The “Americanisation” of migrants: Evidence for the contribution of ethnicity, social deprivation, lifestyle and life-course processes to the mid-20th century Coronary Heart Disease epidemic in the US

Epidemiological transition: a historical analysis of immigration patterns by country of origin (1861-1986) related to circulatory system diseases and all-cause mortality in twentieth-century Australia

BACKGROUND AND OBJECTIVES

Circulatory system disease (CSD) patterns vary over time and between countries, related to lifestyle risk factors, associated in turn with socioeconomic circumstances. Current global CSD epidemics in developing economies are similar in scale to those observed previously in the USA and Australasia. Australia exhibits an important macroeconomic phenomenon as a rapidly transitioning economy with high immigration throughout the nineteenth and twentieth centuries. We wished to examine how that historical immigration related to CSD patterns subsequently.

METHODS AND SETTING

We provide a novel empirical analysis employing census-derived place of birth by age bracket and sex from 1891 to 1986, in order to map patterns of immigration against CSD mortality rates from 1907 onwards. Age-specific generalised additive models for both CSD mortality in the general population, and all-cause mortality for the foreign-born (FB) only, from 1910 to 1980 were also devised for both males and females.

RESULTS

The percentage of FB fell from 32% in 1891 to 9.8% in 1947. Rates of CSD rose consistently, particularly from the 1940s onwards, peaked in the 1960s, then declined sharply in the 1980s and showed a strong period effect across age groups and genders. The main effects of age and census year and their interaction were highly statistically significant for CSD mortality for males (p<0.001, each term) and for females (p<0.001, each term). The main effect of age and year were statistically significant for all-cause mortality minus net migration rates for the FB females (each p<0.001), and for FB males, age (p<0.001) was significant.

CONCLUSIONS

We argue our empirical calculations, supported by historical and socioepidemiological evidence, employing immigration patterns as a proxy for epidemiological transition, affirm the life course hypothesis that both early life circumstances and later life lifestyle drive CSD patterns.

Parental population exposure to historical socioeconomic and political periods and grand-child's birth weight in the Lifeways Cross-Generation Cohort Study in the Republic of Ireland

Exposure to deprived socioeconomic conditions during the peri-conception and early childhood periods can have a negative long-term impact on individuals' health and that of their progeny. We aimed to examine whether relatives' birth period affected index-child (grand-child) birthweight status in the Lifeways Cross-Generation Cohort in the Republic of Ireland. Participants were 943 mothers and offspring, 890 fathers, 938 maternal grandmothers (MGM), 700 maternal grandfathers (MGF) 537 paternal grandmothers (PGM) and 553 paternal grandfathers (PGF). Index-child's birthweight was sex-for-gestational age standardised (UK1990 population), and then classified into low birthweight (≤10th percentile) and high-birthweight (≥90th percentile) and compared against normal-birthweight (>10th to <90th percentiles). Four adult birth periods were considered: The Free State (FS, 1916-1938); Emergency Act (EA, 1939-1946); Post-World War-II Baby-Boom (PWWII-BB, 1947-1964); and Modern Ireland (MI, 1964 onwards). Logistic regression was used to assess the crude and adjusted relationship between index-child's birthweight status and relatives' birth periods. Overall, there were 8.7% (n=82) index-children in the low-birthweight category, 77.9% (n=735) and 13.4% (n=126) within the normal and high birthweight groups respectively. Index-children whose mothers were born during the PWWII-BB had higher birthweight infants (Crude OR(COR)=1.81 (1.08-3.03) which remained the case only for male index-children when adjusted for co-variables (Adjusted OR(AOR)=4.61(1.71-12.42)). Parents' combined PWWII-BB birth period was positively associated with male index-child higher birthweight, even adjusted for maternal characteristics (AOR=4.60(1.69-12.50)). MGFs born during the EA were more likely to have grandchildren with low birthweight after adjustment for maternal characteristics (AOR=2.45(1.03-5.85)), particularly for female index-children (AOR=4.74(1.16-19.25)). Both PGMs and PGFs born during the FS period had higher birthweight grandchildren, adjusted for maternal-related co-variables (PGM, AOR=3.23(1.21-8.63); PGF, AOR=3.93(1.11-13.96)), with the effect of PGM more evident in her granddaughter (AOR=6.53(1.25-34.04)). In conclusion, there is some evidence that period of grandparental birth is associated with their grandchildren's birthweights, suggesting that transgenerational exposures may be particular to historical context, meriting further exploration.

Comparison of general health status, myocardial infarction, obesity, diabetes, and fruit and vegetable intake between immigrant Pakistani population in the Netherlands and the local Amsterdam population

OBJECTIVE

South Asians living in Western countries have shown higher prevalence of cardiovascular disease and related non-communicable diseases as compared to the local populations. The aim of this study was to compare the general health status and prevalence of myocardial infarction (MI), diabetes, high blood pressure, overweight, obesity, and fruit and vegetable intake between Pakistani immigrants in the Netherlands and local Amsterdam population.

DESIGN

A health survey was conducted in 2012-2013 among Pakistanis in the Netherlands. Results were compared with a health survey conducted among inhabitants of Amsterdam in 2012. One hundred and fifty-four Pakistanis from four big cities of the Netherlands and 7218 inhabitants of Amsterdam participated. The data for Amsterdam population were weighed on the basis of age, gender, city district, marital status, ethnicity and income level while the data for Pakistanis were weighed on the basis of age and gender to make both data-sets representative of their general population.

RESULTS

Pakistanis reported a high prevalence of MI (3.3%), diabetes (11.4%), high blood pressure (14.4%), overweight (35.5%) and obesity (18.5%) while Amsterdam population reported the prevalence as 2.5% for MI, 6.8% for diabetes, 15.3% for high blood pressure, 28.1% for overweight and 11.1% for obesity. Pakistanis had a significantly higher level of MI (OR = 2.71; 95% CI: 1.19-6.14), diabetes (OR = 4.41; 95% CI: 2.66-7.33) and obesity (OR = 2.51; 95% CI: 1.53-4.12) after controlling for age, sex and educational level with Amsterdam population as the reference group. Pakistanis showed a higher intake of fruit and fruit juice as compared to Amsterdam population though the latter showed a higher intake of cooked vegetables.

CONCLUSION

Higher prevalence of MI, diabetes and obesity among Pakistanis than Amsterdam population indicates the need for health scientists and policy-makers to develop interventions for tackling non-communicable diseases and its determinants among Pakistanis living in the Netherlands.

Exposure and exclusion: disenfranchised biological citizenship among the first-generation Korean Americans

Based on fieldwork with a highly uninsured and underinsured Korean American population, this article maps how the current healthcare system in the United States disenfranchises those of marginal insurance status. The vulnerability of these disenfranchised biological citizens is multiplied through exposure to disproportional health risks compounded by exclusion from essential healthcare. The first-generation Korean Americans, who commonly work in small businesses, face the double burden of increased health risks from long, stress-laden work hours and lack of access to healthcare due to the prohibitive costs of health insurance for small business owners. Even as their health needs become critical, their insurance status and costly medical bills discourage them from visiting healthcare institutions, leaving Korean Americans outside the "political economy of hope" (Good, Cult Med Psychiatry 52:61-69, 2001). Through an ethnographic examination of the daily practice of doing-without-health among a marginalized sub-group in American society, this paper articulates how disenfranchised biological citizenship goes beyond creating institutional barriers to healthcare to shaping subjectivities of the disenfranchised.

Geographic and racial variation in premature mortality in the U.S.: analyzing the disparities

Life expectancy at birth, estimated from United States period life tables, has been shown to vary systematically and widely by region and race. We use the same tables to estimate the probability of survival from birth to age 70 (S(70)), a measure of mortality more sensitive to disparities and more reliably calculated for small populations, to describe the variation and identify its sources in greater detail to assess the patterns of this variation. Examination of the unadjusted probability of S(70) for each US county with a sufficient population of whites and blacks reveals large geographic differences for each race-sex group. For example, white males born in the ten percent healthiest counties have a 77 percent probability of survival to age 70, but only a 61 percent chance if born in the ten percent least healthy counties. Similar geographical disparities face white women and blacks of each sex. Moreover, within each county, large differences in S(70) prevail between blacks and whites, on average 17 percentage points for men and 12 percentage points for women. In linear regressions for each race-sex group, nearly all of the geographic variation is accounted for by a common set of 22 socio-economic and environmental variables, selected for previously suspected impact on mortality; R(2) ranges from 0.86 for white males to 0.72 for black females. Analysis of black-white survival chances within each county reveals that the same variables account for most of the race gap in S(70) as well. When actual white male values for each explanatory variable are substituted for black in the black male prediction equation to assess the role explanatory variables play in the black-white survival difference, residual black-white differences at the county level shrink markedly to a mean of -2.4% (+/-2.4); for women the mean difference is -3.7% (+/-2.3).

Intention to change dietary habits, and weight loss among Norwegian-Pakistani women participating in a culturally adapted intervention

The aim was to explore the relationships between degree of participation in a culturally adapted lifestyle intervention and stages of change for healthy eating and weight loss among Pakistani immigrant women in Norway. The intervention lasted 7 months and included 198 women, randomized into control and intervention groups. The odds of losing weight from baseline to follow-up, and being in action stages of change (compared to pre-action stages) with regard to intake of amount and type of fat, sugar and white flour at follow-up, increased significantly with number of group sessions attended. Those in action stage of reducing intake of fat and increasing intake of vegetables, as well as of reducing weight, were significantly more likely than others to have experienced weight loss at follow-up. Participation in the culturally adapted intervention was related to increase in intentions to change dietary behaviours and to weight loss.

Hmong food helps us remember who we are: perspectives of food culture and health among Hmong women with young children

OBJECTIVE

To examine perspectives on food habits, acculturation, and health among Hmong women with young children in northern California.

METHODS

Qualitative interviews were conducted with 15 Hmong mothers with young children in a low-income community of northern California. The interviews were transcribed and coded based on the principles of grounded theory.

RESULTS

The main themes that emerged from the interviews included comparisons between American and Hmong food cultures, food culture preservation, obesity issues, diverse acculturation processes, and intergenerational food habits. Hmong food culture has been identified as the representation of their healthful lifestyle, self-identity, and social support. At the same time, mothers are facing enormous challenges in bridging 2 extreme generations; the less acculturated, immigrant adults and the highly acculturated, US-born children in their households.

CONCLUSIONS AND IMPLICATIONS

Addressing the healthful aspects of Hmong food culture and healthful options of American food should be a focus of nutrition-related programs.

Chinese American family food systems: impact of Western influences

OBJECTIVE

To investigate the family food system in first-generation Chinese American families.

DESIGN

Qualitative interviews using reciprocal determinism constructs to understand influences on food choices.

SETTING

Weekend Chinese schools in Pennsylvania.

PARTICIPANTS

Twenty couples with at least 1 child aged 5 or older enrolled in a Chinese school in 1 of 3 sites in Pennsylvania.

PHENOMENON OF INTEREST

Factors influencing adoption of Western food.

ANALYSIS

Thematic analysis with constant comparison of interview transcripts and descriptive statistics of demographic data. Families were divided into "modified" and "traditional" patterns based on degree of parental retention of the Chinese dinner pattern.

RESULTS

Many Chinese American families consumed convenient American food at breakfast, whereas they ate mainly Chinese food for lunch and dinner. Most parents reported their children were picky eaters and learned to prefer Western food to traditional Chinese food in institutional settings. Conflicts arose with children's requests for Western food disliked by their parents. Parents were especially frustrated about their children's refusal to eat vegetables. Most struggled to control children's food choices with inconsistent rules and inequitable rule enforcement at dinner. The father's view of the importance of the Chinese dinner pattern had the most impact on its retention in the face of children's demands.

CONCLUSIONS AND IMPLICATIONS

Chinese American parents established rules backed by parental power to maintain a Chinese meal pattern. They appear to need guidance to identify healthful Western food items that satisfy children's preferences while preserving their vegetable intake.

Overweight and weight dissatisfaction related to socio-economic position, integration and dietary indicators among south Asian immigrants in Oslo

OBJECTIVE

To investigate how socio-economic position, demographic factors, degree of integration and dietary indicators are related to BMI/waist:hip ratio (WHR) and to weight dissatisfaction and slimming among South Asians in Oslo, Norway.

DESIGN

Cross-sectional study consisting of a health check including anthropometric measures and two self-administered questionnaires.

SETTING

Oslo, Norway.

SUBJECTS

Pakistanis and Sri Lankans (n 629), aged 30-60 years, residing in Oslo.

RESULTS

BMI was positively associated with female gender (P = 0.004) and Pakistani origin (P < 0.001), and inversely associated with years of education (P = 0.011) and eating more hot meals (P = 0.016). WHR was positively associated with male gender (P < 0.001), age (P < 0.001) and a dietary pattern with high-fat foods (P = 0.005), and inversely associated with degree of integration (measured by a composite index, independent of duration of residence; P = 0.017). One-third of those with normal weight and most of those obese were dissatisfied with their weight. Among these, about 40 % had attempted to slim during the past year. Dissatisfaction with weight was positively associated with education in women (P = 0.006) and with integration in men (P = 0.026), and inversely associated with physical activity (P = 0.044) in men. Women who had made slimming attempts had breakfast and other meals less frequently than others (P < 0.05).

CONCLUSIONS

Weight dissatisfaction exists among South Asian immigrants. More research is needed regarding bodily dissatisfaction and the relationship between perception of weight and weight-change attempts among immigrants in Norway, in order to prevent and treat both obesity and eating disorders.

The effect of age at migration on cardiovascular mortality among elderly Mexican immigrants

PURPOSE

In this study, we evaluated the influence of age at migration on cardiovascular mortality among older Mexican Americans immigrants.

METHODS

A population-based cohort of Mexican-origin (N = 907) participants ages 60+ was followed up to 8 years. The association between migration before age 20 compared with after age 20 and mortality was analyzed with the use of multivariate Cox proportional models.

RESULTS

Compared with those who migrated later, those who migrated before the age of 20 years had higher income and education, were more likely to speak English, were culturally more Anglo, and more likely to be men. Immigration before 20 years of age was associated with greater rates of cardiovascular mortality (hazard ratio, 2.39; 95% confidence interval, 1.16 - 4.94) compared with those migrating at older ages, even after adjustment for age, sex, education, income, and baseline cardiovascular health. No age at migration differences were observed for noncardiovascular deaths.

CONCLUSIONS

Mexican Americans who migrated in early life experienced greater cardiovascular disease death rates than later migrants. Early experiences related to migration may have consequences for late-life disease that are not mitigated by the higher socioeconomic status achieved by early migrants. Health or economic selection related to migration may play a role although accounting for health and socioeconomic status actually increased differences between early and later migrants.

Changes in food habits after migration among South Asians settled in Oslo: the effect of demographic, socio-economic and integration factors

The aim is to explore changes in food habits after migration, and the resultant present food consumption patterns, as well as the effect of demographic, socio-economic and integration factors on these changes. Analyses were based on data collected through the Oslo Immigrant Health study, from 629 persons 30-60 years of age, born in Sri Lanka and Pakistan, and living in Oslo, Norway. A majority of the Sri Lankans reported increase in the consumption of meat, milk, butter, margarine and potatoes. Around half of those from Pakistan reported increased consumption of oil, meat, fish and potatoes. Both groups reported a decrease in bean and lentil consumption. Multivariate regression showed that age was negatively related to increases in butter and margarine consumption, and a good command of the Norwegian language reduced the likelihood of increased consumption of oil and butter. The likelihood of having present fat and sugar rich food patterns were reduced with age and years of education, whereas scoring high on an index of integration increased the likelihood of a fat rich food pattern. In conclusion, a number of demographic and socio-cultural factors may modify the changes in food habits after migration. Some of these may have substantial health implications.

Secular trends in cardiovascular risk factors: an age-period cohort analysis of 698,954 health examinations in 181,350 Austrian men and women

OBJECTIVES

It is well established that morbidity and mortality patterns in cardiovascular diseases vary strongly over time, yet the determinants of such trends remain poorly understood. To assess the potential contribution of secular or cross-generation patterns, we evaluated birth cohort-related trends across the 20th century of risk factors in a large database of Austrian men and women.

SUBJECTS AND SETTING

Trends in risk factors were investigated for 181,350 adults aged 20-79 years born between 1905 and 1975 undergoing 698,954 health examinations between 1985 and 2005 as participants of the Vorarlberg Health Monitoring and Promotion Programme.

RESULTS

There was clear evidence of cohort-related shifts in all risk factors. Total serum cholesterol and triglyceride declined markedly, particularly in the youngest cohorts, as did systolic and diastolic blood pressure in both men and women. By contrast, fasting glucose showed a strong rising tendency in both sexes and at all ages, most markedly in young males. Average glucose levels were between 4 and 15 mg dL(-1) higher in individuals at the same age born 20 years later. In males, body weight expressed in kg m(-2) (body mass index) was increasing as well; however, in women, patterns were most marked at the 90th percentile.

CONCLUSION

These findings provide strong evidence of population wide secular shifts and suggest that in addition to period influences, most probably through treatment intervention and lifestyle change, determinants across the life-course are programming shifts from childhood onwards.