The Association Between Acculturation and Cardiovascular Disease Risk in Ghanaian and Nigerian-born African Immigrants in the United States: The Afro-Cardiac Study

Understanding the relationships between acculturation, food insecurity, and food parenting practices among socioeconomically/racially diverse parents

Research suggests that acculturation and food insecurity are factors that are separately associated with the use of specific food parenting practices among United States (US) families. Certain food parenting practices, such as coercive control and unstructured food parenting practices, are related to negative health consequences in children, such as disordered eating behaviors. The current study aimed to explore associations between acculturation strategies and food parenting practices in a sample of 577 Latinx, Hmong, Somali/Ethiopian, and Multiracial families. A secondary objective was to understand whether food security status significantly modified the relationships between acculturation strategies and food parenting practices. Results showed that acculturation strategies were significantly related to food parenting practices, and patterns in these relationships differed across race and ethnicity. Further, food security status significantly modified the relationship between acculturation strategies and food parenting practices for Latinx, Hmong, and Somali/Ethiopian families, but not for Multiracial families. These results point to the complex relationships among acculturation strategies, food security status, and food parenting practices in immigrant populations in the US. Longitudinal studies exploring the temporal relationships between acculturation strategies, food security status, and food parenting practices would help tease apart how food parenting practices may evolve upon migrating to the US.

Exploring the dietary practices and perceptions of African immigrants in Illinois- a qualitative study of immigrants from Nigeria and Congo

OBJECTIVE

Previous studies suggest an increased prevalence of diet-related chronic diseases among African immigrants with increased length of stay in the U.S. The objective of the current study is to understand the dietary practices and perceptions of recent African immigrant families.

DESIGN

Focus group sessions were conducted with Nigerian and Congolese immigrant parents residing in Illinois. Participants were recruited using convenience sampling methods and focus group sessions were conducted via videoconference. Participants discussed dietary practices, meal preparation, and family mealtimes for their families. They also discussed experiences with eating different kinds of foods since arrival in the U.S. Verbatim transcription of focus group sessions were completed and deductive thematic analysis of transcribed data was conducted using NVivo (QSR International Pty Ltd. [2020] NVivo [version 12]).

RESULTS

Twenty African immigrant parents (Mean age: 42 years, Female: 95%) residing in Northern and Central Illinois participated in a total of five focus group sessions. Seven themes were derived from the analysis. Participants had a positive attitude toward healthy diet and had a high level of interest in receiving educational resources to make healthier food choices. Participants preferred and mostly consumed foods they were familiar with before migration. A majority of the participants perceived 'American foods' as unhealthy, characterizing them as containing a high amount of sugar and salt. Parents reported that their school-aged children often preferred a western diet over traditional African meals.

CONCLUSION

This study helps to understand unique diet-related practices and perceptions of recent Nigerian and Congolese African immigrants in Illinois. Findings could help to inform cultural adaptation of evidence-based nutrition education programs for these groups of African immigrants.

Duration of Residence and Hypertension in Black Foreign-Born Residents: NHIS, 2004-2017

BACKGROUND

Black Americans have the highest prevalence of hypertension in the USA. Black immigrants, who, by definition, have time-limited exposure to the USA, may provide insight into the relationship between exposure to the US environment, Black race, and hypertension.

METHODS

This is a cross-sectional analysis of pooled National Health Interview Survey (2004-2017) data of foreign-born White European and Black adults (N = 11,516). Multivariable robust Poisson regressions assessed the relationship between self-reported hypertension and duration of the residency (< 5, 5-9, 10-14, ≥ 15 years) among Black, Black African, Black Caribbean, and White European foreign-born residents.

RESULTS

In multivariable analyses-controlling for age, sex, education, poverty-to-income ratio, insurance status, recent encounter with a clinician, and BMI-Black foreign-born residents (PR = 1.40, 95% CI = 1.03, 1.90) and Black Africans (10-14 years.: PR = 1.70, 95% CI = 1.13, 2.56; ≥ 15 years.: PR = 1.56, 95% CI = 1.04, 2.34) with a duration of residency of at least 15 and 10 years, respectively, had a greater prevalence of hypertension than those with duration less than 5 years. A nonsignificant positive association between a duration of residency of at least 15 years (compared to less than 5 years) and self-reported hypertension was observed for White Europeans (PR 1.49, 95% CI = 0.88, 2.51) and Black Caribbeans (PR = 1.09, 95% CI = 0.69, 1.72).

CONCLUSION

Duration of residency is particularly associated with hypertension among Black Africans after migration to the USA. This discrepancy may be explained by differences in primary care utilization and awareness of hypertension diagnoses among recent African immigrants, along with greater stress associated with living in the USA.

Cardiovascular diseases in European ethnic minorities: Beyond the traditional cardiovascular risk factors

This editorial is intended to be a reflection on cardiovascular disease (CVD) burden in European ethnic minorities. In some European countries, ethnic minority realities, due to their recent appearance, are still to be studied in depth. The experience of several European countries, where the migration processes started earlier, even more than a century ago, can help by being an example. Many studies have shown that major differences in CVD burden exist not only between countries, but also within the same country when considering different social strata and ethnic groups. The CV risk factors underlying heart disease have been well established. Important epidemiological studies have helped us understand that the underlying causes of heart disease as well as the behaviors that can help prevent them are the same. We are now well aware that CVD should be treated by considering a holistic approach. This is why the social determinants (SDs) of health that may worsen the disease burden or that, vice versa, may improve the treatment, and even more significantly, the prognosis of a patient's illness should be taken into consideration. For ethnic minority patients, this holistic, hermeneutic approach is of importance. Several SDs of health that influence CVDs have been identified but their relevance for the health of ethnic minorities has not yet been clearly defined. In some European countries, most ethnic minorities are largely also religious minorities. Only a few studies have evaluated the role of religion, which is an important SD that affects the probability of having CV risk factors and diseases. Adolescents, particularly those belonging to the second generation, seem to be the weak link. If we believe that these young people are really citizens of their country of birth, then a way of recognizing their belonging to the community starts from a will to better understand their condition, in order to assist them while they grow physically and mentally. Thinking about safeguarding the health of this population should be more than a health task, rather a goal of social justice.

Is duration of residence a proxy for acculturation? The case of health risk behaviors among international immigrants

AIMS

Among international immigrants, health changes by duration of residence are commonly interpreted as an expression of acculturation to the receiving country context. This study compares changes in immigrants' health risk behaviors by duration of residence to changes by acculturation levels, in order to assess whether duration of residence can be regarded as a proxy for acculturation.

METHODS

Using data from a previous systematic review, we identified 17 quantitative studies examining changes in alcohol, tobacco and drug use, physical inactivity, and diet by both duration of residence and acculturation level in the same population. We compared the directionality and consistency of these associations through tabulation and vote counting.

RESULTS

The majority of studies reported no or inconsistent changes in health risk behaviors by duration of residence versus by acculturation, including with opposite directionality. Four studies reported significant estimates with consistent directionality, while five reported consistent, non-significant estimates.

CONCLUSIONS

Our findings suggest that duration of residence should not be used as a proxy for acculturation when studying health risk behaviors among immigrants. Researchers should consider additional time-dependent factors to explain behavioral changes by duration of residence.

Depressive Symptoms in Older African Immigrants with Mobility Limitations: A Descriptive Study

OBJECTIVES

Before, during, and after their immigration to the United States, immigrants face stressful life circumstances that may render them at risk for depressive symptoms. However, there is a dearth of research on the mental health of African immigrants. We performed secondary data analyses of two studies in the Baltimore-Washington area to describe and identify correlates of depressive symptoms in older African immigrants.

METHODS

Chi square tests, one-way ANOVAs, and linear regressions were used to describe and examine associations between depressive symptoms and immigrant-related risk factors.

RESULTS

This sample included 148 participants who had a mean age of 62 (SD ± 8.2). Clinical depressive symptoms were present in 8.1% of participants, and trouble falling asleep for more than half of the days was the most prevalent symptom (20%). Levels of education, income, and migration reasons differed significantly from clinical depressive symptoms, but these were not significantly associated with more depressive symptoms after controlling for covariates.

CONCLUSIONS

Longitudinal designs may further elucidate incidence, correlates, and long-term effects of depressive symptoms within this population.

CLINICAL IMPLICATIONS

Knowledge of depressive symptom burden and risk factors can inform timely assessment, referral, and treatment of depressive symptoms and other mental health outcomes in older African immigrants.

Contributions of social determinants of health to systolic blood pressure in United States adult immigrants: Use of path analysis to validate a conceptual framework

OBJECTIVE

Validate a conceptual framework and identify pathways between antecedent (life-course socioeconomic status (L-SES)), predisposing (age, sex, married, homeless as a child), enabling (health literacy, acculturation), and need (disability) social determinants of health (SDoH) and systolic blood pressure (SBP) in US immigrants.

METHODS

181 immigrants were enrolled in the study. Path analysis was used to identify paths by which SDoH influence SBP and to determine if antecedents, predisposing, enabling, and need factors have direct and indirect relationships with SBP.

RESULTS

The final model(chi2(5)=14.88, p = 0.011, RMSEA = 0.070, pclose = 0.17, CFI = 0.96) showed L-SES was directly associated with age (0.12, p = 0.019) and disability(0.17, p = 0.001); and indirectly associated with disability (0.29, p < 0.001) and SBP (0.31, p < 0.001). Age (0.31, p < 0.001) and sex(0.25, p < 0.001) were directly associated with SBP, and age was directly associated with disability (0.29, p < 0.001) and indirectly associated with SBP(0.14, p = 0.018). Other predisposing factors such as being married (-0.32, p < 0.001) and being homeless as a child alone (0.16, p < 0.001) were directly associated with disability and indirectly associated (0.14, p = 0.018) with SBP. Enabling factor of health literacy (0.16, p = 0.001) was directly associated with disability and indirectly associated (0.14, p = 0.018) with SBP. Need factor of disability (0.14, p = 0.018) was directly associated with SBP.

CONCLUSIONS

This study provides the first validation of a conceptual model for the relationship between SDoH and SBP among immigrants and identifies potential targets for focused interventions.

African Immigrant Health: The Health Promotion Beliefs of Zimbabwean Immigrants in the United States

To examine the health beliefs that can influence engagement in cardiovascular disease (CVD) risk reduction health promotion activities among Zimbabwe-born immigrants in the US. Focus group interviews with 37 New England-based Zimbabwean immigrants in the US conducted between January and April 2019. Focus groups were led by study investigators who were members of the Zimbabwean community. Interviews were audio-recorded and transcribed. Data were analyzed using framework analysis. Five themes emerged: (1) negative attitudes toward ill health, (2) mistrust toward western medicine, (3) stigma and taboo toward ill health, (4) a negative change in eating habits and (5) negative attitudes toward physical exercise. The participants' attitudes and beliefs may interfere with their engagement in health promotion activities aimed at reducing the burden of CVD risk in this population. Understanding these beliefs paves the way for development of culturally congruent health promotion interventions in Zimbabwean and other African immigrant populations.

Experiences of stress among West Africa-born immigrant women with hypertension in Washington DC area

OBJECTIVE

To report a study that explored hypertension (HTN) stress and coping experiences of West-Africa-born immigrant (WABI) women in Washington DC Metropolitan area of the United States.

DESIGN AND SAMPLE

This qualitative study conducted from December 2017 to May 2018 involved WABI women (n = 15) in Washington Metropolitan area that self-reported diagnosis of HTN. The transactional model of stress and coping (TMSC) provided the conceptual framework. Data collection was through semi-structured one-on-one interviews.  Data analysis was done through manual open-hand coding of themes.

RESULTS

Three themes emerged from the analysis: Perceived Stressors, Sources of Stress, and Coping Measures. Participants perceived that their HTN diagnosis contributed to their stress; reported other financial, school, work, trauma, household and marriage-related stressors, and coping measures that include faith-based and other recreational leisure activities.

CONCLUSION

Participants mentioned stressors related to lack of support with domestic house chores and described various religious practices as coping strategies. These findings provide additional insights relevant to several ongoing public health nursing conversations on acute and chronic stress management in different parts of the globe. Public health nurses need to utilize these findings when assessing stressors and considering safe coping measures that appeal to WABI women experiencing HTN or chronic illness.

Health Risk Behaviours by Immigrants’ Duration of Residence: A Systematic Review and Meta-Analysis

Objectives: The aim was to systematically review and synthesise international evidence on changes in health risk behaviours by immigrants’ duration of residence.

Methods: We searched literature databases for peer-reviewed quantitative studies published from 2000 to 2019, examining alcohol, drug and tobacco use; physical inactivity; and dietary habits by duration of residence.

Results: Narrative synthesis indicated that immigrants tend to adopt health risk behaviours with longer residence in North America, with larger variation in effect sizes and directionality in other contexts. Random-effects meta-analyses examining the pooled effect across all receiving countries and immigrant groups showed lower odds of smoking (OR 0.54, 0.46–0.63, I² = 68.7%) and alcohol use (OR 0.61, 0.47–0.75, I² = 93.5%) and higher odds of physical inactivity (OR 1.71, 1.40–2.02, I² = 99.1%) among immigrants than natives, but did not provide support for a universal trend by duration of residence.

Conclusion: Findings suggest that duration of residence could serve as an effective instrument to monitor immigrants’ health changes. However, differences in receiving country contexts and immigrant populations’ composition seem to be important to predict the level and direction of behavioural change.

Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, PROSPERO CRD42018108881.

Immigrant-Related Policies and the Health Outcomes of Latinx Adults in the United States: A Systematic Review

BACKGROUND

US federal and subfederal immigrant-related policy activity has increased in recent years. We hypothesize that these policies are structural determinants of health for Latinx communities, operating through access to resources, discriminatory enforcement, and stress.

METHODS

We searched seven databases for quantitative studies, published as of September 2021, examining the association between the presence of federal, state, or local immigrant-related policy(ies), over time or cross-sectionally, and mental or physical health outcomes among immigrant or US-born Latinx adults. We rated studies on methodologic quality.

RESULTS

Eleven studies were included. Policies included federal and state policies. Health outcomes included mental health (seven studies), self-rated health (n = 6), and physical disability (n = 1). Among immigrant, noncitizen, or Spanish-preferring Latinx adults, exclusionary policies were associated with poor self-rated health, physical disability, and poor mental health. Inclusive policies were associated with better health, although null findings were more common than among studies of exclusionary policies. Only three studies separately examined policy effects on US-born or citizen Latinx adults and these findings were often null. All studies received a weak overall study quality rating; among quality domains, studies were strongest in confounding control and weakest in outcome information bias and reporting missing data approaches.

CONCLUSIONS

These results support the hypothesis that immigrant-related policies, especially exclusionary policies, are structural drivers of health for immigrant or noncitizen Latinx adults. However, evidence is scant among US-born or citizen Latinx adults. Studies of policies and physical health outcomes besides disability are lacking, as are results disaggregated by nativity and/or citizenship status.

The Cardiometabolic Health of African Immigrants in High-Income Countries: A Systematic Review

In recent decades, the number of African immigrants in high-income countries (HICs) has increased significantly. However, the cardiometabolic health of this population remains poorly examined. Thus, we conducted a systematic review to examine the prevalence of cardiometabolic risk factors among sub-Saharan African immigrants residing in HICs. Studies were identified through searches in electronic databases including PubMed, Embase, CINAHL, Cochrane, Scopus, and Web of Science up to July 2021. Data on the prevalence of cardiometabolic risk factors were extracted and synthesized in a narrative format, and a meta-analysis of pooled proportions was also conducted. Of 8655 unique records, 35 articles that reported data on the specific African countries of origin of African immigrants were included in the review. We observed heterogeneity in the burden of cardiometabolic risk factors by African country of origin and HIC. The most prevalent risk factors were hypertension (27%, range: 6-55%), overweight/obesity (59%, range: 13-91%), and dyslipidemia (29%, range: 11-77.2%). The pooled prevalence of diabetes was 11% (range: 5-17%), and 7% (range: 0.7-14.8%) for smoking. Few studies examined kidney disease, hyperlipidemia, and diagnosed cardiometabolic disease. Policy changes and effective interventions are needed to improve the cardiometabolic health of African immigrants, improve care access and utilization, and advance health equity.

Nativity-Related Disparities in Preterm Birth and Cardiovascular Risk in a Multiracial U.S. Cohort

INTRODUCTION

Having a preterm birth is associated with future cardiovascular risk. Non-Hispanic Black women have higher rates of preterm birth than non-Hispanic White and Hispanic women, but nativity-related disparities in preterm birth are not well understood.

METHODS

Data from 6,096 women in the Boston Birth Cohort: non-Hispanic Black (2,699), non-Hispanic White (997), or Hispanic (2,400), were analyzed in June 2021. Differences in cardiovascular risk factors were assessed. The association of preterm birth with nativity and duration of U.S. residence were investigated using multivariable logistic regression.

RESULTS

U.S.-born women in all 3 racial-ethnic groups had a higher prevalence of obesity, smoking, and severe stress than foreign-born women. Foreign-born non-Hispanic Black and Hispanic women had lower odds of preterm birth than U.S.-born counterparts (non-Hispanic Black: AOR=0.79, 95% CI=0.65, 0.97; Hispanic: AOR=0.72, 95% CI=0.56, 0.93). In all the 3 groups, foreign-born women with shorter (<10 years) duration of U.S. residence had lower odds of preterm birth than the U.S.-born women (non-Hispanic Black: AOR=0.57, 95% CI=0.43, 0.75; Hispanic: AOR=0.72, 95% CI=0.55, 0.94; non-Hispanic White: AOR=0.46, 95% CI=0.25, 0.85), whereas the odds of preterm birth in foreign-born women with ≥10 years of residence were not significantly different.

CONCLUSIONS

Foreign-born women had better cardiovascular risk profiles in all groups and lower odds of preterm birth in non-Hispanic Black and Hispanic groups. In all the 3 groups, a shorter duration of U.S. residence was associated with lower odds of preterm birth. Further studies are needed to understand the biological and social determinants underlying these nativity-related disparities and the impact of acculturation.

The Associations between Depression, Acculturation, and Cardiovascular Health among African Immigrants in the United States

Cardiovascular disease (CVD) is the leading cause of death both globally and in the United States (U.S.). Racial health disparities in cardiovascular health (CVH) persist with non-Hispanic Black adults having a higher burden of CVD morbidity and mortality compared to other racial groups. African immigrants represent an increasingly growing sub-population of the overall U.S. non-Hispanic Black adult population, however little is known about how specific psychological and social factors (i.e., depression and acculturation) influence the CVH of U.S. African immigrants. We sought to examine the association between severity of depression symptomology and CVH among African immigrants, and whether acculturation moderated the relationship between severity of depression symptoms and CVH. Study participants were those in the African Immigrant Health Study conducted in the Baltimore-Washington D.C. area. Severity of depression symptoms were assessed using the Patient Health Questionnaire-8 (PHQ-8). CVH was assessed using the American Heart Association Life's Simple 7 metrics and categorized as poor, intermediate, and ideal CVH. Acculturation measured as length of stay and acculturation strategy was examined as a moderator variable. Multivariable logistic regression was used to examine the association between depression and CVH and the moderating effect of acculturation adjusting for known confounders. In total 317 African immigrants participated in the study. The mean (±SD) age of study participants was 46.9 (±11.1) and a majority (60%) identified as female. Overall, 8.8% of study participants endorsed moderate-to-severe symptoms of depression. African immigrants endorsing moderate-to-severe levels of depression were less likely to have ideal CVH compared to those with minimal-to-mild symptoms of depression (Adjusted Odds Ratio [AOR]: 0.42, 95% CI: 0.17-0.99). Acculturation measured either as length of stay or acculturation strategy did not moderate the relationship between depression and CVH among study participants. Study participants exhibited elevated levels of symptoms of depression. Greater severity of depression symptoms was associated with worse CVH. Efforts to treat and prevent CVD among African immigrants should also include a focus on addressing symptoms of depression within this population.

Diabetes and acculturation in African immigrants to the United States: analysis of the 2010-2017 National Health Interview Survey (NHIS)

Objective: This study sought to assess the association between unidimensional acculturation and diabetes, and analyze mediating pathways of the association in African immigrants to the United States (U.S.).Hypothesis: Acculturation would be positively associated with diabetes and that BMI (Body mass index), physical activity, and psychological distress would mediate this association.Methods: An analysis of cross-sectional data from the 2010-2017 National Health Interview Surveys was performed. Adults aged ≥ 18 years who were born in Africa (African immigrants) and residing in the U.S. were considered. The outcome was self-reported diabetes, and acculturation was defined by percent of life spent in the U.S. and citizenship. Multivariable logistic regression analysis was used to assess the association between acculturation and diabetes, and mediation analysis was used to examine the mediating effects of BMI, physical activity, and psychological distress on this association.Results: The analytic sample included 1648 African immigrants with mean (SD) age of 41.3 ± 0.45 years; 56.4% male. Additionally, 46% had ≥ college education, and 21.4% lived below the poverty threshold. About two-thirds were overweight/obese. Less than 50% exercised at adequate levels of physical activity levels. A small percentage (1.8%) reported psychological distress. The prevalence of self-reported diabetes was 6.1%, and 76.5% reported being acculturated. In the multivariate logistic regression analysis, higher levels of acculturation were associated with higher odds of diabetes diagnosis (Odds Ratio (OR) = 2.2; 95% CI = 1.1-4.4). Although BMI mediated the association between acculturation and diabetes (ZMediation = 2.11, p = 0.036), only 18.9% of the total effect of acculturation on diabetes was explained by BMI.Conclusions: Acculturation increased the odds of diabetes diagnosis, and BMI mediated the association. Thus, tailoring culturally-appropriate interventions to control BMI may contribute to preventing diabetes within African immigrant communities to the U.S.

Self-Care of African Immigrant Adults with Chronic Illness

This cross-sectional study aims to describe the self-care of adult African immigrants in the US with chronic illness and explore the relationship between acculturation and self-care. A total of 88 African immigrants with chronic illness were enrolled. Self-care was measured with the Self Care of Chronic Illness Inventory v3 and the Self-Care Self-Efficacy scale. Scores are standardized 0 to 100 with scores >70 considered adequate. Acculturation was measured using a modified standardized acculturation instrument and predefined acculturation proxies. The self-care scores showed adequate self-care, with the mean scores of 78.6, 77.9, and 75.6 for self-care maintenance, monitoring, and management. Self-care self-efficacy mean score was 81.3. Acculturation was not significantly associated with self-care. Self-care self-efficacy was a strong determinant of self-care maintenance (p < .0001), monitoring (p < .0001), and management (p < .0001). The perception of inadequate income was a significant determinant of poor self-care management (p = .03). Self-care self-efficacy and perceived income adequacy were better determinants of self-care than acculturation.

Sleep and Economic Status Are Linked to Daily Life Stress in African-Born Blacks Living in America

To identify determinants of daily life stress in Africans in America, 156 African-born Blacks (Age: 40 ± 10 years (mean ± SD), range 22–65 years) who came to the United States as adults (age ≥ 18 years) were asked about stress, sleep, behavior and socioeconomic status. Daily life stress and sleep quality were assessed with the Perceived Stress Scale (PSS) and Pittsburgh Sleep Quality Index (PSQI), respectively. High-stress was defined by the threshold of the upper quartile of population distribution of PSS (≥16) and low-stress as PSS < 16. Poor sleep quality required PSQI > 5. Low income was defined as <40 k yearly. In the high and low-stress groups, PSS were: 21 ± 4 versus 9 ± 4, p < 0.001 and PSQI were: 6 ± 3 versus 4 ± 3, p < 0.001, respectively. PSS and PSQI were correlated (r = 0.38, p < 0.001). The odds of high-stress were higher among those with poor sleep quality (OR 5.11, 95% CI: 2.07, 12.62), low income (OR 5.03, 95% CI: 1.75, 14.47), and no health insurance (OR 3.01, 95% CI: 1.19, 8.56). Overall, in African-born Blacks living in America, daily life stress appears to be linked to poor quality sleep and exacerbated by low income and lack of health insurance.

Acculturation and Cardiovascular Risk Screening among African Immigrants: The African Immigrant Health Study

Acculturation and immigration-related factors may impact preventive, routine cardiovascular risk (CV) screening among African immigrants. We examined the associations between length of stay, percent of life spent in the U.S. (proxy for acculturation), and CV screening. Outcomes were recent screening for hypertension, diabetes, and dyslipidemia. Multivariable logistic regression analyses were used to examine these relationships. Among 437 African immigrants, 60% were males, mean age was 47 years, 61% had lived in the U.S. for ≥10 years, mean length of stay was 15 years, and 81% were employed. Only 67% were insured. In the 12 months prior, 85% had screened for hypertension, 45% for diabetes, and 63% for dyslipidemia. African immigrants with a ≥10-year length of U.S. stay had 2.20 (95%Confidence Intervals: 1.31−3.67), and those with >25% years of life spent in the U.S. had 3.62 (95%CI: 1.96−6.68) higher odds of dyslipidemia screening compared to those with a <10-year length of stay and ≤25% years of life spent in the U.S., respectively. Overall, screening for CV risk higher in African immigrants who have lived longer (≥10 years) in the U.S. Recent African immigrants may experience challenges in accessing healthcare. Health policies targeting recent and uninsured African immigrants may improve access to CV screening services.

Longer Residence in the United States is Associated With More Physical Function Limitations in African Immigrant Older Adults

Acculturation and racial discrimination have been independently associated with physical function limitations in immigrant and United States (U.S.)-born populations. This study examined the relationships among acculturation, racial discrimination, and physical function limitations in N = 165 African immigrant older adults using multiple linear regression. The mean age was 62 years (SD = 8 years), and 61% were female. Older adults who resided in the United States for 10 years or more had more physical function limitations compared with those who resided here for less than 10 years (b = -2.62, 95% confidence interval [CI] = [-5.01, -0.23]). Compared to lower discrimination, those with high discrimination had more physical function limitations (b = -2.51, 95% CI = [-4.91, -0.17]), but this was no longer significant after controlling for length of residence and acculturation strategy. Residing in the United States for more than 10 years is associated with poorer physical function. Longitudinal studies with large, diverse samples of African immigrants are needed to confirm these associations.

Disparities in cardiometabolic risk profiles and gestational diabetes mellitus by nativity and acculturation: findings from 2016-2017 National Health Interview Survey

INTRODUCTION

Gestational diabetes mellitus (GDM) is a common complication of pregnancy with implications for cardiovascular health. Among reproductive-aged women, less is known about nativity-related disparities in cardiometabolic risk profiles and GDM history. We examined how cardiometabolic risk profiles and GDM history differed by nativity and explored associations between acculturation, cardiometabolic risk profiles and GDM history.

RESEARCH DESIGN AND METHODS

We analyzed cross-sectional data from the 2016-2017 National Health Interview Survey among reproductive-aged women (18-49 years) who both reported ever being pregnant and answered the question on GDM history. Using multivariable logistic regression, we examined the percentage with GDM history and compared cardiometabolic profiles by nativity status and acculturation (duration of US residence).

RESULTS

Of 9525 women, 22.5% were foreign-born. Also, 11.7% of foreign-born women had a GDM history vs 9.6% of US-born women. Foreign-born women with ≥10 years US residence had the highest age-standardized percentage with GDM history (11.0%) compared with US-born women (9.2%) and foreign-born women with <10 years US residence (6.7%). US-born women had a higher prevalence of hypertension, current smoking, and alcohol use than foreign-born women. Among foreign-born women, those with ≥10 years US residence had a higher prevalence of hypertension, current smoking, and alcohol use than those with <10 years US residence. In the fully adjusted model, foreign-born women with ≥10 years US residence had higher odds of GDM history than US-born women (OR 1.43; 95% CI 1.17 to 1.76) while foreign-born women with <10 years US residence and US-born women has similar odds of GDM history.

CONCLUSIONS

Greater duration of US residence may be associated with nativity-related disparities in GDM. Acculturation, including changing health-related behaviors may explain the disparities among foreign-born women and should be further investigated to appropriately target interventions to prevent GDM and future cardiometabolic diseases.

Racial Disparities in Gestational Diabetes by Maternal Nativity and Length of US Residence in an Urban Low-income Population in the United States

Background

Gestational diabetes mellitus (GDM) is associated with increased risk of cardiovascular disease (CVD). Racial/ethnic differences in GDM prevalence have been described, but disparities by nativity and duration of US residence are not well studied.

Methods

We analyzed data from 6088 women (mean age: 27.5 years [standard deviation: 6.3 years]) from the Boston Birth Cohort who self-identified as non-Hispanic Black (NHB; n = 2697), Hispanic (n = 2395), or non-Hispanic White (NHW; n = 996). Using multivariable logistic regression, we examined the cross-sectional association of nativity and duration of US residence (< 10 vs ≥ 10 years) with GDM within each race/ethnicity group.

Results

Foreign-born NHB, NHW, and Hispanic women with a duration of US residence of < 10 years had a lower prevalence of CVD risk factors than those with US residence of ≥ 10 years, respectively, as follows: smoking (NHB: 1.7% vs 3.1%; NHW: 5.7% vs 8.1%; Hispanic: 0.4% vs 2.6%); obesity (NHB: 17.1% vs 23.4%; NHW: 3.8% vs 15.6%; Hispanic: 10.9% vs 22.7%); and severe stress (NHB: 8.7% vs 11.9%; NHW: 5.7% vs 28.1%; Hispanic: 3.8% vs 7.3%). In analyses adjusting for sociodemographic characteristics and CVD risk factors, foreign-born NHB women with a duration of US residence of < 10 years had higher odds of having GDM (adjusted odds ratio: 1.60, 95% confidence interval: 0.99-2.60), compared with their US-born counterparts, whereas foreign-born Hispanic women with a duration of US residence of < 10 years had lower odds of having GDM (adjusted odds ratio: 0.54, 95% confidence interval: 0.32-0.91). The odds of having GDM in Hispanic and NHB women with a duration of US residence of ≥ 10 years were not significantly different from those of their US-born counterparts.

Conclusions

The “healthy immigrant effect” and its waning with longer duration of US residence apply to the prevalence of GDM among Hispanic women but not NHB women. Further research on the intersectionality of race and nativity-based disparities is needed.

Sleep Health, Acculturation, and Acculturative Stress in Immigrants in the United States: A Scoping Review

INTRODUCTION

Poor sleep health has been widely associated with chronic illnesses, and immigrant populations in the United States do not experience optimal sleep, putting them at increased risk of such illnesses. The purpose of this scoping review was to synthesize published literature on the influence of acculturation and acculturative stress on the sleep health of immigrant populations in the United States.

METHOD

This scoping review was guided by Arksey and O'Malley's framework and the Preferred Reporting Items for Systematic reviews and Meta-Analyses guideline, and 16 research articles were included in its synthesis of results.

RESULTS

Findings indicated that immigrants in the United States have poor sleep health and that acculturation and acculturative stress may be major influencing factors. In addition, demographic and socio-contextual factors such as gender, economic status, education, and employment characteristics influenced immigrants' sleep. Race and ethnicity were additional factors influencing sleep, but the limited number of studies in this area precludes determination of which groups are most affected. Chronic stress, depressive symptoms, and language influenced immigrants' sleep health, but mixed results were observed for generational status.

DISCUSSION

Future sleep studies should include vulnerable and understudied immigrant groups and consider all socio-contextual and psychological factors potentially affecting sleep health. In health settings serving immigrant groups, nurses should emphasize screening for these factors. Also, comparative studies are needed to identify specific factors that may affect sleep health in particular immigrant ethnic groups.

Acculturation Strategies and Pap Screening Uptake among Sub-Saharan African Immigrants (SAIs)

Although regular cervical cancer screening can prevent cervical cancer, screening utilization remains low among immigrant population including sub-Saharan African immigrants (SAIs). Acculturation is a complex process, which can lead to adoption of positive or negative health behaviors from the dominant culture. Acculturation strategies are the varying ways in which individuals seek to go about their acculturation by either maintaining or rejecting their own cultural values ip or accepting or rejecting the host culture’s cultural values. Cervical cancer screening behaviors among SAI women may be influenced by their acculturation strategies. We conducted a secondary analysis of data to examine the relationship between acculturation strategies and Pap screening among 99 SAI women recruited from community settings. Data were collected on Pap screening behavior and acculturation strategy. Traditionalists and Integrationists were the dominant acculturation strategies; 32.3% women were Traditionalists and 67.7% Integrationists. From the logistic regression models, Integrationists had seven times the odds of having ever been screened compared to Traditionalists (OR = 7.08, 95% CI = 1.54–28.91). Cervical cancer screening interventions should prioritize Traditionalists for cancer screening. Acculturation strategies may be used to tailor cancer prevention and control for SAIs. More research among a larger SAI women sample is warranted to further our understanding of Pap screening patterns and acculturation strategies.

The Association of Preterm Birth With Maternal Nativity and Length of Residence Among Non-Hispanic Black Women

Background

Preterm birth (PTB) is associated with future cardiovascular disease (CVD) risk and disproportionally affects non-Hispanic Black (NHB) women. Limited data exist on the influence of length of US residence on nativity-related disparities in PTB. We examined PTB by maternal nativity (US born vs foreign born) and length of US residence among NHB women.

Methods

We analyzed data from 2699 NHB women (1607 US born; 1092 foreign born) in the Boston Birth Cohort, originally designed as a case-control study. Using multivariable logistic regression, we investigated the association of PTB with maternal nativity and length of US residence.

Results

In the total sample, 29.1% of women delivered preterm (31.4% and 25.6% among US born and foreign born, respectively). Compared with foreign born, US-born women were younger (25.8 vs 29.5 years), had higher prevalence of obesity (27.6% vs 19.6%), smoking (20.5% vs 4.9%), alcohol use (13.2% vs 7.4%), and moderate to severe stress (73.5% vs 59.4%) (all P < 0.001). Compared with US-born women, foreign-born women had lower odds of PTB after adjusting for sociodemographic characteristics, alcohol use, stress, parity, smoking, body mass index, chronic hypertension, and diabetes (adjusted odds ratio [aOR], 0.79; 95% confidence interval [CI], 0.65-0.97). Foreign-born NHB women with < 10 years of US residence had 43% lower odds of PTB compared with US-born (aOR, 0.57; 95% CI, 0.43-0.75), whereas those with ≥ 10 years of US residence did not differ significantly from US-born women in their odds of PTB (aOR, 0.76; 95% CI, 0.54-1.07).

Conclusions

The prevalence of CVD risk factors and proportion of women delivering preterm were lower in foreign-born than US-born NHB women. The "foreign-born advantage" was not observed with ≥ 10 years of US residence. Our study highlights the need to intensify public health efforts in exploring and addressing nativity-related disparities in PTB.

Acculturation and biological stress markers: A systematic review

BACKGROUND

The association of acculturation with health among immigrant populations is believed to be mediated, in part, by acculturation-related stress and stress biology.

OBJECTIVES

To review and qualitatively synthesize empirical findings on the relationship of acculturation with stress-related inflammatory and endocrine biomarkers and composite allostatic load (AL) scores.

METHODS

A literature search was performed in the PubMed and PsycInfo databases. Article titles, abstracts or full-texts were screened and checked for match with the search criteria. Studies were eligible if they empirically tested the relationship between acculturation and inflammatory/endocrine stress biomarkers or composite AL scores, and were published in the English language.

RESULTS

Among the 41 articles identified as relevant and included in this review, the majority were published after 2010, included adult Hispanic U.S.-based populations, used cross-sectional study designs, operationalized acculturation as a unidimensional construct, and varied considerably in the selection of covariates in the analyses. Acculturation was significantly associated with stress biomarkers in 29 studies, but the direction of effects varied across studies. Specifically, acculturation, operationalized as a higher orientation towards the host culture, was associated with inflammatory biomarkers in 10 of 14 studies, with endocrine stress biomarkers in 12 of 20 studies, and with composite AL scores in 7 of 8 studies. Overall, language-based proxy measures of acculturation were related to higher levels of stress-related inflammatory and endocrine biomarkers and to lower levels of AL scores, whereas nativity-, generation status- and length of stay-based proxy measures of acculturation were related to higher levels of inflammatory biomarkers and AL score.

DISCUSSION

The majority of studies reported associations between measures of acculturation and stress biomarkers, however the directions of effects varied across studies. We suggest this heterogeneity may, in part, be a function of limitations imposed by cross-sectional research designs and unidimensional measures of acculturation measures, and we highlight the need for longitudinal studies and use of multidimensional measures of acculturation to better uncover the biobehavioral mechanisms and pathways linking acculturation with health outcomes.

Exploring Health Literacy and the Correlates of Pap Testing Among African Immigrant Women: Findings from the AfroPap Study

African immigrant (AI) women have low rates of Pap testing. Health literacy plays a pivotal role in health behaviors. Sources and types of health information could shape health literacy and inform the Pap testing behaviors of AI women. However, the influences of health literacy, sources, and types of health information along with cultural and psychosocial correlates on the Pap testing behaviors of AI women are poorly understood. To examine how sources and types of health information impact health literacy, and in turn, how health literacy and cultural and psychosocial factors influence the Pap testing behaviors of AI women. An adapted Health Literacy Skills Framework guided the selection of variables for this cross-sectional study. Convenience sampling was used to recruit 167 AI women, 21-65 years. Multivariate logistic regression was used to assess correlates of Pap testing after adjusting for covariates (age, education, English proficiency, employment, income, health insurance, access to primary care, marital status, and healthcare provider recommendation). Most participants (71%) had received a Pap test in the past and used multiple (two or more) sources (65%) and types (57%) of health information. Using multiple sources of health information (aOR 0.11, p < 0.01) but not types of health information was associated with Pap testing. Having negative cultural beliefs (aOR 0.17, p = 0.01) and having high self-efficacy (aOR 9.38, p < 0.01) were significantly associated with Pap testing after adjusting for covariates. High health literacy (OR 3.23, p < 0.05) and high decisional balance (OR 5.28, p < 0.001) were associated with Pap testing in bivariate models but did not remain significant after controlling for covariates. Cultural beliefs was a significant correlate of AI women's Pap testing behaviors regardless of other known social determinants of health (education, English proficiency, age, access to primary care). Disseminating health information through various sources has the potential to promote Pap testing among AI women. Larger studies which utilize a robust sampling strategy and include a diverse group of AI women are needed in order to optimize health interventions aimed at improving Pap test screening behaviors among AI women.

Greater Acculturation is Associated With Poorer Cardiovascular Health in the Multi-Ethnic Study of Atherosclerosis

Background Greater acculturation is associated with increased risk of cardiovascular disease. However, little is known about the association between acculturation and ideal cardiovascular health (CVH) as measured by the American Heart Association's 7 CVH metrics. We investigated the association between acculturation and ideal CVH among a multi-ethnic cohort of US adults free of clinical cardiovascular disease at baseline. Methods and Results This was a cross-sectional analysis of 6506 men and women aged 45 to 84 years of 4 races/ethnicities. We examined measures of acculturation(birthplace, language spoken at home, and years lived in the United States [foreign-born participants]) by CVH score. Scores of 0 to 8 indicate inadequate, 9 to 10 average and 11 to 14 optimal CVH. We used multivariable regression to examine associations between acculturation and CVH, adjusting for age, sex, race/ethnicity, education, income and health insurance. The mean (SD) age was 62 (10) years, 53% were women, 39% non-Hispanic White-, 26% non-Hispanic Black-, 12% Chinese- and 22% Hispanic-Americans. US-born participants had lower odds of optimal CVH (odds ratio [OR]: 0.63 [0.50-0.79], P<0.001) compared with foreign-born participants. Participants who spoke Chinese and other foreign languages at home had greater odds of optimal CVH compared with those who spoke English (1.91 [1.08-3.36], P=0.03; and 1.65 [1.04-2.63], P=0.03, respectively). Foreign-born participants who lived the longest in the United States had lower odds of optimal CVH (0.62 [0.43-0.91], P=0.02). Conclusions Greater US acculturation was associated with poorer CVH. This finding suggests that the promotion of ideal CVH should be encouraged among immigrant populations since more years lived in the United States was associated with poorer CVH.

Meaning in life and impact of COVID-19 pandemic on African immigrants in the United States

This study explored the 2020 COVID-19 pandemic impact, with its unprecedented isolation norm and social distancing requirements, on African immigrants in the United States. We focused on the sources of meaning in their daily lives, how they navigated their meaning-making process, and cultural proclivities amidst the official and unofficial mandates for social distancing. Additionally, we investigated the role technologies play in the entire process. A qualitative inquiry conducted virtually generated data from a sample of 20 participants. Results show that African immigrants derive meaning from social relationships, personal life goals, religious faith, service, and good health. The COVID-19 pandemic undoubtedly threatened participants' core meaning sources, which they rely on for life satisfaction, personal growth, and healing. Various emergent technologies helped in ameliorating the situation by providing conduits for participants to engage, albeit virtually, in most activities that positively impact their lives. This study highlights clinicians' need to integrate meaning in life discussions in their African immigrant patients' care and incorporate congruent technologies as needed.

"All I know is that there is a lot of discrimination": Older African immigrants' experiences of discrimination in the United States

Discrimination is implicated in the disproportionate burden of disease and health disparities in racial/ethnic minorities. This qualitative descriptive study explored the experiences of discrimination and its impact on the health of older African immigrants. Semi-structured interviews were conducted with 15 participants. Three main themes and six sub-themes were identified. These included: (1) types of discrimination which were: (a) accent-based, (b) unfair treatment during routine activities, (c) experience with systems; (2) consequences of discrimination; and (3) surviving and thriving with discrimination: (a) "blind eye to it", (b) reacting to it, (c) avoiding it. These themes described common experiences of discrimination, current strategies used to deal with discrimination, and the impact of discrimination on this sample. Health care providers should be aware of discrimination experiences, how to assess for it, and identify when to refer patients to appropriate community resources that include mental health, employment, cultural groups and legal services.

Cardiovascular disease risk factors in Spain: A comparison of native and immigrant populations

Cardiovascular disease (CDV) risk factors are highly prevalent among adults with low social class in Spain. However, little is known on how these factors are distributed in the immigrant population, a socio-economic disadvantaged population. Thus, this study aims to examine inequalities in CVD risk factors among immigrant and native populations. We conducted a cross-sectional study using data from the Spanish National Health Survey 2017 and used log-binomial regression to quantify the association of immigrant status on CVD risk factors among adults aged 25-64 years. The probabilities of having at least three CVD risk factors were higher for immigrants from Eastern Europe (PR: 1.25; 95% CI: 1.15-1.35) and lower for immigrants from Africa (PR: 0.79; 95% CI: 0.69-0.89) when compared with natives. The association of immigrant status and CVD risk factors varies with educational attainment (p-interaction = 0.001). Immigrants from Eastern Europe with low educational attainment have a higher probability of having at least three CVD risk factors compared with their native counterparts. In contrast, immigrants from Africa and Latin America with low educational attainment had a protective effect against having at least three CVD risk relative to natives. Health prevention and promotion strategies to reduce the burden of CVD taking should account for educational attainment given its differential effect among the immigrant population in Spain.

Discrimination Is Associated with Elevated Cardiovascular Disease Risk among African Immigrants in the African Immigrant Health Study

Background

African Americans and other persons of African descent in the United States are disproportionately affected by cardiovascular diseases (CVD). Discrimination is associated with higher CVD risk among US adults; however, this relationship is unknown among African immigrants.

Methods

The African Immigrant Health Study was a cross-sectional study of African immigrants in Baltimore-Washington, DC, with recruitment and data collection taking place between June 2017 and April 2019. The main outcome was elevated CVD risk, the presence of ≥3 CVD risk factors including hypertension, diabetes, high cholesterol, overweight/obesity, tobacco use, and poor diet. The secondary outcomes were these six individual CVD risk factors. The exposure was discrimination measured with the Everyday Discrimination Scale; summed scores ≥2 on each item indicated frequent experiences of discrimination. Resilience was assessed with the 10-item Connor-Davidson resilience scale. Logistic regression was used to examine the odds of elevated CVD risk, adjusting for relevant covariates.

Results

We included 342 participants; 61% were females. The mean (±SD) age was 47(±11) years, 61% had at least a bachelor's degree, 18% had an income <$40,000, and 49% had lived in the US ≥15 years. Persons with frequent experiences of discrimination were 1.82 times (95%CI: 1.04-3.21) more likely to have elevated CVD risk than those with fewer experiences. Resilience did not moderate the relationship between CVD risk and discrimination.

Conclusion

African immigrants with frequent experiences of discrimination were more likely to have elevated CVD risk. Targeted and culturally appropriate interventions are needed to reduce the high burden of CVD risk in this population. Health care providers should be aware of discrimination as a meaningful social determinant of CVD risk. At the societal level, policies and laws are needed to reduce the occurrence of discrimination among African immigrants and racial/ethnic minorities.

Stress Measured by Allostatic Load Varies by Reason for Immigration, Age at Immigration, and Number of Children: The Africans in America Study

Stress leads to physiologic dysfunction and cardiometabolic disease. Allostatic load score (ALS) measures stress-induced cardiovascular, metabolic, and inflammatory biomarkers. We estimated the odds of high ALS by reason for and age at immigration, duration of American residence, number of children, and socioeconomic status in 193 African immigrants (male: 65%, age 41 ± 10 y (mean ± Standard Deviation (SD)), range 22–65 y). ALS was calculated with High-ALS defined as ALS ≥ 3.0 and Low-ALS defined as ALS < 3.0. Oral glucose tolerance tests (OGTT) were performed, the cardiovascular disease (CVD) risk estimated, and TNF-α, an inflammatory cytokine, measured. Logistic regression was used to estimate odds of High-ALS. In the High- and Low-ALS groups, ALS were 4.0 ± 1.2 vs. 1.3 ± 0.7, diabetes prevalence: 14% vs. 4%, CVD risk: 23% vs. 8%, TNF-α levels: 15 ± 9 vs. 11 ± 6 pg/mL, respectively (all p ≤ 0.01). Immigrants were more likely to be in the High-ALS group if their reason for immigration was work or asylum/refugee (OR 2.18, p = 0.013), their age at immigration was ≥30 y (OR 3.28, p < 0.001), their duration of residence in United States was ≥10 y (OR 3.16, p = 0.001), or their number of children was ≥3 (OR 2.67, p = 0.019). Education, income, health insurance, marital status, and gender did not affect High-ALS odds. Factors adversely influencing allostatic load and cardiometabolic health in African immigrants were age at and reason for immigration, duration of residence in America, and number of children.

The relationship of acculturation to cardiovascular disease risk factors among U.S. South Asians: Findings from the MASALA study

AIM

We investigated the association between acculturation strategies and cardiometabolic risk among South Asian (SA) immigrants in the US.

METHODS

In this cross-sectional analysis of data from 849 SA participants in the Mediators of Atherosclerosis in SAs Living in America (MASALA), we performed multidimensional measures of acculturation to categorize the participants into three acculturation classes: separation (preference for SA culture), assimilation (preference for US culture), and integration (similar preference for both cultures). Differences in glycemic indices, blood pressure, lipid parameters and body composition by acculturation strategy were examined.

RESULTS

Women in the integration class had the lowest prevalence of diabetes (16.4%), prediabetes (29.7%), fasting and 2-h glucose compared to women in the separation class with the highest prevalence of diabetes (29.3%), prediabetes (31.5%), fasting and 2-h glucose and 2-hr insulin (all p < 0.05). Women in the assimilation class had significantly lower triglycerides, BMI, and waist circumference and higher HDL compared to women in the separation class after adjusting for age, study site, and years in the US. After additionally accounting for socioeconomic/lifestyle factors, women in the assimilation class had significantly lower triglyceride and higher HDL levels compared to women in the separation class (p < 0.01). There was no significant association between acculturation strategies and cardiometabolic risk in SA men.

CONCLUSION

SA women who employed an assimilation or integration strategy had a more favorable cardiometabolic profile compared to women using a separation strategy. Future research should investigate the behavioral and psychosocial pathways linking acculturation strategies with cardiometabolic health to inform preventive interventions among SAs living in America.

The effectiveness of living well multicultural-lifestyle management program among ethnic populations in Queensland, Australia

ISSUE

Some migrant groups have higher risks of deaths and chronic diseases due to barriers associated with socioeconomic disadvantage, social isolation, racism, language, poor access to health services and low levels of health literacy. However, few culturally tailored interventions have targeted ethnic groups in Australia. This study evaluated the effectiveness of the Living Well Multicultural-Lifestyle Management Program (LWM-LMP) in Queensland, Australia.

METHODS

The LWM-LMP was originally co-designed with the targeted communities. Participants aged ≥18 years were eligible to participate without a fee. The evaluation was a quasi-experimental design without a control group, with data collected at baseline, the end of the programme and after-programme follow-up at week 14. The programme lasted 8 weeks with one group-based session of 120 minutes delivered each week in local community venues. Each session also included time to undertake physical activity (PA). Eating and PA behaviours were self-reported. Weight, height, waist circumference and blood pressure were measured using standard protocols.

RESULTS

Participants were more likely to consume ≥2 servings of fruit/day, five servings of vegetable/day, low-fat milk, processed meat, fast food, hot chips/fries, salty snacks, sweet snacks, sweet beverages less than once per week and meet the PA recommendation of ≥150 minutes/wk (P < .001) at week 8. Weight, BMI, waist circumference, waist-to-height ratio and blood pressure were also improved at week 8. Many of the changes were sustained at week 14.

CONCLUSIONS

The LWM-LMP was effective in improving participants' lifestyle behaviours and cardiometabolic indicators.

SO WHAT

Engaging targeted communities in designing interventions focussed on healthy personal behaviours helps with delivery and implementation. Behavioural interventions should be culturally tailored to increase their effectiveness.

Social networks and obesity among Somali immigrants and refugees

BACKGROUND

Somali immigrants and refugees to the United States are at high risk for obesity and related cardiovascular risk. Social network factors influence health behaviors and are important contributors to the obesity epidemic. The objective of this study was to describe social networks and obesity-related characteristics among adult Somali immigrants in a Minnesota city in order to inform a community-based, participatory, research-derived, social network intervention to decrease obesity rates.

METHODS

Survey data (demographics, general health measures, and sociobehavioral and network measures) and height and weight measures (for calculating body mass index) were collected from adult Somali immigrants by bilingual study team members at community locations. Descriptive statistics were used to report the survey and biometric data. Logistic regression models were used to describe the basic associations of participants and network factors. Network data were analyzed to identify nodes and ties, to visualize the network, and to identify potential interventionists for a future social network intervention.

RESULTS

Of the 646 participants, 50% were overweight or affected by obesity. The network had 1703 nodes with 3583 ties between nodes, and modularity was high (0.75). Compared with respondents of normal weight, participants who were overweight or affected by obesity had more network members who were also overweight or obese (odds ratio [OR], 2.90; 95% CI, 1.11-7.56; P = .03); this was most notable for men (OR, 4.58; 95% CI, 1.22-17.22; P = .02) and suggestive for those 50 years or older (OR, 24.23; 95% CI, 1.55-377.83; P = .03). Weight loss intention among participants who were overweight or affected by obesity was associated with number of family members and friends trying to lose weight, enabling functional network factors (social norms for weight loss, social support for healthy eating, and social cohesion), and less favorable obesogenic social norms.

CONCLUSIONS

In this community sample of Somali immigrants, distinct social networks are clustered by weight status, and social contacts and functional network characteristics are related to individuals' weight loss intentions. These factors should be considered in weight loss interventions and programs. A social network intervention targeting weight loss, within a community-based participatory research framework, is feasible in this vulnerable population.

Mediating Role of Acculturation and Lifestyle Behaviors on Cardiometabolic Risk Among a National Sample of U.S. Asian Indians

Asian Indians are the third largest and fastest growing Asian subgroup in the U.S. and have high risks for diabetes and cardiovascular disease. This study explored the mediating role of lifestyle behaviors on the relationship between acculturation and cardiometabolic risk factors among Asian Indians using the Diabetes in Indian Americans national study. The cross-sectional study sample comprised 1038 randomly selected adult Asian Indians in seven U.S. sites. Acculturation was assessed using the Acculturation Scale for Southeast Asians. Diet and lifestyle behaviors were measured using the Health-Promoting Lifestyle Profile II subscales. Path analyses with bootstrap methods were conducted. Dietary behavior significantly mediated the relationship between acculturation and HbA1C (β = 0.004, p = 0.047), and physical activity mediated the relationship between acculturation and HDL (β = 0.08, p = 0.011). Other mediation models were not significant (p > 0.05). Mediating factors besides lifestyle behaviors should be explored in future studies.

Length of Residence and Cardiovascular Health among Afro-Caribbean Immigrants in New York City

Cardiovascular disease (CVD) disproportionately affects non-Hispanic blacks (NHB) in the United States (U.S.). Afro-Caribbean (AC) immigrants comprise over 50% of the immigrant black population and are critical in understanding the health trajectories of blacks in the U.S. We assessed the relationship between length of residence (proxy measure for acculturation) and cardiovascular health (CVH) based on the American Heart Association's (AHA) seven ideal cardiovascular health components among AC immigrants in New York City (NYC). CVH scores were categorized into poor/intermediate CVH (0-3 components) or ideal CVH (≥ 4 components). Multivariable logistic regression was used to examine the association between length of residence in the U.S. and poor/intermediate CVH. In adjusted models, the odds of poor/intermediate CVH were significantly higher for Guyanese (OR = 3.51; 95% CI 1.03-11.95) and Haitian immigrants (OR = 8.02; 95% CI 1.88-34.12) residing in the U.S. for ≥ 10 years than for those living in the U.S. for < 10 years. Length of residence was not significantly associated with CVH among Jamaican immigrants. We found evidence of ethnic differences in the association between acculturation and CVH among AC immigrants in a major metropolitan city. Culturally tailored interventions are needed to improve the CVH of AC immigrants as they become integrated into the U.S., with special consideration of country of birth.

Co-morbid Non-communicable Diseases and Associated Health Service Use in African and Caribbean Immigrants with HIV

We sought to characterize non-communicable disease (NCD)-related and overall health service use among African and Caribbean immigrants living with HIV between April 1, 2010 and March 31, 2013. We conducted two population-based analyses using Ontario's linked administrative health databases. We studied 1525 persons with HIV originally from Africa and the Caribbean. Compared with non-immigrants with HIV (n = 11,931), African and Caribbean immigrants had lower rates of hospital admissions, emergency department visits and non-HIV specific ambulatory care visits, and higher rates of health service use for hypertension and diabetes. Compared with HIV-negative individuals from these regions (n = 228,925), African and Caribbean immigrants with HIV had higher rates of health service use for chronic obstructive pulmonary disease [rate ratio (RR) 1.78; 95% confidence interval (CI) 1.36-2.34] and malignancy (RR 1.20; 95% CI 1.19-1.43), and greater frequency of hospitalizations for mental health illness (RR 3.33; 95% CI 2.44-4.56), diabetes (RR 1.37; 95% CI 1.09-1.71) and hypertension (RR 1.85; 95% CI 1.46-2.34). African and Caribbean immigrants with HIV have higher rates of health service use for certain NCDs than non-immigrants with HIV. The evaluation of health services for African and Caribbean immigrants with HIV should include indicators of NCD care that disproportionately affect this population.

Increased cardiovascular disease risk in international migrants is independent of residence duration or cultural orientation: the HELIUS study

BACKGROUND

International migrants differ from host populations in cardiovascular disease (CVD) risk. It has been postulated that these disparities narrow with longer residence duration. Our aim was to determine whether CVD risk still differs between migrants and host population after decades of residence and to determine whether this potential convergence of CVD risk would occur mainly among migrants with a strong cultural orientation towards the host culture.

METHODS

In the Healthy Life in an Urban Setting study, we obtained data regarding residence duration, cultural orientation as estimated by the Psychological Acculturation Scale and CVD risk as estimated by SCORE among the Dutch host population and first generation migrants from South-Asian Surinamese, African Surinamese, Moroccan and Turkish ethnic background residing in Amsterdam. Estimated CVD risk was compared with the Dutch, separately for medium-term residence (15-30 years) or long-term residence (>30 years) migrants, and by strong/weak cultural orientation towards the Dutch culture, using age-adjusted regression analyses.

RESULTS

Among 8672 participants without prior CVD, estimated CVD risk was higher among migrant groups relative to the Dutch. CVD risk relative to the Dutch did not differ by residence duration (betas ranging from 0.1 to 3.4 for medium-term and from 0.6 to 3.3 for long-term residence, respectively). Furthermore, these patterns did not differ by cultural orientation towards the Dutch culture.

CONCLUSION

We find no indication that CVD risk among South-Asian Surinamese, African Surinamese, Turkish or Moroccan migrants converges to that of the Dutch host population with increasing residence duration, not even among those with strong cultural orientation towards the host culture.