to find that it was still widely accepted as a genuine psycho-pharmacological affliction in the Eastern Caribbean country of St. Vincent and the Grenadines in the 1990s. This paper describes and analyzes the reasons for this discontinuity between the West and the Rest by referring to the multiplicity of factors supporting the Vincentian RM syndrome: a generalized tropical "intellectual backwardness" and associated moral apathy; the real and alleged behavioral-psychological effects of acute cannabis ingestion; the peculiarly Caribbean character of Vincentian RM and the way it differs from its American counterpart; the types of people promoting the affliction; the larger anti-marijuana context that includes opposition to any involvement with the substance; and, most importantly, the national system of racial and class stratification. [ABSTRACT FROM AUTHOR]