Pathways between acculturation and health behaviors among residents of low-income housing: the mediating role of social and contextual factors

Perceptions of brain health and aging among middle-aged latinos: A qualitative paper

OBJECTIVES

Latinos living in the US are disproportionately impacted by Alzheimer's disease and related dementias (ADRD). To develop culturally-informed interventions, a first step is engaging with key stakeholders. The present study aimed to explore perspectives on brain health and aging among middle-aged Latinos living in Chicago, IL.

METHODS

Individual, semi-structured interviews were conducted with 30 English- or Spanish-speaking Latinos between 35 to 64 years old. Questions from a previously used interview guide were leveraged and addressed knowledge about the brain, perceptions of healthy and unhealthy aging, ideas of how to care for the brain, where knowledge was acquired, and suggestions for disseminating brain health education. Responses were analyzed using thematic analysis.

RESULTS

The following themes were identified: (1) Understanding of the brain is varied (including cognitive, behavioral, anatomical, and psychological descriptions); (2) Perceptions surrounding healthy aging are broad and demonstrate a depth of understanding (e.g., physical and cognitive abilities, independence, positive emotions, and sociability), yet understanding of signs of an unhealthy brain is somewhat limited (e.g., focus on memory); (3) Brain health promotion is largely viewed as actionable (spanning physical health, cognitively stimulating activities, emotional wellbeing, medical self-management, and social connectedness); (4) Suggestions for disseminating education included media, clinics, churches, libraries, and community centers, with consideration of possible barriers and facilitators to behavior change (e.g., finances, prioritizing family).

CONCLUSIONS

Results showed significant heterogeneity in understanding of the brain, albeit with promising attitudes that actions can be taken to protect one's brain from ADRD.

PRACTICE IMPLICATIONS

Takeaways include the need for increasing education on normative versus nonnormative memory loss and signs of ADRD beyond memory impairment. Messaging may benefit from utilizing analogies, considering familism and spirituality, and highlighting lifestyle changes that do not carry a financial burden or place blame on individuals.

Time in the U.S. and colorectal cancer screening adherence among diverse immigrants

BACKGROUND

Colorectal cancer screening rates are lower among immigrants compared to U.S.-born individuals. This study examined the association between time spent in the U.S. and CRC screening adherence in a diverse sample of immigrants, while considering the role of sociodemographic factors.

METHODS

Data from the 2010, 2013, 2015, and 2018 NHIS were analyzed. The sample included 6298 immigrants aged 50-75. Multivariable logistic regression was used to assess the association between time in the U.S. (<15 years vs. ≥15 years) and CRC screening adherence, adjusting for sociodemographic factors.

RESULTS

Overall, 47.6 % of immigrants adhered to CRC screening guidelines. Immigrants residing in the U.S. for 15 years or more had significantly higher odds of screening adherence (AOR = 1.63; 95 % CI, 1.29-2.05) compared to those with less than 15 years of residence in the U.S. This association varied by race/ethnicity, with the greatest impact seen among Asian immigrants. Socioeconomic factors, particularly education and having a usual source of care, were also significantly associated with screening adherence.

CONCLUSIONS

Time in the U.S. is a significant predictor of CRC screening adherence among immigrants, with those residing 15 years or more showing higher adherence across racial and ethnic groups. Socioeconomic factors, including education, income, health insurance, and having a usual place of care, are strongly associated with screening adherence across all immigrant groups. These findings underscore the need for tailored interventions to enhance screening rates, particularly among recent immigrants and those with limited socioeconomic resources.

Sociocultural determinants of children's oral health among immigrants in Canada

OBJECTIVE

A conceptual model was designed and tested to predict immigrant children's oral health in Canada by examining parental acculturation and perceived social support (PSS) using structural equation modelling.

METHODS

A convenience sample of first-generation immigrant parents and their children aged 2-12 years were recruited by multilingual community workers in Edmonton, Canada. Parents completed a validated questionnaire on demographics, child's oral health (OH) behaviours, parental acculturation and PSS. Dental examinations determined children's dental caries rate using DMFT/dmft index. Structural equation modelling (SEM) was used to analyse the data.

RESULTS

A total of 336 families participated in this study. The average parental acculturation level was 10.46 with a maximum of 15, and the average PSS was 63.27 with a maximum of 75. SEM showed that 77% of the variance of DMFT/dmft scores in children was explained by parental PSS, acculturation level, immigration-related variables, socioeconomic variables and children's OH behaviours. The direct effect of parental PSS was associated with a significantly reduced rate of dental caries (β = -.076, p-value = .008) and lower sugar consumption (β = -.17, p-value = .04). While the mediation effect of parental acculturation on PSS was associated with positive OH behaviours of children (e.g., toothbrushing frequency and dental care utilization), the indirect effect was negatively associated with caries rate (β = .77, p-value = .00).

CONCLUSIONS

The direct effect of Parental Perceived Stress Scale (PSS) was associated with more favourable oral health behaviours and a lower prevalence of dental caries, while the mediation effect of acculturation was linked to a higher prevalence of dental caries.

Sociodemographic and Mental Health Factors Associated with Obesity in Resettled Refugees in Syracuse, New York

Introduction

Resettled refugees have been exposed to stressful and life-threatening events preresettlement and are among the most marginalized and vulnerable groups in society. Postresettlement, they face challenges when assimilating to an unfamiliar host country, which renders them vulnerable to adverse health outcomes including obesity, a major public health burden. This study was conducted to examine the association of mental health and sociodemographic factors, including language proficiency and educational attainment, with obesity in first-generation resettled refugees.

Methods

We used data from electronic health records from the Adult Ambulatory Medicine Clinic of the State University of New York Upstate, Syracuse, NY. The probability of being overweight and obese (class I and class II) relative to normal weight was estimated using fully adjusted multinomial logistic regression models with relative risk ratios (RRRs).

Findings

Relative to male refugees, female refugees were more likely to have class I obesity (RRR=1.83; 95% confidence interval [CI]=1.19, 2.80) and class II obesity (RRR=4.07; 95% CI=2.41, 6.87). Limited English proficiency increased the risk of being overweight (RRR=2.02; 95% CI=1.29, 3.17) and having class II obesity (RRR=2.14, 95% CI=1.20, 3.81). A clinical mental health diagnosis increased the risk of class I (RRR=2.00; 95% CI=1.35, 2.96) and class II (RRR=1.76; 95% CI=1.15, 2.71) obesity. Having no formal education was associated with decreased risk of class II obesity (RRR=0.42; 95% CI=0.19, 0.90).

Discussion

Obesity prevalence and subsequent related morbidity continue to be major public health burdens in vulnerable, often underserved populations in the United States. Further investigation into social determinants of obesity in refugees in a community setting that captures the unique experiences of heterogenous refugee groups outside the clinical setting is warranted.

Predictors of Toxic Metal/Metalloid Exposures Among Mexican Americans in Starr County, Texas

BACKGROUND

Arsenic, cadmium, and lead are toxic elements that widely contaminate our environment. These toxicants are associated with acute and chronic health problems, and evidence suggests that minority communities, including Hispanic/Latino Americans, are disproportionately exposed. Few studies have assessed culturally specific predictors of exposure to understand the potential drivers of racial/ethnic exposure disparities.

OBJECTIVE

We sought to evaluate acculturation measures as predictors of metal/metalloid (hereafter "metal") concentrations among Mexican American adults to illuminate potential exposure sources that may be targeted for interventions.

METHODS

As part of a longitudinal cohort, 510 adults, aged 35 to 69 years, underwent baseline interview, physical examination, and urine sample collection. Self-reported acculturation was assessed across various domains using the Short Acculturation Scale for Hispanics (SASH). Multivariable linear regression was used to assess associations between acculturation and urinary concentrations of arsenic, cadmium, and lead. Ordinal logistic regression was utilized to assess associations between acculturation and a metal mixture score. Lastly, best subset selection was used to build a prediction model for each toxic metal with a combination of the acculturation predictors.

RESULTS

After adjustment, immigration factors were positively associated with arsenic and lead concentrations. For lead alone, English language and American media and food preferences were associated with lower levels. Immigration and parental heritage from Mexico were positively associated with the metal mixture, while preferences for English language, media, and food were negatively associated.

CONCLUSION

Acculturation-related predictors of exposure provide information about potential sources of toxic metals, including international travel, foods, and consumer products. The findings in this research study provide information to empower future efforts to identify and address specific acculturation-associated toxicant exposures in order to promote health equity through clinical guidance, patient education, and public policy.

Translation and validation of the East Asian Acculturation Measure (EAAM) among Myanmar migrants in Thailand

Background

Acculturation provides a framework for exploring the health behaviors of ethnic minority or cultural groups. Research on the acculturation level and patterns of Myanmar migrants is crucial since there is ample evidence that acculturation promotes health-promoting behaviors. However, no Myanmar version has undergone cross-cultural validation.

Objective

This study aimed to translate the original East Asian Acculturation Measure (EAAM) into the Myanmar version (EAAM-M) and investigate its psychometric properties.

Methods

The validation study was conducted on a sample of 200 Myanmar migrants in three factories in Bangkok, Thailand, by a multistage random sampling method from August to September 2023. Brislin's back translation technique was applied to convert the original EAAM into its modified version, EAAM-M. The reliability, content validity, and construct validity of the EAAM-M were examined, and confirmatory factor analysis (CFA) was employed to test the appropriateness of the model that underpins the EAAM-M structure.

Results

The average age of the participants was 38.39 years (SD = 5.56), and 68% of participants reported they earned less than 9000 baht. In terms of how long they stayed in Thailand, slightly over half (52.5%) did so for 1-5 years. Nearly half of them (46%) cannot communicate at all regarding their proficiency in speaking Thai. The score regarding the comparability of language and similarity of interpretability between the original EAAM and the EAAM-M was satisfactory. The overall alpha reliability of the EAAM-M was 0.76. Based on the CFA, the measurement model was well fit, with acceptable goodness-of-fit values (Chi-square test of model fit (p = 0.05), CMIN/df = 1.70 (χ2 = 624.931, df = 366), RMSEA = 0.02, CFI = 0.98, and SRMR = 0.06). The validity and reliability of the factors were affirmed through appropriate factor loadings and satisfactory levels of composite reliability (0.942) and average variance extracted (0.538).

Conclusion

The EAAM-M is a reliable and valid instrument to measure the acculturation patterns of Myanmar migrants. It is beneficial for scholars across various disciplines, including health professionals and nurses, to deliver culturally tailored care for migrants.

The Role of Inflammation and Psycho-Behavioral Factors as Mediators Between Acculturation and Time to Incident Dementia Among Older Mexican Americans

Background

The mechanisms through which acculturation influences the onset of cognitive impairment and dementia are not well understood, especially among older Hispanics.

Objective

To investigate whether inflammation and psycho-behavioral factors mediate the relationship between acculturation and incident dementia among older Mexican Americans.

Methods

We analyzed the Sacramento Area Latino Study on Aging (1998-2007, SALSA), a longitudinal study (N = 1,194) with 10 years of follow-up, and used g-computation for mediation analysis with pooled logistic regression to evaluate whether acculturation (assessed by the Revised Acculturation Rating Scale for Mexican Americans [ARSMA-II]) affected dementia or cognitive impairment but not dementia (CIND) through inflammation (i.e., interleukin 6 [IL-6], tumor necrosis factor-α (TNF-α), high-sensitivity C-reactive protein [hs-CRP]), smoking, alcohol consumption, and depressive symptoms. The potential mediators were assessed at baseline.

Results

The 10-year average adjusted risk ratio (aRR) for the effect of high U.S. acculturation and dementia/CIND was 0.66, 95% CI (0.36, 1.30). The indirect effects were: IL-6 (aRR = 0.98, 95% CI (0.88, 1.05)); TNF-α (aRR:0.99, 95% CI (0.93, 1.05)); hs-CRP: (aRR = 1.21, 95% CI (0.84, 1.95)); current smoking: aRR = 0.97, 95% CI (0.84, 1.16); daily/weekly alcohol consumption (aRR = 1.00, 95% CI (0.96, 1.05)); and depressive symptom score (aRR = 1.03, 95% CI (0.95, 1.26)). Hs-CRP yielded a proportion mediated of -26%, suggesting that hs-CRP could suppress the potential effect of high U.S. acculturation. The other factors explored resulted in little to no mediation.

Conclusions

The effect of acculturation on time to incident dementia/CIND varied over time. Our study suggests that inflammation could suppress the effect between high U.S. acculturation and dementia risk.

Social patterning of childhood overweight in the French national ELFE cohort

An inverse social gradient in early childhood overweight has been consistently described in high-income countries; however, less is known about the role of migration status. We studied the social patterning of overweight in preschool children according to the mother's socio-economic and migration background. For 9250 children of the French ELFE birth cohort with body mass index collected at age 3.5 years, we used nested logistic regression to investigate the association of overweight status in children with maternal educational level, occupation, household income and migration status. Overall, 8.3% (95%CI [7.7-9.0]) of children were classified as overweight. The odds of overweight was increased for children from immigrant mothers (OR 2.22 [95% CI 1.75-2.78]) and descendants of immigrant mothers (OR 1.35 [1.04-2.78]) versus non-immigrant mothers. The highest odds of overweight was also observed in children whose mothers had low education, were unemployed or students, or were from households in the lowest income quintile. Our findings confirm that socio-economic disadvantage and migration status are risk factors for childhood overweight. However, the social patterning of overweight did not apply uniformly to all variables. These new and comprehensive insights should inform future public health interventions aimed at tackling social inequalities in childhood overweight.

Considering the role of integration experiences in shaping immigrants' post-migration food choices and eating practices

This article draws on data collected from qualitative interviews with 38 recent immigrants in two Ontario cities to provide an overview of recent immigrants' general dietary acculturation experiences. With insights from both Cockerham's health lifestyle theory and Berry's acculturation model, this article explores how structural inequalities related to integration and settlement may shape recent immigrants' post-migration food choices and eating practices. The results of this study revealed that immigrants from non-Western countries experienced greater challenges in healthy eating. Findings are in line with Cockerham's health lifestyle theory: immigrants' post-migration food choices and dietary acculturation strategies were not only bounded by socioeconomic status and cultural differences but were also shaped by various structural inequalities, especially those related to systematic barriers during the integration and settlement process. Overall, this paper provides a more holistic understanding of the multifaceted nature of immigrants' dietary acculturation experiences.

Cultural and neighborhood characteristics associated with activity-specific parenting practices in Hispanic/Latino youth: a secondary analysis of the Hispanic Community Children's health study/study of Latino youth

Hispanic/Latino youth are less physically active than non-Hispanic/Latino youth. We assessed whether activity-specific parenting practices relate to moderate-to-vigorous physical activity (MVPA) and sedentary behavior among Hispanic/Latino youth, and whether cultural (acculturation) and neighborhood characteristics (perceived barriers to activity) relate to the use of parenting practice patterns. Using the Hispanic Community Children's Health Study/Study of Latino Youth (SOL Youth, n = 976 8-16-year-olds), we modeled linear regression associations between parenting practices and mean daily MVPA and sedentary behavior. Parenting practice patterns were then developed using k-means cluster analysis, and regressed on parental acculturation and neighborhood characteristics. Discipline predicted higher MVPA in females (β 1.89 [95% CI 0.11-3.67]), while Monitoring/Reinforcement predicted higher MVPA in males (β 4.71 [95% CI 0.68-8.74]). Three patterns were then identified: Negative Reinforcement (high Limit Setting and Discipline use), Positive Reinforcement (high Limit Setting and Monitoring/Reinforcement use), and Permissive Parenting (low parenting practice use). Higher acculturation predicted use of Positive Reinforcement. Activity-specific parenting practices are associated with activity in sex-specific ways among Hispanic/Latino youth, and cultural factors predict the use of parenting practices.

Ethnic differences in physical and mental multimorbidity in working age adults with a history of depression and/or anxiety

BACKGROUND

The current study used data from an ethnically diverse population from South London to examine ethnic differences in physical and mental multimorbidity among working age (18-64 years) adults in the context of depression and anxiety.

METHOD

The study included 44 506 patients who had previously attended Improving Access to Psychological Therapies services in the London Borough of Lambeth. Multinomial logistic regression examined cross-sectional associations between ethnicity with physical and mental multimorbidity. Patterns of multimorbidity were identified using hierarchical cluster analysis.

RESULTS

Within 44 056 working age adults with a history of depression or anxiety from South London there were notable ethnic differences in physical multimorbidity. Adults of Black Caribbean ethnicity were more likely to have physical multimorbidity [adjusted relative risk ratio (aRRR) = 1.25, 95% confidence interval (CI) 1.15-1.36] compared to adults of White ethnicity. Relative to adults of White ethnicity, adults of Asian ethnicity were more likely to have physical multimorbidity at higher thresholds only (e.g. 4 + conditions; aRRR = 1.53, 95% CI 1.17-2.00). Three physical (atopic, cardiometabolic, mixed) and three mental (alcohol/substance use, common/severe mental illnesses, personality disorder) multimorbidity clusters emerged. Ethnic minority groups with multimorbidity had a higher probability of belonging to the cardiometabolic cluster.

CONCLUSION

In an ethnically diverse population with a history of common mental health disorders, we found substantial between- and within-ethnicity variation in rates of physical, but not mental, multimorbidity. The findings emphasised the value of more granular definitions of ethnicity when examining the burden of physical and mental multimorbidity.

Healthy immigrants, unhealthy ageing? Analysis of health decline among older migrants and natives across European countries

The probability of having multiple chronic conditions simultaneously, or multimorbidity, tends to increase with age. Immigrants face a particularly high risk of unhealthy ageing. This study investigates the immigrant-native disparities in the speed of age-related chronic disease accumulation, focusing on the number of chronic health conditions; and considers the heterogeneity of this trajectory within immigrant populations by origin and receiving country. We use data from the Survey of Health, Ageing and Retirement in Europe from 2004 to 2020 on adults aged 50 to 79 from 28 European countries and employ both cross-sectional and longitudinal analyses. For longitudinal panel analyses, we use fixed-effects regression models to account for the unobserved heterogeneity related to individual characteristics including migration background. Our results indicate that immigrants report a higher number of chronic conditions at all ages relative to their native-born peers, but also that the immigrant-native differential in the number of chronic conditions decreases from age 65 onwards. When considering differences by origin country, we find that the speed of chronic disease accumulation is slower among immigrants from the Americas and the Asia and Oceania country groups than it is among natives. When looking at differences by receiving country group, we observe that the speed of accumulating chronic diseases is slower among immigrants in Eastern Europe than among natives, particularly at older ages. Our findings suggest that age-related trajectories of health vary substantially among immigrant populations by origin and destination country, which underscore that individual migration histories play a persistent role in shaping the health of ageing immigrant populations throughout the life course.

A Gene-Acculturation Study of Obesity Among US Hispanic/Latinos: The Hispanic Community Health Study/Study of Latinos

OBJECTIVE

In the United States, Hispanic/Latino adults face a high burden of obesity; yet, not all individuals are equally affected, partly due in part to this ethnic group's marked sociocultural diversity. We sought to analyze the modification of body mass index (BMI) genetic effects in Hispanic/Latino adults by their level of acculturation, a complex biosocial phenomenon that remains understudied.

METHODS

Among 11,747 Hispanic/Latinos adults in the Hispanic Community Health Study/Study of Latinos aged 18 to 76 years from four urban communities (2008-2011), we a) tested our hypothesis that the effect of a genetic risk score (GRS) for increased BMI may be exacerbated by higher levels of acculturation and b) examined if GRS acculturation interactions varied by gender or Hispanic/Latino background group. All genetic modeling controlled for relatedness, age, gender, principal components of ancestry, center, and complex study design within a generalized estimated equation framework.

RESULTS

We observed a GRS increase of 0.34 kg/m 2 per risk allele in weighted mean BMI. The estimated main effect of GRS on BMI varied both across acculturation level and across gender. The difference between high and low acculturation ranged from 0.03 to 0.23 kg/m 2 per risk allele, but varied across acculturation measure and gender.

CONCLUSIONS

These results suggest the presence of effect modification by acculturation, with stronger effects on BMI among highly acculturated individuals and female immigrants. Future studies of obesity in the Hispanic/Latino community should account for sociocultural environments and consider their intersection with gender to better target obesity interventions.

Barriers to breast and cervical cancer screening uptake among Black, Asian, and Minority Ethnic women in the United Kingdom: evidence from a mixed-methods systematic review

BACKGROUND

Cancer is currently the leading cause of mortality globally, with new cancer cases estimated at 19.3 million and almost 10 million deaths in 2020. Specifically, breast and cervical cancer incidence and mortality prevalence among women of the minority group or marginalised populations in Europe have continued to be a public health concern due to the low uptake of cancer screening. Thus, this study utilised a mixed-method systematic review to identify barriers to breast and cervical screening uptake among Black, Asian, and Minority Ethnic women in the United Kingdom.

METHODS

Databases including PubMed, CINAHL, British Nursing Index, Web of Science, EMBASE, and Scopus databases, were systematically searched for studies on barriers to breast and cervical screening uptake among Black, Asian, and Minority Ethnic women in the United Kingdom published in English between January 2010 to July 2022. This mixed-method systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in reporting the included studies' results. The cluster mapping approach was used to identify and classify the barriers into themes.

RESULTS

Thirteen eligible studies were included in this current review. Seven of the thirteen studies used quantitative cross-sectional research design, while six used qualitative cross-sectional research design. These studies were conducted across the United Kingdom. Five themes were developed from the cluster mapping, and thirty-four sub-theme barriers to the uptake of breast and cervical cancer screening among Black, Asian, and Minority Ethnic women in the United Kingdom were identified. The developed themes in relation to the barriers include; socio-demographic characteristics, health service delivery, cultural, religious & language, the gap in knowledge & awareness, and emotional, sexual & family support.

CONCLUSION

The study concluded that barriers in socio-demographic characteristics, health service delivery, cultural, religious and language, the gap in knowledge & awareness, and emotional, sexual & family support were identified as non-uptake of breast and cervical cancer screening among Black, Asian, and Minority Ethnic women in the United Kingdom. Reducing or eliminating these barriers would improve the benefits of timely breast and cervical cancer screening in the United Kingdom.

Associations of peer generational status on adolescent weight across Hispanic immigrant generations: A social network analysis

BACKGROUND

Childhood obesity disproportionately impacts Hispanics in the United States (US), the nation's largest ethnic minority population. However, even among Hispanic children, those born in the US are at increased risk of developing obesity than those not born in the US (i.e. first-generation Hispanics). The objective of this study is to assess whether ethnic and generational differences in the friend networks of Hispanic adolescents moderate the association between immigrant generation and weight.

METHODS

We analyzed data from first-generation, second-generation, and third-generation Hispanic 12 to 19 year-old participants in Wave 1 of the Longitudinal Study of Adolescent to Adult Health (Add Health). Using multivariable linear regression, we examined the association between generational status and body mass index (BMI), and whether the ethnic and generational composition of friends moderated that association.

RESULTS

Higher generational status was associated with higher BMI. The ethnic and generational composition of friends was not independently associated with BMI among Hispanic adolescents. However, a social network with a greater proportion of second-generation Hispanics was positively associated with BMI among first-generation Hispanics, and negatively associated with BMI among second-generation Hispanics.

CONCLUSIONS

The generational status of peers in Hispanic adolescents' social networks, particularly the proportion that are second-generation Hispanic, moderates the positive association between immigrant generation and BMI. Moreover, this moderation effect is different across immigrant generations so that the proportion of second-generation adolescents within a social network is associated with higher BMI in first-generation Hispanic adolescents, but with lower BMI among those who are second-generation. These results were confirmed in sensitivity analyses. Our findings suggest that the generational composition of social networks alters the association between the generational status and weight of Hispanic adolescents, and thus that social factors within those networks may contribute to those associations.

Association between Feelings of Trust and Security with Subjective Health among Mexican Migrants in the New York City Area

The size of the foreign-born population living in the United States makes migrants' health a substantive policy issue. The health status of Mexican immigrants might be affected by the level of social capital and the social context, including the rhetoric around immigration. We hypothesize that a diminished perception of trust and safety in the community has a negative impact on self-reported health. In a cross-sectional study, we conducted a survey among 266 Mexican Immigrants in the New York City Area who used the Mexican Consulate between May and June 2019 for regular services provided to documented and undocumented immigrants. A univariate and bivariate descriptive analysis by trust and security items first shows the diversity of the Mexican population living in the US and the conditions of vulnerability. Then, logistic regression models estimate the association between trust and security items with self-reported health status. Results show that safety is consistently associated with good self-rated health, especially when rating the neighborhood, and trust showed mixed results, more reliant to the way it is operationalized. The study illustrates a pathway by which perceptions of the social context are associated with migrants' health.

George SM. The Effects of Parent-Adolescent Acculturation Gaps on Adolescent Lifestyle Behaviors: Moderating Role of Family Communication

Objectives

This study examined 1) associations between parent-adolescent acculturation gaps in Americanism and Hispanicism and adolescents' lifestyle behaviors (fruit and vegetable intake and physical activity), and 2) the moderating roles of adolescent- and parent-reported family communication on these associations.

Methods

Hispanic adolescents who have overweight or obesity (n=280; 52% female, 13.0±0.8 years old) and their parents (88% female, 44.9±6.5 years old) completed baseline measures on acculturation, family communication, weekly physical activity, and daily fruit and vegetable intake as part of their participation in a family-based health promotion efficacy trial. Acculturation gaps were calculated by taking the product of adolescent and parent scores for each subscale (Americanism and Hispanicism). We conducted multiple linear regression analyses with three-way interaction terms (e.g., parent Americanism x adolescent Americanism x family communication) to assess for moderation.

Results

Family communication significantly moderated the association between parent-adolescent acculturation gaps in Americanism and adolescent fruit and vegetable intake. For families with low adolescent-reported family communication, parent-adolescent discrepancies in Americanism were associated with lower adolescent fruit and vegetable intake whereas there were no significant associations for families with high family communication. There were no effects on weekly minutes of physical activity. Acculturation gaps in Hispanicism were not significantly associated with either outcome.

Conclusions

Findings highlight the importance of parent-adolescent acculturation gaps and family communication on fruit and vegetable intake for Hispanic adolescents. Targeting parent-adolescent acculturation gaps for families with low levels of communication may be important to improve dietary behaviors in Hispanic adolescents, who are already disproportionately affected by obesity.

Low assets predict persistent depression through living difficulties amid large-scale disasters: A cohort study

BACKGROUND

In face of large-scale disasters, persons with fewer assets are at greater risk of persistent poorer mental health than persons with more assets. Everyday daily routine disruptions and financial hardship could mediate this association.

METHODS

This prospective population-representative study in Hong Kong aimed to investigate the relation between assets during the acute phase of COVID-19 (February-August 2020, T1) and persistent probable depression from T1 to March-August 2021 (T2), as well as the mediating effects of daily routine disruptions and financial hardship on the assets-depression association.

RESULTS

Low assets at T1 prospectively related to persistent probable depression from T1 to T2. Primary routine disruptions (i.e., healthy eating and sleep) at T1 and financial hardship at T2 were found to fully mediate the association between T1 assets and persistent probable depression.

LIMITATIONS

Persistent probable depression reported on the PHQ-9 should be further verified with clinical diagnoses/interviews.

CONCLUSIONS

The COVID-19 pandemic was accompanied by a global economic downturn. Persons who have fewer assets could be at greater risk of depression during this period. Our findings suggest a need to provide behavioral and financial assistance to persons with fewer assets in the short run and a need to ensure that everyone has adequate assets to mitigate the mental health consequences of the COVID-19 pandemic in the long run.

mHealth-Supported Gender- and Culturally Sensitive Weight Loss Intervention for Hispanic Men With Overweight and Obesity: Single-Arm Pilot Study

BACKGROUND

Hispanic men have disproportionate rates of overweight and obesity compared with other racial and ethnic subpopulations. However, few weight loss interventions have been developed specifically for this high-risk group. Furthermore, the use of mobile health (mHealth) technologies to support lifestyle behavior changes in weight loss interventions for Hispanic men is largely untested.

OBJECTIVE

This single-arm pilot study examined the feasibility and acceptability of integrating mHealth technology into a 12-week gender- and culturally sensitive weight loss intervention (GCSWLI) for Hispanic men with overweight and obesity.

METHODS

A total of 18 Hispanic men (mean age 38, SD 10.9 years; mean BMI 34.3, SD 5.5 kg/m²; 10/18, 56% Spanish monolingual) received a GCSWLI, including weekly in-person individual sessions, a daily calorie goal, and prescription of ≥225 minutes of moderate-intensity physical activity per week. mHealth technology support included tailored SMS text messaging, behavior self-monitoring support using Fitbit Charge 2, and weight tracking using a Fitbit Aria Wi-Fi Smart Scale. Changes in weight from baseline to 12 weeks were estimated using a paired 2-tailed t test. Descriptive analyses characterized the use of Fitbit and smart scales. Semistructured interviews were conducted immediately after intervention to assess the participants' weight loss experiences and perspectives on mHealth technologies.

RESULTS

Of 18 participants, 16 (89%) completed the 12-week assessments; the overall attrition rate was 11.1%. The mean weight loss at week 12 was -4.7 kg (95% CI 7.1 to -2.4 kg; P<.001). Participants wore the Fitbit 71.58% (962/1344) of the intervention days and logged their body weight using the smart scale (410/1344, 30.51% of the intervention days). Participants identified barriers to the use of the technology, such as lack of technological literacy and unreliable internet access for the smart scale.

CONCLUSIONS

Although clinically significant weight loss was achieved by integrating mHealth technology into the GCSWLI, adherence to the prescribed use of technology was modest. Addressing barriers to the use of such technologies identified in our work may help to refine an mHealth intervention approach for Hispanic men.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02783521; https://clinicaltrials.gov/ct2/show/NCT02783521.

A cultural approach to dementia - insights from US Latino and other minoritized groups

Alzheimer disease and related dementias present considerable challenges to health-care and medical systems worldwide. In the USA, older Black and Latino individuals are more likely than older white individuals to have Alzheimer disease and related dementias. In this Perspective, we leverage our experience and expertise with older US Latino groups to review and discuss the need to integrate cultural factors into dementia research and care. We examine the importance of considering the effects of cultural factors on clinical presentation and diagnosis, dementia risk, clinical research and recruitment, and caregiving practices, with a focus on minoritized groups in the USA. We highlight critical gaps in the literature to stimulate future research aimed at improving the prevention and early detection of Alzheimer disease and related dementias and developing novel treatments and interventions across ethnoracially diverse populations. In addition, we briefly discuss some of our own initiatives to promote research and clinical care among Latino populations living in the USA.

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.

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.

The effects of acculturation and environment on lifestyle behaviors in Korean immigrants: the mediating role of acculturative stress and body image discrepancy

OBJECTIVES

Despite high rates of cardiometabolic diseases in Korean immigrants (KIs), little is known about cultural and environmental factors contributing to lifestyle behaviors. The purpose of this cross-sectional study was to examine the relationships among acculturation, environment, and lifestyle behaviors (dietary behavior, physical activity, and sedentary behavior) through culturally sensitive psychological mediators, body image discrepancy and acculturative stress in middle-aged KIs.

DESIGN

A cross-sectional study was conducted. KIs aged 30-65 years were recruited online and at Korean community centers and churches in the Northeastern US Participants completed validated measures of dietary behavior (the Nutrition Subscale of the Health Promoting Lifestyle Profile (HPLP) II), physical activity (the International Physical Activity Questionnaire (IPAQ) - short form), and sedentary behavior (the Sedentary Behavior Questionnaire). Acculturative stress was measured by the Acculturative Stress Index and body image discrepancy was measured by the Stunkard Figure Rating Scale. Acculturation was defined as a latent variable measured by Korean and American orientation (Vancouver Index of Acculturation), age of immigration to the US, length of residency in the US, and English proficiency. Data were analyzed with structural equation modeling (SEM).

RESULTS

The sample included 361 KIs (mean age = 41.77 ±10.28 years, 48.1% female, and 46.4% overweight or obese). In the SEM model, acculturation had significant indirect effects on dietary behavior, physical activity, and sedentary behavior through body image discrepancy. Acculturative stress mediated the relationship between acculturation and sedentary behavior. Greater environmental support for physical activity and better healthy food accessibility were related to higher levels of physical activity and healthier dietary behavior, respectively.

CONCLUSION

In our study, acculturation and environmental support for physical activity and healthy food simultaneously influenced KIs' lifestyle behaviors. Addressing an unhealthy body image and acculturative stress may be additional strategies for lifestyle intervention programs to prevent cardiometabolic diseases in KIs.

Prostate cancer screening behaviors among Indo-Guyanese

OBJECTIVE

The objective of this study was to explore prostate cancer screening behaviors among Indo-Guyanese men.

METHODS

This qualitative study was conducted in the surrounding neighborhood of Queens, New York during 2018 and 2019. In-depth, one-on-one interviews were conducted using 20 Indo-Guyanese men between the ages of 45 and 75.

RESULTS

The findings suggest that Indo-Guyanese men are being screened for prostate cancer at a very low rate. Only 30% (n = 6) of participants underwent prostate cancer screening. Four major themes were derived from the data, which could have contributed to the decreased level of screening. These included: (1) recommendations must come from their healthcare professional; (2) reluctance to engage in screening; (3) distrust of the medical system; and (4) screening only if symptoms are present or they know someone with prostate cancer.

CONCLUSIONS

Behavioral patterns for prostate cancer screening among Indo-Guyanese men share some similarities with other Caribbean countries. Clinicians and Healthcare Professionals should be culturally competent for the patients they serve. Understanding the behavioral variations within this diverse culture could help provide the highest possible care, specifically tailored to each patient.

Self-Efficacy Mediates Acculturation and Respite Care Knowledge of Immigrant Caregivers

Past studies have shown that acculturation and self-efficacy can affect respite care knowledge, which are notable issues among immigrant caregivers due to the rapid increasing aging family members. The aim of this study was to investigate relationships among acculturation, self-efficacy, and respite care knowledge in immigrant caregivers, and to determine the mediating effects of self-efficacy on the relationship between acculturation and respite care knowledge. A cross-sectional design was used. We enrolled 134 female immigrant caregivers who had married Taiwanese men and lived with care recipients who used LTC services. Based on Baron and Kenny' mediating analytic framework, multiple regression and Sobel tests were used to examine whether self-efficacy mediated the relationship between acculturation and respite care knowledge. The findings showed that after controlling for confounding factors, acculturation and self-efficacy separately affected respite care knowledge (B = 0.229, standard error (SE) = 0.084; B = 0.123, SE = 0.049, respectively). Acculturation had a positive impact on respite care knowledge through self-efficacy (B = 0.181, SE = 0.084). Therefore, self-efficacy partially mediated the effect of acculturation on respite care knowledge, and accounted for 20.9% of the total mediating effect in this study. Acculturation predicted immigrant caregiver' respite care knowledge partially through self-efficacy. The association between acculturation and respite care knowledge was partially mediated by immigrant caregivers' self-efficacy. As a result, it was proposed that boosting self-efficacy could increase and drive immigrant caregivers' respite care knowledge. To assist this population in obtaining enough resources, targeted educational programs to promote immigrant caregivers' self-efficacy should be designed and implemented. Furthermore, health care practitioners should be aware of the relevance of immigrant caregivers' acculturation.

Between- and within-Group Differences in Fruit and Vegetable Purchases, Consumption, and BMI among Hispanic Farmers' Market Shoppers Who Use SNAP

(1) Background: Despite considerable efforts to increase farmers' market access (FM) and improve household fruit and vegetable (FV) purchasing in low-income communities, little is known about the FV purchasing and consumption characteristics of low-income Hispanic farmers' market shoppers. (2) Methods: A secondary analysis of baseline data from a farmers' market study conducted between 2015 and 2017 (n = 2825) was performed. Participants who also received supplemental nutrition assistance program (SNAP) completed a 31-item online survey assessing demographics, health characteristics, and FV purchasing and consumption habits. Descriptive statistics and bivariate analyses were used to assess between- and within-group differences amongst Hispanic and non-Hispanic households. Regression analyses were used to examine associations among BMI, FV purchasing and consumption, and household size for Hispanic and non-Hispanic households as well as for Hispanic subgroups. (3) Results: The sample included 515 Hispanic and 2310 non-Hispanic SNAP-using FM shoppers in 13 states. Despite experiencing significantly higher food insecurity (89% vs. 81%, non-Hispanic), Hispanic shoppers consumed similar amounts of FV (3.04 cups/day) and spent less doing so. Significant subgroup differences were identified for FV purchasing. (4) Conclusions: Findings emphasize the importance of food insecurity and household size in FV interventions and underscore the capacity of Hispanic families to maintain FV consumption.

The Influence of Living Conditions on Self-Rated Health: Evidence from China

Despite growing attention to living conditions as a social determinant of health, few studies have focused on its diverse impacts on self-rated health. Using data from the China Family Panel Study in 2018, this study used logistic regression analysis to examine how living conditions affect self-rated health in China, finding that people cooking with sanitary water and clean fuel were more likely to report good health, and that homeownership was associated with higher self-rated health. The self-rated health of people living in high-quality housing was lower than that of people living in ordinary housing, and people living in tidy homes were more likely to report good health. The findings suggest that the link between multiple living conditions and self-rated health is dynamic. Public health policies and housing subsidy programs should therefore be designed based on a comprehensive account of not only housing grade or income status, but also whole dwelling conditions.

Exploring Potential Mediation Pathways on the Relationship Between Acculturation and Body Mass Index (BMI) Among Latino Adolescents

BACKGROUND

Positive associations have been observed between acculturation and body mass index (BMI), but the mediators of this relationship are not well established. Acculturation researchers have called for investigating the influence of socio-contextual variables as mediators. The objective of this study was to test the mediating effects of salty snacks, sweet snacks, physical activity, and sedentary behavior on the relationship between acculturation and BMI among Latino adolescents.

METHODS

Adolescents who self-identified as Latino (n = 431) at public high schools in Southern California were recruited and completed a self-report survey. A bootstrapped multiple mediation model was used to test mediation pathways.

RESULTS

Acculturation was positively associated with physical activity (B = 0.09, p < .05). The indirect effects of salty snacks, sweet snacks, physical activity, and sedentary behavior were not associated with BMI, suggesting no mediation.

CONCLUSIONS

Future research should examine additional mediating variables on the relationship between acculturation and BMI.

Acculturation and endocrine disrupting chemical-associated personal care product use among US-based foreign-born Chinese women of reproductive age

BACKGROUND

Personal care products (PCPs) are an important source of endocrine disrupting chemicals (EDCs) linked to adverse reproductive health outcomes.

OBJECTIVE

We evaluated EDC-associated PCP use and acculturation among Asian women.

METHODS

Our study included 227 foreign-born Chinese women ages 18-45 seeking obstetrics-gynecology care at community health centers (Boston, MA). Acculturation was measured by English-language use, length of US residence, and age at US entry. Self-reported use of PCPs (crème rinse/conditioner, shampoo, perfume/cologne, bar soap/body wash, liquid hand soap, moisturizer/lotion, colored cosmetics, sunscreen, and nail polish) in the last 48 h was collected. Latent class analysis was used to identify usage patterns. We also conducted multivariable logistic to determine the cross-sectional associations of acculturation measures and the use of individual PCP types.

RESULTS

Those who used more PCP types, overall and by each type, tended to be more acculturated. Women who could speak English had 2.77 (95% CI: 1.10-7.76) times the odds of being high PCP users compared to their non-English speaking counterparts. English-language use was associated with higher odds of using perfume/cologne and nail polish.

SIGNIFICANCE

Our findings give insight about EDC-associated PCP use based on acculturation status, which can contribute to changes in immigrant health and health disparities.

Adaptation and Validation of a Short Acculturation Scale in a Multi-Ethnic Asian Population

The Short Acculturation Scale (SAS) has been widely used for assessing the level of the acculturation of migrants in Western countries. However, the validity of SAS for use in cosmopolitan settings without a single prevailing culture is unclear. We examined the validity and reliability of a version of the SAS adapted to a multi-ethnic Asian society. We used cross-sectional data from 12,610 Singaporean citizens and permanent residents, aged 21–75 years, of Chinese, Malay, and Indian ethnicity. Our version used 11 items, with 5 questions on language use, 3 on media use, and 3 on ethnic social relations, to measure acculturation. Our version of the SAS had good internal consistency. The three-factor CFA model had a good fit to our data. The results from the multiple group CFA supported metric invariance and partial scalar invariance across the three ethnic groups. The total score was positively correlated with generation in Singapore and the number of languages spoken. Among first generation immigrants, country of origin, but not the duration of residence was significantly associated with the acculturation score. Our three-factor version of the SAS is a reliable and valid tool for measuring acculturation in Singapore residents. These findings indicate that adapted SAS can be used to assess acculturation in multicultural settings.

Diet during pregnancy: Influence of social characteristics and migration in the ELFE cohort

Better adherence to dietary guidelines during pregnancy is supposed to result in healthier perinatal outcomes. We aim to characterize the diets of pregnant women by hypothesis‐driven and exploratory approaches and describe potential social determinants. Analyses included 12 048 mothers from the French nationwide ELFE birth cohort. Dietary intake over the last three months of the pregnancy was assessed by a food frequency questionnaire. Two hypothesis‐driven scores (the Diet Quality score, based on benchmarks derived from the National Health and Nutrition Program Guidelines, and the PANDiet score, based on nutrient intake) were calculated. Exploratory dietary patterns were also identified by principal component analysis. Multiple linear regressions were used to assess associations of maternal social characteristics with dietary patterns, accounting for the possible effect modification by their migration status. Five dietary patterns were identified: the Western, Balanced, Bread and toppings, Processed products, and Milk and breakfast cereals. Younger maternal age, single motherhood, unemployment and the presence of older children in the household were related to a suboptimal diet during pregnancy. The less acculturated the women were, the healthier and less processed their diets were, independent of their socio‐economic position. Several social determinants of the quality of women's diets were however moderated by their migration status. These findings shed light on the relations between indicators of social vulnerability, such as single motherhood and unemployment, and poorer diet quality. Given the reduced diet quality that accompanies the acculturation process, it is of paramount importance to identify the specific factors or obstacles that affect migrant women in maintaining their diet quality advantage over the majority population.

Participatory decision-making for cancer care in a high-risk sample of low income Mexican-American breast cancer survivors: The role of acculturation

Background

Despite declining cancer incidence and mortality rates, Latina patients continue to have lower 5-year survival rates compared to their non-Hispanic white counterparts. Much of this difference has been attributed to lack of healthcare access and poorer quality of care. Research, however, has not considered the unique healthcare experiences of Latina patients.

Methods

Latina women with prior diagnoses of stage 0-III breast cancer were asked to complete a cross-sectional survey assessing several socio-demographic factors along with their experiences as cancer patients. Using a series of linear regression models in a sample of 68 Mexican-American breast cancer survivors, we examined the extent to which patients' ratings of provider interpersonal quality of care were associated with patients' overall healthcare quality, and how these associations varied by acculturation status.

Results

Findings for Latina women indicated that both participatory decision-making (PDM) (β = 0.62, p < .0001) and trust (β = 0.53, p = .02) were significantly associated with patients' ratings of healthcare quality. The interaction between acculturation and PDM further suggested that participating in the decision-making process mattered more for less acculturated than for more acculturated patients (β = -0.51, p ≤ .01).

Conclusions

The variation across low and high acculturated Latinas in their decision-making process introduces a unique challenge to health care providers. Further understanding the relationship between provider-patient experiences and ratings of overall healthcare quality is critical for ultimately improving health outcomes.

Egocentric social networks, lifestyle behaviors, and body size in the Asian Community Health Initiative (CHI) cohort

BACKGROUND

Social networks have been shown to influence lifestyle behaviors in non-Latinx white (NLW) populations. We examined their influence in Asian American, Native Hawaiian and Pacific Islander (AANHPI) women.

METHODS

We included 477 AANHPI women from the Asian Community Health Initiative Study who provided egocentric (degree, density, composition) and epidemiologic (size, types of ties) social network data and data on alcohol intake, physical activity, smoking, diet, and body size. We used logistic regression to evaluate associations of social network measures and dichotomous outcomes, and linear regression for continuous outcomes.

RESULTS

In multivariable-adjusted analyses, higher degree and/or proportion of friends were significantly related to higher Western diet, higher odds of any alcohol consumption, and lower odds of physical inactivity and body mass index (BMI)≥23 kg/m2. Additionally, a higher proportion of NLW in women's networks was related to lower Asian diet but also lower waist size. Community participation was related to higher Western diet and lower Asian diet. By contrast, degree and/or proportion of relatives were positively related to BMI, waist size and to a higher odds of BMI≥23 kg/m2 and of ever smoking 100 cigarettes. Being married was related to fewer alcoholic drinks per week and higher Asian diet. A higher density of relationships with frequent contact was also associated with higher Asian diet.

CONCLUSIONS

AANHPI women with larger proportions of friends and NLWs in their networks had more Western health behaviors and smaller body size. Norms for health behaviors and body size may be influenced by the size, composition, and structure of social networks, relevant to chronic disease prevention.

Distinct patterns of socio-economic disparities in child-to-adolescent BMI trajectories across UK ethnic groups: A prospective longitudinal study

BACKGROUND

In many high-income countries, body mass index (BMI)/obesity levels are inversely associated with socio-economic position (SEP). Little is known whether socio-economic patterns in BMI trajectories throughout childhood differ by ethnicity, especially in the United Kingdom.

OBJECTIVES

To investigate socio-economic disparities in child-to-adolescent BMI trajectories and risks of overweight and obesity during adolescence across ethnic groups.

METHODS

Mixed-effects fractional polynomial and multinomial regression models were applied to estimate socio-economic differences in BMI trajectories (3-14 years) and risk of overweight/obesity at 14 years, respectively, in the UK Millennium Cohort Study (n = 15 996). Analysis was stratified by ethnicity.

RESULT

Poverty was associated with higher BMI in children of White and South Asian origins, with a small difference at 3 years, which widened with age to 0.75 kg/m2 (95% CI, 0.59-0.91) and 0.77 kg/m2 (0.26-1.27) at 14 years for the White and South Asian groups, respectively. There was a reverse income-BMI association in children of Black (African-Caribbean) origin with the poverty group having a lower BMI (-0.37 kg/m2 [-0.71 to -0.04] at 5 years; -0.95 kg/m2 [-1.79 to -0.11] at 14 years). These patterns also presented with maternal education as a SEP indicator and for obesity at 14 years.

CONCLUSIONS

Socio-economic advantage may not be universally associated with lower BMI, which should be considered when planning obesity interventions. The positive SEP-BMI association in children of Black origin requires replication and merits further investigation into underpinning mechanisms.

The association of acculturation with accelerometer-assessed and self-reported physical activity and sedentary behavior: The Hispanic Community Health Study/Study of Latinos

The adoption of US culture among immigrants has been associated with higher leisure-time physical activity and sedentary behavior. However, most research to date assesses this association using single measures of acculturation and physical activity. Our objective was to describe the cross-sectional association between acculturation and both physical activity and sedentary behavior among US Hispanic/Latino adults. Participants included Hispanic/Latinos 18-74 years living in four US locations enrolled in the Hispanic Community Health Study/Study of Latinos from 2008 to 2011. Acculturation was measured using acculturation scales (language and social), years in the US, language preference, and age at immigration. Physical activity and sedentary behavior were measured using the Global Physical Activity Questionnaire (N = 15,355) and Actical accelerometer (N = 11,954). Poisson, logistic, and linear regression were used, accounting for complex design and sampling weights. English-language preference was positively associated with self-reported leisure-time and transportation physical activity and accelerometer-assessed moderate-to-vigorous physical activity (MVPA). Social acculturation was positively associated with self-reported leisure-time and transportation physical activity and MVPA. Years in the US and age at immigration were positively associated with accelerometer-assessed MVPA. Language acculturation, years in the US, and age at immigration were associated with occupational physical activity among those who reported employment. Most acculturation measures were associated with self-reported sitting but not with accelerometer-assessed sedentary behavior. Different measures of acculturation, capturing various domains acculturation, were associated with physical activity and sedentary behavior. However, the direction of the association was dependent on the measures of acculturation physical activity/sedentary behavior, highlighting the complexity of these relationships.

An Examination of Family Variables as Mediators of the Association of Acculturation With Sugar-Sweetened Beverage Consumption Among Latinx Adolescents

The objective of this study was to examine the mediating effects of family support for dietary habits and family meal frequency on the relationship between acculturation and sugar-sweetened beverage (SSB) consumption among Latinx adolescents (N = 131). Acculturation was positively associated with SSB consumption (B = 0.07, P < .01). Results suggest that family support for dietary habits and family meal frequency did not mediate the relationship between acculturation and SSB consumption. However, acculturation was negatively associated with family support for dietary habits (B = -0.10, P < .01) and family meal frequency (B = -0.11, P < .05). Future research should examine other family influences as mediators of the relationship between acculturation and SSB consumption.

Positive Influences of Social Support on Sense of Community, Life Satisfaction and the Health of Immigrants in Spain

The main objective of this study was to investigate the association of social support and the sense of community (SOC) with satisfaction with life (SWL) and immigrant health. We propose a model in which perceived social support from close sources (family and friends), as mediated by SOC and life satisfaction, would be positively associated with mental and physical health. Limited evidence exists from multivariate models that concurrently examine the association of both factors with SWL and health-related outcomes. We investigate the hypothesized association in a structural equations model (SEM) analysis. The participants consisted of 1131 immigrants (49% men and 51% women) (age 18-70, M = 33). The study was conducted in Malaga (Spain). Cross-sectional data were collected using a random-route sampling and survey methodology. In this model, greater social support from native friends was associated with a greater SOC. Social support from family and native friends was associated with greater SWL. Also, a greater SOC was associated with greater SWL. No association was found between SOC and mental health symptoms, whereas, greater SWL was associated with fewer mental health and illness symptoms. These results suggest that among immigrants, support networks involving family and native friends, and integration into the community are important influences for immigrants to achieve life satisfaction. These results are widely applicable and have implications that are relevant to the design of health promotion interventions.

Correlates of Physical Activity Among Disadvantaged Groups: A Systematic Review

CONTEXT

Socioeconomically disadvantaged adults have lower engagement in leisure-time physical activity than those who are more affluent. Identification of correlates of physical activity can inform the design of effective interventions. The aim of this systematic review was to identify consistent correlates of unspecified physical activity and leisure-time physical activity among socioeconomically disadvantaged adults.

EVIDENCE ACQUISITION

PubMed and Scopus were searched up to May 2018, and titles/abstracts and full texts were screened against eligibility criteria. Methodologic quality was assessed, and correlates were synthesized from July to September 2018.

EVIDENCE SYNTHESIS

Seventy-three studies were selected for synthesis; 48 examined unspecified physical activity and 31 examined leisure-time physical activity (6 examined both). Self-rated health, functional capacity, and physical activity self-efficacy were consistently, positively associated with unspecified physical activity. Mental health status and perceived benefits and enjoyment of physical activity were consistently, positively associated with leisure-time physical activity. Most studies were cross-sectional and used validated self-report measures of physical activity; few reported response rates >50%.

CONCLUSIONS

Few factors were consistently associated with either unspecified physical activity or leisure-time physical activity. Based on available evidence, strategies to increase physical activity should consider the needs of, and focus on, those with poor self-rated health and functional capacity and should use strategies to improve physical activity self-efficacy. Strategies to increase leisure-time physical activity should focus on simultaneously addressing leisure-time physical activity and mental health concerns and improving perceptions of physical activity benefits and enjoyment. It is recommended that future studies focus on leisure-time physical activity, focus on men, use longitudinal design, examine variables related to behavioral attributes and skills, and carefully consider and plan recruitment strategies.

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.

Health Literacy, Depression Literacy, and Depression among Older Korean Americans

The purpose of this study was to explore depression and its relationship with background characteristics, health literacy, and depression literacy among Korean Americans (KAs). A cross-sectional survey was conducted among 178 older KAs (age 60≥) in the Washington D.C. metro area in 2016. Three open-ended questions were included to obtain narrative responses for thoughts about depression and its symptoms, and the living situation that might be related to depression. Depression was measured on the Patient Health Questionnaire-9 translated into Korean. The rate of depression was 22.5% among older KAs. No relationship between health literacy and depression was shown. In the regression analysis with covariates, limited English proficiency, less family support, shorter length of U.S. residency, male, and higher depression literacy were significantly associated with higher odds of depression. On narrative questions, only 35% among respondents believed that depression was a mental status. The others described it as environmental or attitude problems such as stress or goals being set too high. Education about depression engaging older KAs immigrants with limited English, and their families are the important health issue in the Korean community.

Exploring Generational Differences of British Ethnic Minorities in Smoking Behavior, Frequency of Alcohol Consumption, and Dietary Style

Background: This article explores ethnic minority generational differences in smoking behavior, frequency of alcohol consumption, and dietary style in Britain, and whether these differences can be explained by generational differences in socioeconomic status and ethnic identity. Method: Multivariate analyses using wave 2 (2010–2012) and wave 5 (2013–2015) of the United Kingdom Household Longitudinal Study on smoking behavior, frequency of alcohol consumption, and dietary style from 59,189 White British, 1690 Indians, 960 Pakistanis, 555 Bangladeshis, 1060 Black Caribbeans, and 1059 Black Africans, adjusted for demographic characteristics, socioeconomic status and ethnic identity. Results: While we find little evidence for generational differences in dietary style, second-generation Indians, Pakistanis, and Black Caribbeans have a significantly higher probability of smoking than the first-generation, and all second-generation minorities are significantly more likely to consume alcohol than their first-generation counterparts. Such generational differences in alcohol consumption are partly explained by second-generation minorities’ weakened ethnic identity and higher socioeconomic status. Conclusions: This study facilitates a better understanding of minority generational differences in health behaviors and the role of socioeconomic status and ethnic identity, highlighting the need for future policy interventions to target certain second-generation ethnic minorities who have adopted certain host society unhealthy lifestyles.

A Gender- and Culturally Sensitive Weight Loss Intervention for Hispanic Men: Results From the Animo Pilot Randomized Controlled Trial

Background. Hispanic males have the highest rates of overweight and obesity compared with men of all other racial/ethnic groups. While weight loss can significantly reduce obesity-related health risks, there is limited research examining effective gender- and culturally tailored behavioral weight loss programs for Hispanic men. Objective. To assess the feasibility and preliminary efficacy of a 12-week gender- and culturally sensitive weight loss intervention (GCSWLI) as compared with a waist-list control (WLC) in sedentary, Hispanic males with overweight/obesity. Method. Fifty Hispanic males (age: 43 years [SD = 11]; BMI: 34 ± 5 kg/m²; 58% Spanish monolingual) were randomized to one of two groups: GCSWLI (n = 25) or WLC (n = 25). GCSWLI participants attended weekly in-person individual sessions with a bilingual, bicultural Hispanic male lifestyle coach, and were prescribed a daily reduced calorie goal and 225 minutes of moderate-intensity physical activity per week. The WLC were asked to maintain their usual diet and physical activity habits for 12 weeks. GCSWLI participants continued with 12 additional weeks of follow-up including biweekly phone calls with lifestyle coaches. Results. At Week 12, the mean weight loss in the GCSWLI was -6.3 kg (95% confidence interval [CI; -8.1, -4.4]) compared with -0.8 kg (95% CI [-2.5, 0.9]) for the WLC (difference = -5.5 kg, 95% CI [-8.0, -2.9], p < .01). At Week 24, weight loss in the GCSWLI was maintained. Conclusions. The GCSWLI appears to be a feasible strategy to engage Hispanic males in short-term weight loss. Our pilot study indicates preliminary evidence of efficacy, though confirmation of these findings is needed in a larger study.

Improving Dietary Behavior Among Ethnic Minority Women in Denmark: A Feasibility Study Based on a Participatory and Culturally Adapted Intervention

The Danish Heart Foundation and the non-governmental organization Neighborhood Mothers have co-developed a culturally adapted intervention seeking to promote healthy dietary behaviour among ethnic minority women. This feasibility study explores the potential of the intervention to reach ethnic minority women using health promotion initiatives. Participants attended instructor courses or cooking events, where culturally adapted, healthy recipes were introduced and meals prepared. Feasibility was explored using a mixed-method approach. Surveys were completed by 59 volunteers and 150 participants at five instructor courses and 21 cooking events. Individual interviews and focus group discussions were conducted with volunteers and participants after completion of the intervention. After the intervention, 61% of the 150 participants had high levels of knowledge about dietary recommendations, 96% intended to cook healthy dishes in the future and 84% intended to incorporate measuring equipment into their daily cooking routine. Participants with a high level of knowledge reported intention to change dietary behaviour more often than participants with lower levels of knowledge. Interviews confirmed that the participants cooked healthy dishes after participating, and incorporated knowledge about healthy food practices into their daily cooking. Few participants used measuring equipment. The intervention proved to be feasible as a health promotion initiative targeting a hard-to-reach population.

US acculturation and poor sleep among an intergenerational cohort of adult Latinos in Sacramento, California

Acculturation may shape the disproportionate burden of poor sleep among Latinos in the United States. Existing studies are limited by unidimensional acculturation proxies that are incapable of capturing cultural complexities across generations. Understanding how acculturation relates to sleep may lead to the identification of modifiable intervention targets. We used multivariable regression and latent class methods to examine cross-sectional associations between a validated multidimensional scale of US acculturation and self-reported poor sleep measures. We analyzed an intergenerational cohort: first-generation (GEN1) older Latinos (Sacramento Area Latino Study on Aging; N = 1,716; median age: 69.5) and second-generation (GEN2) middle-aged offspring and relatives of GEN1 (Niños Lifestyle and Diabetes Study; N = 670; median age: 54.0) in Sacramento, California. GEN1 with high US acculturation, compared with high acculturation towards another origin/ancestral country, had less restless sleep (prevalence ratio [PR] [95% confidence interval (CI)]: 0.67 [0.54, 0.84]) and a higher likelihood of being in the best sleep class than the worst (OR [95% CI]: 1.62 [1.09, 2.40]), but among nonmanual occupations, high intergenerational US acculturation was associated with more general fatigue (PR [95% CI: 1.86 [1.11, 3.10]). GEN2 with high intergenerational US acculturation reported shorter sleep (PR [95% CI]: 2.86 [1.02, 7.99]). High US acculturation shaped sleep differentially by generation, socioeconomic context, and intergenerational acculturative status. High US acculturation was associated with better sleep among older, lower socioeconomic Latinos, but with shorter sleep duration among middle-aged, higher socioeconomic Latinos; results also differed by parental acculturation status. Upon replication, future studies should incorporate prospective and intergenerational designs to uncover sociobehavioral pathways by which acculturation may shape sleep to ultimately inform intervention efforts.

Impact of acculturation on oral health among immigrants and ethnic minorities: A systematic review

OBJECTIVE

Cultural changes faced by immigrants and ethnic minorities after moving to a host country may have a detrimental or beneficial influence on their oral health and oral health-related behaviors. Therefore, this paper reviews the literature to see the impact of acculturation on immigrants and ethnic minorities' oral health outcomes.

METHODS

We searched seven electronic databases up to January 2018. All cross-sectional and longitudinal quantitative studies that examined associations between acculturation and oral health status and/or oral health behaviors among ethnic minority and immigrant population[s] were included. Study selection, data extraction, and risk of bias assessment were completed in duplicate. The Newcastle-Ottawa checklist was used to appraise the methodological quality of the quantitative studies. A meta-analytic approach was not feasible.

RESULTS

A total of 42 quantitative studies were identified. The studies showed a positive association between acculturation and oral health status/behaviors. The most frequently used acculturation indicators were language spoken by immigrant and ethnic minorities and length of stay at the host country. High-acculturated immigrant and ethnic minority groups demonstrated better oral health outcomes, oral health behaviors, dental care utilization, and dental knowledge.

CONCLUSIONS

According to existing evidence, a positive effect of acculturation on oral health status and behaviors was found.

PRACTICAL IMPLICATIONS

Dental practitioners should be culturally competent to provide the appropriate services and treatments to immigrant and ethnic minorities. Policymakers should also be sensitive to cultural diversities and properly address the unique needs of each group in order to maintain oral health equity.

Migration and cognitive function: a conceptual framework for Global Health Research

BACKGROUND

Migration is a fundamental demographic process that has been observed globally. It is suggested that migration is an issue of global health importance that can have an immediate and lasting impact on an individual's health and well-being. There is now an increasing body of evidence linking migration with cognitive function in older adults. In this paper, we synthesized the current evidence to develop a general conceptual framework to understand the factors contributing to the association between migration and cognitive function.

METHODS

A comprehensive review of the literature was conducted on the associations between migration and cognition among middle-aged and older adults.

RESULTS

Five potential mechanisms were identified from the literature: 1) socioeconomic status-including education, occupation, and income; 2) psychosocial factors-including social networks, social support, social stressors, and discrimination; 3) behavioral factors-including smoking, drinking, and health service utilization; 4) physical and psychological health status-including chronic conditions, physical function, and depression; and 5) environmental factors-including both physical and social environment. Several underlying factors were also identified-including early-life conditions, gender, and genetic factors.

CONCLUSIONS

The factors linking migration and cognitive function are multidimensional and complex. This conceptual framework highlights potential implications for global health policies and planning on healthy aging and migrant health. Additional studies are needed to further examine these mechanisms to extend and refine our general conceptual framework.

Dietary Acculturation among Puerto Rican Adults Varies by Acculturation Construct and Dietary Measure

Background

The role of acculturation in dietary behaviors among Hispanics/Latinos in the United States remains unclear. Discrepancies may be explained by variations in acculturation constructs or ethnicity-specific dynamics.

Objective

We aimed to compare relations between 3 different acculturation constructs with dietary quality and patterns among Puerto Ricans in the mainland United States.

Methods

We analyzed cross-sectional data with 1194-1380 Puerto Ricans, aged 45-75 y. Acculturation was measured with the use of a language-based scale (0-100; higher score denotes more English use), a psychological-based scale (0-50; higher score denotes stronger US orientation), and years living in the mainland United States. Diet quality scores (higher scores denote healthier diet) were defined with the use of the Alternate Healthy Eating Index-2010 (AHEI) and the Mediterranean Diet Score (MeDS). Three dietary patterns were previously derived with the use of principal components analysis. Adjusted multivariable regression models tested the association of each acculturation construct with diet quality score or pattern. Interaction terms were included for income or education status.

Results

Psychological-based acculturation, but not the other constructs, was positively associated with AHEI (β ± SE: 0.013 ± 0.004; P = 0.002) and MeDS (0.009 ± 0.005; P = 0.041). Income, but not education, moderated this association (P = 0.03), with higher diet quality observed with higher income (>$25,000) and stronger US orientation. All constructs were inversely associated with a traditional dietary pattern, with the language-based scale being stronger (z score β ± SE: -0.160 ± 0.032; P < 0.0001) than the psychological-based scale (-0.097 ± 0.028; P = 0.001) or years living in the mainland United States (-0.058 ± 0.028; P = 0.041). No associations were observed for the Western or sweets/desserts patterns.

Conclusions

In Puerto Rican adults, stronger psychological US orientation was associated with higher diet quality, particularly with higher income. More Spanish use, stronger psychological Puerto Rican orientation, and shorter length of mainland-US residency were associated with traditional dietary patterns. Appropriate diet-related acculturation constructs should be carefully considered among Hispanics/Latinos. This trial was registered at clinicaltrials.gov as NCT01231958.

Immigrant health trajectories in historical context: Insights from European immigrant childhood mortality in 1910

Recent studies of immigrant health have focused on an apparent paradox in which some new immigrants arrive healthier than expected but exhibit poorer health outcomes with duration of residence. Although a variety of explanations have been put forth for this epidemiological pattern, questions remain about the socio-historical generalizability of the empirical findings and accompanying theoretical explanations. By examining childhood mortality patterns of European immigrants to the United States in the early 20th century, this study tests hypotheses from current immigrant health literature in a previous era of immigration. In contrast with post-1965 immigrant groups, European arrivals did not have better outcomes than their U.S.-born white counterparts. Rather, their rates corresponded to a "middle tier" status in between U.S.-born black and white populations. Analysis of post-migration trajectories returned mixed results that similarly differ from contemporary patterns. Many new immigrant groups had higher rates of excess childhood mortality than their U.S-born counterparts, but outcomes appear to have improved with duration of residence or among the second generation. These findings suggest socio-historical variation in the context of reception may act as a "fundamental cause" of immigrant health and mortality outcomes.

Acculturation and dietary intake pattern among Jamaican immigrants in the US

Information on dietary intakes of Jamaican immigrants in the United States is sparse. Understanding factors that influence diet is important since diet is associated with chronic diseases. This study examined the association between acculturation, socio-cultural factors, and dietary pattern among Jamaican immigrants in Florida. Jamaican persons 25–64 years who resided in two South Florida counties were recruited for participation. A health questionnaire that assessed acculturation, dietary pattern, and risk factors for cardiovascular disease was administered to participants. Generalized Estimating Equations were used to determine associations. Acculturation score was not significantly associated with dietary intake pattern (β = − 0.02 p = 0.07). Age at migration was positively associated with traditional dietary pattern (β = 0.02 p < 0.01). Persons with 12 or fewer years of education (β = − 0.55 p < 0.001), divorced (β = − 0.26 p = 0.001), or engaged in less physical activity (β = − 0.07 p = 0.01) were more likely to adhere to a traditional diet. Although acculturation was not a statistically significant predictor of dietary intake, findings show the role of demographic and lifestyle characteristics in understanding factors associated with dietary patterns among Jamaicans. Findings point to the need to measure traditional dietary intakes among Jamaicans and other immigrant groups. Accurate assessment of disease risk among immigrant groups will lead to more accurate diet-disease risk assessment and development of effective intervention programs.

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Age at migration was associated with traditional diet among Jamaican immigrants.

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Persons with lower educational attainment were more likely to eat traditional foods.

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Residing in an ethnic enclave was not associated with having a traditional diet.