Social Relations and Health: Comparing "Invisible" Arab Americans to Blacks and Whites

Intergenerational Relations and Well-being Among Older Middle Eastern/Arab American Immigrants During the COVID-19 Pandemic

This study aimed to examine the consequences of COVID-19 socialization restrictions on familial and social support systems of older Middle Eastern/Arab immigrants in Michigan, home to the largest, most visible concentration of Middle Eastern/Arab Americans in the United States. Six focus group (N = 45) interviews were conducted with Middle Eastern/Arab American immigrants aged 60 and older to assess difficulties faced during the pandemic as it related to familial, social, and medical care. Inductive analysis identified two major themes to advance meanings of intergenerational relations among older immigrants (a) the breakdown of family relations, which describes a shift in both the experience and expectations of intergenerational relations in Middle Eastern/Arab families; and (b) cultural sources of increased stress, illustrating how the pandemic interfered with valued family interactions to affect well-being. These findings indicated social and cultural sources of heightened stress linked to shifts in intergenerational relations among Middle Eastern/Arab American older immigrants.

Current and Cumulative Stress Experiences: A Model for Arab American Young Adults

BACKGROUND

The effect of multiple stressors on immigrant young adults' endocrine functioning and health outcomes has not been comprehensively investigated.

AIMS

This study tested a theoretical model of cumulative and current stressor effects on the hypothalamic-pituitary-adrenocortical (HPA) axis functioning and health-related quality of life (HRQL) among Arab American young adults.

METHODS

Using a cross-sectional design, we recruited 160 participants, ages 18 to 24 years, from an urban university in the Midwest. Cumulative stress was assessed by self-report measures of childhood adversity, bullying victimization, and perceived ethnic discrimination. Current perceived stress was measured using the Perceived Stress Scale (PSS) while cortisol levels were measured in participants' hair. Structural equation modeling tested the effects of cumulative and current stress on cortisol and HRQL.

RESULTS

Cumulative stress was negatively associated with HRQL (standardized path coefficient = -.51, p < .05). Interestingly, however, cumulative stress was inversely associated with hair cortisol level (standardized path coefficient = -.51, p < .05). Current stress was positively associated with cortisol level (standardized path coefficient = .43, p < .05) and negatively associated with the mental HRQL (standardized path coefficient < -.37, p < .05).

CONCLUSION

Cumulative stress exhibited a different effect on HPA functioning from current perceived stress. Mental health was significantly impaired by both cumulative and current perceived stress. Implications for mental health nursing practice and research among Arab Americans are discussed.

Self-Reported Cognitive Aging and Well-Being among Older Middle Eastern/Arab American Immigrants during the COVID-19 Pandemic

BACKGROUND

The COVID-19 pandemic posed new challenges for cognitive aging since it brought interruptions in family relations for older adults in immigrant communities. This study examines the consequences of COVID-19 for the familial and social support systems of aging Middle Eastern/Arab immigrants in Michigan, the largest concentration in the United States. We conducted six focus groups with 45 participants aged 60 and older to explore participant descriptions of changes and difficulties faced during the pandemic relating to their cognitive health, familial and social support systems, and medical care. The findings indicate challenges around social distancing for older Middle Eastern/Arab American immigrants, which generated three overarching themes: fear, mental health, and social relationships. These themes provide unique insights into the lived experiences of older Middle Eastern/Arab American adults during the pandemic and bring to light culturally embedded risks to cognitive health and well-being. A focus on the well-being of older Middle Eastern/Arab American immigrants during COVID-19 advances understanding of how environmental contexts inform immigrant health disparities and the sociocultural factors that shape minority aging.

Mental Health in Indigenous Children and Adolescents: The Contribution of Cultural Backgroud

The purpose of this study is to describe and compare the prevalence of mental health problems in Aymara and non-Aymara children and adolescent. The study sample comprised 1839 students from 8 to 19 years, from educational institutions of Northern Chile. Forty-nine percent of students identified with the Aymara ethnic group. The Child and Adolescent Evaluation System was used to evaluate internal and external problems. In Elementary school, Aymara students showed significantly lower scores in externalized problems and in high school, there were significantly lower scores in interiorized, exteriorized and other problems than Non-Aymara students. It seems that the legacy of the Aymara culture has favored the development of protective factors in relation to the mental health of these students. In a context of growing recognition and appreciation of this culture, greater involvement with Aymara culture could promote better mental health of school children.

Cognitive Limitations Among Middle Eastern and North African Immigrants

OBJECTIVES

To estimate and compare the prevalence of cognitive limitations among Middle Eastern and North African (MENA) immigrants compared to US- and foreign-born non-Hispanic Whites from Europe (including Russia/former USSR) and examine differences after controlling for risk factors.

METHODS

Cross-sectional data using linked 2000-2017 National Health Interview Survey and 2001-2018 Medical Expenditure Panel Survey data (ages >=65 years, n = 24,827) were analyzed.

RESULTS

The prevalence of cognitive limitations was 17.3% among MENA immigrants compared to 9.6% and 13.6% among US- and foreign-born non-Hispanic Whites from Europe. MENA immigrants had higher odds (OR = 1.88; 95% CI = 1.06-3.34) of reporting a cognitive limitation than US-born non-Hispanic Whites after controlling for age, sex, education, hearing loss, hypertension, depression, social isolation, and diabetes.

DISCUSSION

To further examine cognitive health among the MENA aging population, policy changes are needed to identify this group that is often absent from research because of their federal classification as non-Hispanic Whites.

Disability, Discrimination, and Mental Health during the COVID-19 Pandemic: A Stress Process Model

Drawing on data from a community survey with a sizeable subsample of people with physical, intellectual, and psychological disabilities in the Intermountain West region of the United States (N = 2,043), this investigation examined the association of social stressors stemming from the COVID-19 pandemic with ableism or disability-related discrimination. We further assessed the significance of these associations for variation by disability status in psychological well-being with a moderated mediation analysis. Study findings provide clear evidence that greater pandemic-related stressor exposure was associated with greater discrimination, which in turn increased the psychologically distressing aspects of the pandemic for people with disabilities relative to people without disabilities. This set of findings challenges us to think about how we engage in research concerning ableism and the proliferation of macro-level stressors such as those associated with the COVID-19 pandemic. The findings also support the application of a minority stress model in addressing mental health contingencies among people with disabilities-in this case, in examining the pandemic's psychological impact.

Anorexia and Young Womens' Personal Networks: Size, Structure, and Kinship

Anorexia is a serious threat to young women's wellbeing worldwide. The effectiveness of mental health intervention and treatment is often evaluated on the basis of changes in the personal networks; however, the development of such measures for young women with anorexia is constrained due to the lack of quantitative descriptions of their social networks. We aim to fill this substantial gap. In this paper, we identify the basic properties of these women's personal networks such as size, structure, and proportion of kin connections. The empirical analysis, using a concentric circles methodology, is based on 50 ego networks constructed on data drawn from interviews with Russian-speaking bloggers who have been diagnosed with anorexia and write about this condition. We conclude that young women with anorexia tend to support a limited number of social ties; they are prone to select women as alters, but do not have a preference to connect to their relatives. Further research is needed to elucidate whether these personal network characteristics are similar among women with anorexia who belong to different age, ethnic, cultural, and income groups.

Injustice Through Cultural Lens: A Pilot Qualitative Exploration of Pain-Related Injustice Appraisals Among Arab-Americans with Chronic Low Back Pain

The current qualitative study sought to obtain an in-depth understanding of how Arab-Americans conceptualize perceived injustice concerning their chronic low back pain (CLBP) by reflecting on the Injustice Experience Questionnaire (IEQ). Twelve Arab-American adults with CLBP were recruited from a metropolitan area in Alabama using a purposive sampling technique. Participants took part in individual, face-to-face, semi-structured interviews reflecting on each statement from the IEQ. Descriptive data analysis was generated for demographic and pain variables. Directed content analysis was conducted to identify themes and sub-themes. 'Blame and unfairness' and 'severity and irreparability of loss,' the 2 established theoretical factors comprising pain-related injustice appraisal were used as predominant themes. Acceptance emerged as an inductive theme with the following sub-themes: positive appraisal and resilience, attempts to reduce pain, religious values and fate, and belief that everything happening for a reason. The influence of religion was noted across all themes. The current pilot findings suggest that Arabic culture, heavily infused with Islamic beliefs, influences how Arab-Americans conceptualize pain-related injustice appraisals. Additional exploration of the cultural appropriateness of the IEQ among individuals of Arab background is needed to further elaborate on the subject of faith and religious belief suggested by the current study. Perspective: Although the study findings largely reflected established injustice literature constructs, several emergent themes regarding pain-related injustice appraisal were influenced by the participants' culture and religious beliefs. These findings may indicate that specific psychotherapeutic approaches that have been proven effective among some groups may not function similarly in other populations.

Prevalence of Self-reported Cognitive Impairment Among Arab American Immigrants in the United States

Background and Objectives

Studies evaluating self-reported cognitive impairment among Arab American immigrants have not been conducted. Our objective was 2-fold: (a) to estimate and compare the age- and sex-adjusted prevalence of self-reported cognitive impairment between Arab American immigrants and U.S.- and immigrant non-Hispanic Whites, non-Hispanic Blacks, Hispanics and non-Hispanic Asians and (b) to examine associations between race, ethnicity, nativity status, and cognitive impairment among Arab American immigrants and non-Hispanic Whites (U.S.- and foreign-born) after controlling for explanatory factors.

Research Design and Methods

We used 18 years (2000–2017) of National Health Interview Survey data (n = 228 985; ages ≥ 45 years). Weighted percentages, prevalence estimates, and multivariable logistic regression models were calculated.

Results

The age- and sex-adjusted prevalence of self-reported cognitive impairment was significantly higher among Arab American immigrants (9.7%) compared to U.S.-born and non-Hispanic White immigrants (~7.4%).

Discussion and Implications

This is the first study to indicate that ethnic disparities in self-reported cognitive impairment may extend to Arab American immigrants. Additional studies need to be conducted to better understand the prevalence of cognitive impairment.

Partnering with Middle Eastern/Arab American and Latino Immigrant Communities to Increase Participation in Alzheimer's Disease Research

Purpose

Recruitment and retention of US ethnic groups traditionally underrepresented in research continues to pose challenges. The Michigan Center for Contextual Factors in Alzheimer's Disease (MCCFAD) engages with two underserved immigrant communities in Michigan - Middle Eastern/Arab Americans in metro-Detroit and Latinos in the Grand Rapids area - to recruit and retain two Participant Resource Pools (PRP).

Procedures

We adapt an existing community-based participatory research (CBPR) approach to recruit Middle Eastern/Arab American and Latino adults of all ages for Alzheimer's disease and related dementia (ADRD) research. Using American Community Survey (2014-2018) data, we compare socio-demographic characteristics of Middle Eastern/Arab Americans and Latinos living in Michigan to our PRPs. Assessment tools and community advisory board feedback identified missteps and culturally sensitive solutions.

Main Findings

In the first year of MCCFAD activities, 100 Middle Eastern/Arab Americans and 117 Latinos joined the MCCFAD PRPs. Comparisons to state-level data showed that PRP participants were on average older and more likely to be female than the Middle Eastern/Arab American and Latino populations in Michigan. Further, Middle Eastern/Arab Americans in the PRP reported higher education levels while Latinos reported lower education levels than their respective statewide populations. Community partnerships/feedback identified the importance of connecting with community leaders, attending to matters of within-group diversity, as well as language and semantics.

Conclusion

Partnership with communities to develop culturally targeted and sensitive community health events can fill a significant gap in addressing ADRD health disparities by establishing sustainable relationships to increase participation in ADRD research.

Racial and Citizenship Disparities in Health Care Among Middle Eastern Americans

OBJECTIVE

To assess differences in health access and utilization among Middle Eastern American adults by White racial identity and citizenship.

METHODS

Data from the 2011 to 2018 National Health Interview Surveys (N=1013) and survey-weighted logistic regression analyses compare Middle Eastern immigrants by race and citizenship on access and utilization of health care in the United States.

RESULTS

White respondents had 71% lower odds of delaying care [adjusted odds ratio (AOR)=0.34; 95% confidence interval (CI)=0.13, 0.71] and 84% lower odds of being rejected by a doctor as a new patient (AOR=0.16; 95% CI=0.03, 0.88) compared to non-White respondents. US citizens had higher odds of visiting the doctor in the past 12 months compared with noncitizens (AOR=1.76; 95% CI=1.25, 2.76).

CONCLUSION

Middle Eastern immigrants who do not identify as White and who are not US citizens are significantly less likely to access and utilize health care compared with those who identify as White and are US citizens.

POLICY IMPLICATIONS

This study shows that racial and citizenship disparities persist among Middle Eastern Americans at a national-level, playing a critical role in access to and use of health care.

A Descriptive Study of Bullying Victimization Among Arab American Adolescents in Southeast Michigan Middle and High Schools

PURPOSE

This cross-sectional study examined the frequency of different forms of bullying victimization (verbal, physical, and social), predictors of victimization, and whether bullying is reported to an adult.

DESIGN AND METHODS

The study utilized a community sample of 150 Arab American adolescents, age 12 to 16 years. The Adolescent Peer Relations Instrument-Victimization Scale was used to determine the participant's experiences of victimization in the past year. The adolescents indicated where bullying occurred, why, and whether they reported the incidence to an adult.

RESULTS

Approximately 30% of the study sample reported that victimization occurred occasionally (once a month or more frequent). Classrooms and hallways were the most common locations where bullying had occurred. Country-of-origin and obesity were the most frequent reasons for victimization. Predictors varied among the different forms of victimization; however, cyber-victimization [OR = 24.5; 95% CI 5-119.5)], perceived problematic attire [OR = 8.4; 95% CI 2.2-31.9)], female gender [OR = 5.2; 95% CI 1.2-22.7)], and being overweight [OR = 0.14; 95% CI 0.01-2.6)] all predicted overall victimization.

CONCLUSIONS

Our findings provide a foundation for future research focusing on Arab American adolescents, an underrepresented population, more research is needed to understand the scope of bullying victimization among Arab American adolescents.

PRACTICE IMPLICATIONS

This study will inform future intervention research and practice to consider victimization and related factors among Arab American adolescents. Culturally sensitive and multilevel interventions are imperative to decrease bullying victimization among Arab American adolescents and prevent negative effects on their health and families.

HIV Knowledge of Middle Eastern and North Africans 18-35 Residing in the U.S.: A Cross Sectional Study

The current body of literature on the HIV knowledge related to young adult Middle Eastern and North African (MENA) individuals residing in the United States is substantially underdeveloped. As the number of MENA individuals residing in the US continues to rise, there remains a need for research investigating the levels of general HIV knowledge for this unique group. An exploratory cross-sectional design was used for an anonymous online survey of MENA adults ages 18-35 (n = 198) residing in the United States concerning their levels of HIV knowledge. Results showed that less than fifty percent (46.40%) of the sample reported adequate knowledge of HIV transmission and prevention methods. Multiple regression analyses indicate that prior sexual health education, prior HIV testing, a four-year college degree and identification as a Muslim predicted higher HIV knowledge. These findings may assist with the development of MENA specific HIV prevention and education programs.

Social Relations Across the Life Span: Scientific Advances, Emerging Issues, and Future Challenges

Accumulating evidence demonstrates the importance of social relations at all stages of life (infancy, childhood, adolescence, adulthood, and old age) and in diverse domains of life (including health and well-being). To illustrate the newest advancements in the scientific study of social relations over the life course, we address five emerging areas of importance: societal and demographic changes in family structure; effects of new technologies on social relations; the fundamental influence of context on social relations, illustrated with the sample case of health; the role of social relations in the unfortunate but pressing crisis of trauma among the increasing number of refugees worldwide; and, finally, effects of social relations on cognitive functioning in late life. Each of these areas highlights critical key concepts and methodological approaches, illustrating that the study of social relations is demanding but holds great promise for meeting the urgent needs of developmental science specifically and society generally.

Disparities in functional disability among Arab Americans by nativity, immigrant arrival cohort, and country of birth

This study contributes to a growing literature that documents the importance of arrival cohort and country of birth for differentiating the health of U.S. immigrants. We use nationally-representative data from nine years of the American Community Survey (2008-2016) to examine if an immigrant health advantage exists among Arab Americans ages 40+ (n = 49,867) and test if differences among the foreign-born vary by arrival cohort (pre-1991, 1991-2000, and 2001+). Results from multivariate logistic regression models find that foreign-born Arab Americans have higher odds of physical and self-care disability, and this varies by immigrant arrival cohort. The post-2001 cohort had the highest odds of both disabilities, while the earlier two cohorts did not differ from the native-born after adjustments for covariates. Compositional differences in birthplace, particularly the large influx of immigrants from Iraq in the most recent cohort, explained these differences. Political instabilities globally have contributed to a growing number of U.S. immigrants with vulnerabilities that might be overlooked when arrival cohorts are not considered.

Sociodemographic Differences in Humility: The Role of Social Relations

The present research builds upon recent scientific developments in the field of social relations and ongoing advances in the study of humility. We examine whether gender, education, and racial/ethnic group are associated with humility as well as how social relations mediate the association between these sociodemographic variables and humility across the life course. Data are from the Detroit Community Study and were collected via a telephone survey focused on three groups prominent in the metro-Detroit area: Arab Americans, African Americans, and Non-Hispanic White Americans (N=907). Findings indicate that racial/ethnic group membership is associated with humility. Arab Americans and African Americans report greater humility than Whites. Further, social relations partially mediate this association, but only among Arab Americans. Arab Americans report a higher proportion of family than White Americans, which are associated with greater humility. Examination of whether these links depend on age indicates that the partial mediating role of social relations on the link between race/ethnicity and humility is replicated among older, but not younger adults. Findings are discussed within a developmental science perspective to consider the relational aspects of the individual and context over the life course.

Arab American Cognitive Aging: Opportunities for Advancing Research on Alzheimer's Disease Disparities

BACKGROUND AND OBJECTIVES

This article highlights the dearth of and need for research on Arab American cognitive aging. We propose that studying cognitive health issues among older Arab Americans provides an innovative opportunity to advance knowledge about causes and consequences of Alzheimer's disease (AD) disparities and refine understanding of factors linked to immigrant health in the United States.

RESEARCH DESIGN AND METHODS

Demographic information is provided on Arab Americans, who are on the cusp of being recognized by the U.S. government as a distinct ethnic group separate from whites. In the tradition of minority aging, we present a broad review of specific issues in the contemporary case of Arab Americans.

RESULTS

We detail how including Arab Americans provides unique information on the importance of: (i) extending racial/ethnic group comparisons; (ii) linking social experiences to late-life cognitive health; and (iii) incorporating ethnic factors related to immigration and religion in the study of AD disparities.

DISCUSSION AND IMPLICATIONS

Studying Arab American cognitive aging provides an innovative opportunity to more fully delineate factors that create and sustain health disparities, with special insights into both causes and consequences.