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Omar M, Miller LE, Bhattacharyya S, Monga M. Implications of the Revised US Demographic Standards on Understanding Kidney Stone Disease Disparities in Middle Eastern and North African Americans. Urology 2024:S0090-4295(24)00489-8. [PMID: 38942393 DOI: 10.1016/j.urology.2024.06.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/26/2024] [Accepted: 06/19/2024] [Indexed: 06/30/2024]
Affiliation(s)
- Mohamad Omar
- Urology Department, Menoufia University, Shibin El Kom, Egypt
| | - Larry E Miller
- Department of Biostatistics, Miller Scientific, Johnson City, TN.
| | | | - Manoj Monga
- University of California San Diego, San Diego, CA
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2
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Lababidi H, Lababidi G, Rifai MA, Nasir K, Al-Kindi S. Cardiovascular disease in Arab Americans: A literature review of prevalence, risk factors, and directions for future research. Am J Prev Cardiol 2024; 18:100665. [PMID: 38634110 PMCID: PMC11021916 DOI: 10.1016/j.ajpc.2024.100665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/26/2024] [Accepted: 04/04/2024] [Indexed: 04/19/2024] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of mortality worldwide. Recent evidence suggests Arab Americans, individuals with ancestry from Arabic-speaking countries, have an elevated risk for CVD compared to other ethnicities in the US. However, research focusing specifically on CVD in this population is limited. This literature review synthesizes studies investigating CVD prevalence, risk factors, and outcomes in Arab Americans. Multiple studies found higher rates of coronary heart disease, cerebrovascular disease, and hypertension compared to non-Hispanic White participants. The prevalence of type 2 diabetes, a major CVD risk factor, was also markedly higher, ranging from 16 % to 41 % in Arab Americans based on objective measures. Possible explanations include high rates of vitamin D deficiency, genetic factors, and poor diabetes control. Other metabolic factors like dyslipidemia and obesity did not consistently differ from general population estimates. Psychosocial factors may further increase CVD risk, including acculturative stress, discrimination, low health literacy, and barriers to healthcare access. Smoking, especially waterpipe use, was more prevalent in Arab American men. Though heterogenous, Arab Americans overall appear to have elevated CVD risk, warranting tailored screening and management. Culturally appropriate educational initiatives on CVD prevention are greatly needed. Future directions include better characterizing CVD prevalence across Arab American subgroups, delineating genetic and environmental factors underlying increased diabetes susceptibility, and testing culturally tailored interventions to mitigate CVD risks. In summary, this review highlights concerning CVD disparities in Arab Americans and underscores the need for group-specific research and preventive strategies.
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Affiliation(s)
- Hossam Lababidi
- Houston Methodist DeBakey Heart and Vascular Institute, Houston Methodist Hospital, 6550 Fannin St, Houston, TX 77030, United States
| | - Ghena Lababidi
- Medical program, American University of Beirut, United States
| | - Mahmoud Al Rifai
- Houston Methodist DeBakey Heart and Vascular Institute, Houston Methodist Hospital, 6550 Fannin St, Houston, TX 77030, United States
| | - Khurram Nasir
- Houston Methodist DeBakey Heart and Vascular Institute, Houston Methodist Hospital, 6550 Fannin St, Houston, TX 77030, United States
| | - Sadeer Al-Kindi
- Houston Methodist DeBakey Heart and Vascular Institute, Houston Methodist Hospital, 6550 Fannin St, Houston, TX 77030, United States
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Albdour M, DiMambro MR, Solberg MA, Jenuwine ES, Kurzer JAMJ, Hong JS. Association of adversities and mental health among first- and second-generation Arab American young adults. Res Nurs Health 2024; 47:208-219. [PMID: 37778014 DOI: 10.1002/nur.22340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 08/11/2023] [Accepted: 09/17/2023] [Indexed: 10/03/2023]
Abstract
The prevalence of mental health problems among young adults is widely recognized. However, limited research has examined the mental health of Arab American young adults specifically. To address this gap in the literature, this study aimed to investigate the effects of multiple stressors including adverse childhood experiences (ACEs), discrimination, and bullying victimization on the mental health of first- and second-generation Arab American young adults. The participants (N = 162) were recruited from a Midwest university using online and in-person methods. They were screened and completed a demographic questionnaire and self-report measures of ACEs, discrimination, bullying victimization, and mental health. Hierarchical multiple regression analysis was conducted to examine the effect of psychosocial stressors on mental health and the moderating effect of generation (first vs. second) on that relationship. Female gender, increased perceived discrimination, and more ACEs were associated with lower mental health scores (β = -0.316, p < 0.001, β = -0.308, p < 0.001, and β = -0.230, p = 0.002, respectively). There was a significant negative relationship between victimization and mental health for first-generation Arab Americans (β = -0.356, p = 0.010). However, that association all but disappeared for second-generation participants (β = 0.006, p = 0.953). The results highlight the impact of multiple adversities on Arab American young adults' mental health and indicate important nuances related to their generation in the association between bullying victimization and mental health. Implications for practice and future research are discussed.
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Affiliation(s)
- Maha Albdour
- College of Nursing, Wayne State University, Detroit, Michigan, USA
| | | | - Marvin A Solberg
- College of Nursing, Wayne State University, Detroit, Michigan, USA
| | | | | | - Jun Sung Hong
- School of Social Work, Wayne State University, Detroit, Michigan, USA
- Department of Social Welfare, Ewha Womans University, Seoul, South Korea
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4
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Albdour M, Templin T, Zilioli S, Hong JS, Lumley MA. Current and Cumulative Stress Experiences: A Model for Arab American Young Adults. J Am Psychiatr Nurses Assoc 2024; 30:364-377. [PMID: 36217725 DOI: 10.1177/10783903221110235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Maha Albdour
- Maha Albdour, PhD, APHN-BC, RN, College of Nursing, Wayne State University, Detroit, MI, USA
| | - Thomas Templin
- Thomas Templin, PhD, College of Nursing, Wayne State University, Detroit, MI, USA
| | - Samuele Zilioli
- Samuele Zilioli, PhD, Department of Family Medicine and Public Health Sciences, Department of Psychology, Wayne State University, Detroit, MI, USA
| | - Jun Sung Hong
- Jun Sung Hong, PhD, School of Social Work, Wayne State University, Detroit, MI, USA
| | - Mark A Lumley
- Mark A. Lumley, PhD, Department of Psychology, Wayne State University, Detroit, MI, USA
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5
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Chebli P, Strayhorn SM, Hanneke R, Muramatsu N, Watson K, Fitzgibbon M, Abboud S, Molina Y. A Scoping Review of Cancer Interventions with Arab Americans. J Immigr Minor Health 2024; 26:200-226. [PMID: 37266829 DOI: 10.1007/s10903-023-01497-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 06/03/2023]
Abstract
This scoping review provides an overview of cancer interventions implemented with Arab Americans across the cancer control continuum, including an examination of outcomes and implementation processes. The search strategy included database searching and reviewing reference lists and forward citations to identify articles describing interventions with Arab adults living in the US, with no restrictions on date of publication or research methodology. The review included 23 papers describing 12 unique cancer interventions. Most interventions focused on individual-level determinants of breast and cervical cancer screening; used non-quasi-experimental research designs to evaluate intervention effectiveness; and demonstrated improvements in short-term cancer screening knowledge. Implementation processes were less commonly described. Most interventions were culturally and linguistically tailored to communities of focus; were delivered in educational sessions in community settings; engaged with the community mostly for recruitment and implementation; and were funded by foundation grants. Suggestions for research and intervention development are discussed.
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Affiliation(s)
- Perla Chebli
- School of Public Health, University of Illinois at Chicago, Chicago, IL, USA.
- NYU Department of Population Health, NYU Grossman School of Medicine, New York, NY, 10016, USA.
| | - Shaila M Strayhorn
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Rosie Hanneke
- Information Services & Research Department at the Library of the Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Naoko Muramatsu
- School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Karriem Watson
- School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Marian Fitzgibbon
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Sarah Abboud
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Yamilé Molina
- School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
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Mansuri S, Daniel MN, Westrick JC, Buchholz SW. Physical Activity Behavior and Measurement in Arab American Women: An Integrative Review. JOURNAL OF PREVENTION (2022) 2023; 44:749-776. [PMID: 37728719 DOI: 10.1007/s10935-023-00746-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/20/2023] [Indexed: 09/21/2023]
Abstract
Physical activity (PA) is associated with cardiovascular health; however, in the U.S., only 20% of women are physically active, compared to 28% of men. Arab American women (AAW) experience unique barriers to engaging in the recommended PA. This review examines quantitative PA studies conducted with AAW with a specific focus on how PA outcomes were assessed. Studies were analyzed to explore: (a) types of PA behavior, (b) components of PA interventions/interest (if conducted), (c) PA measurement, and (d) translation of PA tools. After screening titles, abstracts, and a full-text review of articles from five different databases, 12 studies met the inclusion criteria. Leisure-time PA was the most readily used PA measure. Only two out of the 12 studies included women-only participants. There was a total of 10 cross-sectional studies and two quasi-experimental studies. All the studies used a self-report PA questionnaire; one study used a pedometer to measure PA. Six PA questionnaires were translated into Arabic. Future studies must explore the use of reliable and valid translated instruments, objective PA measures, and randomized controlled trial designs.
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Affiliation(s)
- Sudaba Mansuri
- College of Nursing, Rush University, 600 S. Paulina St., Suite 1080, Chicago, IL, 60612, United States.
| | - Manju N Daniel
- College of Nursing, Rush University, 600 S. Paulina St., Suite 1080, Chicago, IL, 60612, United States
| | | | - Susan W Buchholz
- College of Nursing, Michigan State University, East Lansing, United States
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Bhattacharya R, Chen N, Shim I, Kuwahara H, Gao X, Alkuraya FS, Fahed AC. Massive underrepresentation of Arabs in genomic studies of common disease. Genome Med 2023; 15:99. [PMID: 37993966 PMCID: PMC10664351 DOI: 10.1186/s13073-023-01254-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/08/2023] [Indexed: 11/24/2023] Open
Abstract
Arabs represent 5% of the world population and have a high prevalence of common disease, yet remain greatly underrepresented in genome-wide association studies, where only 1 in 600 individuals are Arab. We highlight the persistent and unaddressed underrepresentation of Arabs in genomic databases and discuss its impact on public health genomics and missed opportunities for biological discovery.
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Affiliation(s)
- Romit Bhattacharya
- Department of Medicine, Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, 185 Cambridge Street | CPZN 3.128, Boston, MA, 02114, USA
- Department of Medicine, Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - NingNing Chen
- Computational Biosciences Research Center (CBRC), King Abdullah University of Science and Technology (KAUST), Thuwal, Kingdom of Saudi Arabia
- Computer Science Program, Computer, Electrical and Mathematical Sciences and Engineering Division, King Abdullah University of Science and Technology (KAUST), Thuwal, Kingdom of Saudi Arabia
| | - Injeong Shim
- Department of Medicine, Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Digital Health, Samsung Medical Center, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic of South Korea
| | - Hiroyuki Kuwahara
- Computational Biosciences Research Center (CBRC), King Abdullah University of Science and Technology (KAUST), Thuwal, Kingdom of Saudi Arabia
- Computer Science Program, Computer, Electrical and Mathematical Sciences and Engineering Division, King Abdullah University of Science and Technology (KAUST), Thuwal, Kingdom of Saudi Arabia
| | - Xin Gao
- Computational Biosciences Research Center (CBRC), King Abdullah University of Science and Technology (KAUST), Thuwal, Kingdom of Saudi Arabia
- Computer Science Program, Computer, Electrical and Mathematical Sciences and Engineering Division, King Abdullah University of Science and Technology (KAUST), Thuwal, Kingdom of Saudi Arabia
| | - Fowzan S Alkuraya
- Department of Translational Genomics, Center for Genomic Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
| | - Akl C Fahed
- Department of Medicine, Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, 185 Cambridge Street | CPZN 3.128, Boston, MA, 02114, USA.
- Department of Medicine, Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
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Zahodne LB, Brauer S, Tarraf W, Morris EP, Antonucci TC, Ajrouch KJ. Measurement and structural invariance of a neuropsychological battery among Middle Eastern/North African, Black, and White older adults. Neuropsychology 2023; 37:975-984. [PMID: 36996172 PMCID: PMC10544699 DOI: 10.1037/neu0000902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
OBJECTIVE There is a lack of guidance on common neuropsychological measures among Arabic speakers and individuals who identify as Middle Eastern/North African (MENA) in the United States. This study evaluated measurement and structural invariance of a neuropsychological battery across race/ethnicity (MENA, Black, White) and language (Arabic, English). METHOD Six hundred six older adults (128 MENA-English, 74 MENA-Arabic, 207 Black, 197 White) from the Detroit Area Wellness Network were assessed via telephone. Multiple-group confirmatory factor analyses examined four indicators corresponding to distinct cognitive domains: episodic memory (Consortium to Establish a Registry for Alzheimer's Disease [CERAD] Word List), language (Animal Fluency), attention (Montreal Cognitive Assessment [MoCA] forward digit span), and working memory (MoCA backward digit span). RESULTS Measurement invariance analyses revealed full scalar invariance across language groups and partial scalar invariance across racial/ethnic groups suggesting a White testing advantage on Animal Fluency; yet this noninvariance did not meet a priori criteria for salient impact. Accounting for measurement noninvariance, structural invariance analyses revealed that MENA participants tested in English demonstrated lower cognitive health than Whites and Blacks, and MENA participants tested in Arabic demonstrated lower cognitive health than all other groups. CONCLUSIONS Measurement invariance results support the use of a rigorously translated neuropsychological battery to assess global cognitive health across MENA/Black/White and Arabic/English groups. Structural invariance results reveal underrecognized cognitive disparities. Disaggregating MENA older adults from other non-Latinx Whites will advance research on cognitive health equity. Future research should attend to heterogeneity within the MENA population, as the choice to be tested in Arabic versus English may reflect immigrant, educational, and socioeconomic experiences relevant to cognitive aging. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | - Simon Brauer
- Institute for Social Research, University of Michigan
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Sarsour NY, Ballouz D, Mokbel M, Hammoud M. Medical Trainees Comfort and Confidence in Providing Care to Arab and Muslim Patients at a Large Academic Medical Center. TEACHING AND LEARNING IN MEDICINE 2022; 34:246-254. [PMID: 34107830 DOI: 10.1080/10401334.2021.1930544] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 04/16/2021] [Accepted: 05/03/2021] [Indexed: 06/12/2023]
Abstract
PHENOMENON There are currently 3.5 million Americans of Arab descent and 3.45 million Muslims living in the United States. These rapidly growing populations face significant health disparities, which is likely in part due to the lack of culturally competent physicians trained to treat these populations. While the Institute of Medicine calls for cross-cultural training for all providers, it is not clear if this need is being met. The purpose of this study is to examine medical trainees' current level of cultural training and whether this corresponds to confidence in caring for Arab and Muslim patients. APPROACH The authors created an anonymous survey that was distributed via email to medical students and residents at Michigan Medicine between January and March 2020. Questions included trainees' comfort and confidence level in caring for Arab and Muslim patients, as well education received on this topic. FINDINGS Results showed that 41% of respondents were confident in their ability to take a history from an Arab patient immigrated to the U.S. Additionally, 55% of non-Muslim participants reported that they felt comfortable in caring for fasting patients, while only 24% felt confident in their ability to answer patient questions about fasting. Approximately half of respondents felt confident in their ability to examine an Arabic-speaking woman (47%) or woman wearing a hijab (49%). The majority of respondents had not received any training or education in the care of Arab patients (64%) or fasting patients (81%). INSIGHT Medical trainees at one large academic medical center in the state with the second largest Arab-American population, and one of the largest populations of Muslim-Americans lack comfort and confidence in providing culturally competent care for Arab and Muslim patients. Education of trainees about Arab and Muslim health should be implemented into the curriculum to optimize care delivered to this patient population.
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Affiliation(s)
| | - Dena Ballouz
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Majd Mokbel
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Maya Hammoud
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Alosaimy S, Mohammad I, Chahine EB, Saad A, Jaber LA, El‐Ghali A. Culturally Sensitive Recommendations for the Clinical Pharmacist to Engage the Arab American Patient. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Sara Alosaimy
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences Wayne State University Detroit Michigan
| | - Insaf Mohammad
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences Wayne State University Detroit Michigan
| | - Elias B. Chahine
- Department of Pharmacy Practice Gregory School of Pharmacy, Palm Beach Atlantic University West Palm Beach Florida
| | - Aline Saad
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences Wayne State University Detroit Michigan
| | - Linda A. Jaber
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences Wayne State University Detroit Michigan
| | - Amer El‐Ghali
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences Wayne State University Detroit Michigan
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Middle Eastern and North African Americans may not be perceived, nor perceive themselves, to be White. Proc Natl Acad Sci U S A 2022; 119:2117940119. [PMID: 35131945 PMCID: PMC8851556 DOI: 10.1073/pnas.2117940119] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 11/18/2022] Open
Abstract
The US government’s classification of Middle Eastern and North African (MENA) Americans as White means there is no direct way to numerically count members of this group in official statistics. Therefore, any potential disparities and inequalities faced by MENA Americans remain hidden. Nevertheless, we find that MENA Americans may not be perceived, nor perceive themselves, to be White. These findings underscore the minoritized status of MENA Americans and support the inclusion of a new MENA identity category in the US Census. This would allow researchers to examine the social, economic, and health status of this growing population and empower community advocates to ameliorate existing inequalities. People of Middle Eastern and North African (MENA) descent are categorized as non-White in many Western countries but counted as White on the US Census. Yet, it is not clear that MENA people see themselves or are seen by others as White. We examine both sides of this ethnoracial boundary in two experiments. First, we examined how non-MENA White and MENA individuals perceive the racial status of MENA traits (external categorization), and then, how MENA individuals identify themselves (self-identification). We found non-MENA Whites and MENAs consider MENA-related traits—including ancestry, names, and religion—to be MENA rather than White. Furthermore, when given the option, most MENA individuals self-identify as MENA or as MENA and White, particularly second-generation individuals and those who identify as Muslim. In addition, MENAs who perceive more anti-MENA discrimination are more likely to embrace a MENA identity, which suggests that perceived racial hostility may be activating a stronger group identity. Our findings provide evidence about the suitability of adding a separate MENA label to the race/ethnicity identification question in the US Census, and suggest MENAs’ official designation as White may not correspond to their lived experiences nor to others’ perceptions. As long as MENA Americans remain aggregated with Whites, potential inequalities they face will remain hidden.
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Samuels EA, Orr L, White EB, Saadi A, Padela AI, Westerhaus M, Bhatt AD, Agrawal P, Wang D, Gonsalves G. Health Care Utilization Before and After the "Muslim Ban" Executive Order Among People Born in Muslim-Majority Countries and Living in the US. JAMA Netw Open 2021; 4:e2118216. [PMID: 34328502 PMCID: PMC8325073 DOI: 10.1001/jamanetworkopen.2021.18216] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE The health effects of restrictive immigration and refugee policies targeting individuals from Muslim-majority countries are largely unknown. OBJECTIVE To analyze whether President Trump's 2017 executive order 13769, "Protecting the Nation from Foreign Terrorist Entry into the United States" (known as the "Muslim ban" executive order) was associated with changes in health care utilization by people born in targeted nations living in the US. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included adult patients treated at Minneapolis-St. Paul HealthPartners primary care clinics or emergency departments (EDs) between January 1, 2016, and December 31, 2017. Patients were categorized as (1) born in Muslim ban-targeted nations, (2) born in Muslim-majority nations not listed in the executive order, or (3) non-Latinx and born in the US. Data were analyzed from October 1, 2019, to May 12, 2021. EXPOSURES Executive order 13769, "Protecting the Nation from Foreign Terrorist Entry into the United States." MAIN OUTCOMES AND MEASURES Primary outcomes included the number of (1) primary care clinic visits, (2) missed primary care appointments, (3) primary care stress-responsive diagnoses, (4) ED visits, and (5) ED stress-responsive diagnoses. Visit trends were evaluated before and after the Muslim ban issuance using linear regression, and differences between the study groups after the executive order issuance were evaluated using difference-in-difference analyses. RESULTS A total of 252 594 patients were included in the analysis: 5667 in group 1 (3367 women [59.4%]; 5233 Black individuals [92.3%]), 1254 in group 2 (627 women [50%]; 391 White individuals [31.2%]), and 245 673 in group 3 (133 882 women [54.5%]; 203 342 White individuals [82.8%]). Group 1 was predominantly born in Somalia (5231 of 5667 [92.3%]) and insured by Medicare or Medicaid (4428 [78.1%]). Before the Muslim ban, primary care visits and stress-responsive diagnoses were increasing for individuals from Muslim-majority nations (groups 1 and 2). In the year after the ban, there were approximately 101 additional missed primary care appointments among people from Muslim-majority countries not named in the ban (point estimate [SE], 6.73 [2.90]; P = .02) and approximately 232 additional ED visits by individuals from Muslim ban-targeted nations (point estimate [SE], 3.41 [1.53]; P = .03). CONCLUSIONS AND RELEVANCE Results of this cohort study suggest that after issuance of the Muslim ban executive order, missed primary care appointments and ED visits increased among people from Muslim-majority countries living in Minneapolis-St. Paul.
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Affiliation(s)
- Elizabeth A. Samuels
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Lilla Orr
- Department of Political Science, Yale University, New Haven, Connecticut
| | - Elizabeth B. White
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Altaf Saadi
- Department of Neurology, Massachusetts General Hospital, Boston
| | - Aasim I. Padela
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee
| | | | - Aarti D. Bhatt
- Division of General Internal Medicine, University of Minnesota, Minneapolis
| | - Pooja Agrawal
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Dennis Wang
- Yale School of Medicine, New Haven, Connecticut
| | - Gregg Gonsalves
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
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Relationships Between Personal Satisfaction, Cardiovascular Disease Risk, and Health Promoting Behavior Among Arab American Middle-Aged Women. J Cardiovasc Nurs 2020; 36:273-282. [PMID: 32398497 DOI: 10.1097/jcn.0000000000000690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of death among middle-aged women. Health-promoting behavior is essential to the prevention of CVD. During middle adulthood, women experience biopsychosocial changes that may reduce personal satisfaction and affect health-promoting behavior and CVD risk. OBJECTIVE This study aimed to examine the impact of personal satisfaction on health-promoting behavior and CVD risk in middle-aged Arab American women. METHODS A convenience sample of 114 middle-aged Arab American women was recruited from 2 clinical sites in Michigan in the United States. Participants completed a demographic questionnaire, the Health-Promoting Lifestyle Profile-II, the Multidimensional Scale of Perceived Social Support, the Satisfaction With Life Scale, the Rosenberg Self-esteem Scale, and a single item assessing health satisfaction. Risk for CVD was calculated using the 10-year atherosclerotic CVD Risk Estimator. RESULTS Health-promoting behavior was significantly correlated with self-satisfaction (r = 0.54, P < .0001), health satisfaction (r = 0.45, P < .0001), and life satisfaction (r = 0.41, P < .0001). Risk for CVD was significantly negatively correlated with self-satisfaction (r = -0.17, P = .039), health satisfaction (r = -0.18, P = .029), and life satisfaction (r = -0.27, P = .002). Self-satisfaction and health satisfaction accounted for 32% of the variance in health-promoting behavior (F = 7.568, P < .0001). Age and life satisfaction accounted for 50% of the variance in CVD risk score (F = 58.28, P < .0001). CONCLUSIONS Personal satisfaction was associated with health-promoting behavior and CVD risk. Future research would benefit from the inclusion of longitudinal data and comparative groups.
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14
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Abuelezam NN, El-Sayed AM, Galea S. Differences in health behaviors and health outcomes among non-Hispanic Whites and Arab Americans in a population-based survey in California. BMC Public Health 2019; 19:892. [PMID: 31286920 PMCID: PMC6613261 DOI: 10.1186/s12889-019-7233-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/24/2019] [Indexed: 01/09/2023] Open
Abstract
Background Few population-based studies of Arab American health behaviors and outcomes exist outside of Michigan. We aimed to provide prevalence estimates of health behaviors and outcomes for Arab Americans and compare them to non-Hispanic Whites in California. Methods We used data from the 2003–2016 California Health Interview Surveys. We determined Arab American ethnicity using an algorithm that considered place of birth of the respondent or parent and use of Arabic language at home. Survey-weighted frequencies, chi-squared statistics, and logistic regression analyses were used to compare Arab Americans and non-Hispanic Whites on socioeconomic indicators, health behaviors and health outcomes. Multivariable models were adjusted for age, education level, and insurance status. Results Arab Americans had higher prevalence of no insurance, living below the federal poverty level, and home ownership than non-Hispanic Whites despite high levels of education and low unemployment prevalence. Arab Americans had reduced odds of alcohol consumption (OR: 0.33, 95% CI: 0.24, 0.45), binge drinking (OR: 0.28, 95% CI: 0.19, 0.40), and suicidal ideation (OR: 0.41, 0.25, 0.66) when compared to non-Hispanic Whites in multivariable models. Arab Americans had decreased odds of hypertension (OR: 0.64, 95% CI: 0.50, 0.83) and increased odds of diabetes (OR: 2.03, 95% CI: 1.23, 3.34) when compared to non-Hispanic Whites in multivariable models. Conclusions Arab Americans in California participate in less risky health behaviors and have better health outcomes than non-Hispanic Whites, except with regards to diabetes. Future work aiming to understand the health of Arab Americans should allow for self-identification and less reliance on country of origin and language use at home for sample selection.
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Affiliation(s)
- Nadia N Abuelezam
- Boston College, William F. Connell School of Nursing, 140 Commonwealth Avenue, Maloney Hall 352, Chestnut Hill, MA, 02467, USA.
| | | | - Sandro Galea
- School of Public Health, Boston University, Boston, MA, USA
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15
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Abuelezam NN, El-Sayed AM, Galea S. The Health of Arab Americans in the United States: An Updated Comprehensive Literature Review. Front Public Health 2018; 6:262. [PMID: 30255009 PMCID: PMC6141804 DOI: 10.3389/fpubh.2018.00262] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/22/2018] [Indexed: 01/09/2023] Open
Abstract
Background: Arab Americans are a historically understudied minority group in the United States and their health needs and risks have been poorly documented. We aim to provide an updated comprehensive review of the literature on Arab American physical and mental health and provide suggestions for future work in this field. Methods: A comprehensive review of the English language medical and public health literature published prior to 2017 identified through multiple database searches was conducted with search terms describing Arab Americans and health outcomes and behaviors. The literature was qualitatively summarized by health behavior (vaccination, tobacco use, drug and alcohol use, and physical activity), health outcome (diabetes, mental health, cardiovascular disease, cancer, women's, and child health), and populations at increased risk of poor health outcomes (adolescents and the elderly). Results: The majority of studies identified exploring Arab American health have been published since 2009 with an increase in the number of longitudinal and intervention studies done with this population. The majority of research is being undertaken among individuals living in ethnic enclaves due to the lack of an ethnic or racial identifier that may help identify Arab Americans from population-based studies. Studies highlight the conflicting evidence in the prevalence of diabetes and cardiovascular disease based on study sample, an increased understanding of cancer incidence and barriers to identification, and an increased level of knowledge regarding mental health and sexual health needs in the population. Information on health behaviors has also increased, with a better understanding of physical activity, alcohol and drug use, and vaccination. Conclusion: More research on Arab American health is needed to identify risks and needs of this marginalized population given the current social and political climate in the United States, especially with regard to acculturation status and immigrant generation status. We provide recommendations on approaches that may help improve our understanding of Arab American health.
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Affiliation(s)
- Nadia N Abuelezam
- Boston College, William F. Connell School of Nursing, Chestnut Hill, MA, United States
| | | | - Sandro Galea
- School of Public Health, Boston University, Boston, MA, United States
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16
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Salma J, Hunter KF, Ogilvie L, Keating N. An Intersectional Exploration: Experiences of Stroke Prevention in Middle-Aged and Older Arab Muslim Immigrant Women in Canada. Can J Nurs Res 2018. [PMID: 29536774 DOI: 10.1177/0844562118760076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Arab immigrants have increasing rates of stroke and uncontrolled stroke risk factors coupled with minimal resources for stroke prevention. Purpose This article describes the results of an interpretive descriptive study about Arab immigrant women's experiences of practicing stroke prevention. We use an intersectionality approach to discuss some of the factors that influenced women's ability to manage their health. Methods Sixteen middle-aged and older Arab Muslim immigrant women were recruited between 2015 and 2016 from two religious centers in an urban Canadian center. Women were between the ages of 45 and 75 years, were living in the community, and had a combination of stroke risk factors. Semi-structured interviews lasting 2-3 h were conducted in Arabic by the primary bilingual researcher. Data analysis was completed in Arabic, with final themes and exemplars translated to English with the support of a certified translator. Results Study themes include relating life stressors to physical health, pursuing knowledge in the dark, negotiating medication and treatment options, making an effort to eat healthy and be active, and identifying triple ingredients for empowerment. Conclusion Economic status, access to transportation, language fluency, life stressors, and personal coping strategies influenced Arab women's ability to manage personal health.
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Affiliation(s)
- Jordana Salma
- 1 Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | | | - Linda Ogilvie
- 1 Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Norah Keating
- 2 Department of Human Ecology, University of Alberta, Edmonton, AB, Canada
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17
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Ajrouch KJ, Antonucci TC. Social Relations and Health: Comparing "Invisible" Arab Americans to Blacks and Whites. SOCIETY AND MENTAL HEALTH 2018; 8:84-92. [PMID: 30705780 PMCID: PMC6350821 DOI: 10.1177/2156869317718234] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This paper establishes preliminary benchmarks by comparing average values of social relations and health among Arab Americans, Blacks and Whites. Specifically, we expand traditional racial/ethnic categories to distinguish Arab Americans, historically and legally considered White. Data come from a unique random digit dial (RDD) sample of Arab Americans (N=96), Blacks (N=102) and Whites (N=100) from metro-Detroit collected in 2011, ranging in age from 19-89. Analysis of covariance (ANCOVA) was conducted to compare health, network structure, composition and support quality. Findings established preliminary benchmarks showing that Arab Americans reported more depressive symptoms (7.6) than Whites (5.2), but no difference in physical health. Arab Americans also reported more contact frequency (4.4) than Blacks (4.1) and Whites (4.0), yet lower proportions of networks comprised of the same ethnicity (77%) compared to Blacks (96%) and Whites (97%). Unpacking the White category to identify Arab Americans in a comparative analysis identified benchmarks to show how Arab American health and social relations are distinct from Blacks and Whites, yielding unique avenues for thinking about new ways to conceptualize how race and social relations impact health disparities.
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18
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Ajrouch KJ, Zahodne LB, Antonucci TC. Arab American Cognitive Aging: Opportunities for Advancing Research on Alzheimer's Disease Disparities. Innov Aging 2018; 1:igx034. [PMID: 30480122 PMCID: PMC6243697 DOI: 10.1093/geroni/igx034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Kristine J Ajrouch
- Department of Sociology, Anthropology and Criminology, Eastern Michigan University.,Institute for Social Research, University of Michigan
| | - Laura B Zahodne
- Institute for Social Research, University of Michigan.,Department of Psychology, University of Michigan
| | - Toni C Antonucci
- Institute for Social Research, University of Michigan.,Department of Psychology, University of Michigan
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19
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Havstad S, Sitarik AR, Johnson CC, Zoratti EM, Ownby DR, Levin AM, Wegienka G. Allergic sensitization in American children of Middle Eastern ethnicity at age 2. Ann Allergy Asthma Immunol 2017; 119:464-466. [PMID: 28941706 PMCID: PMC5694375 DOI: 10.1016/j.anai.2017.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 07/28/2017] [Accepted: 08/15/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Suzanne Havstad
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan.
| | - Alexandra R Sitarik
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan
| | | | - Edward M Zoratti
- Division of Allergy, Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Dennis R Ownby
- Department of Pediatrics, Augusta University, Augusta, Georgia
| | - Albert M Levin
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan
| | - Ganesa Wegienka
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan
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20
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Burghardt KJ, Masri DE, Dass SE, Shikwana SS, Jaber LA. Association between haptoglobin gene and insulin resistance in Arab-Americans. Biomark Med 2017; 11:937-945. [PMID: 29039222 DOI: 10.2217/bmm-2017-0094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To analyze associations between variation in the HP gene and lipid and glucose-related measures in Arab-Americans. Secondary analyses were performed based on sex. PATIENTS & METHODS Genomic DNA was extracted from samples obtained from a previous epidemiological study of diabetes in Arab-Americans. The HP 1 and 2 alleles were analyzed by polymerase chain reaction and gel electrophoresis. Associations were analyzed by linear regression. RESULTS & CONCLUSION Associations were identified between the heterozygous haptoglobin 2-1 genotype and insulin resistance, fasting insulin and fasting c-peptide. The effect of sex did not remain significant after adjustment for relevant variables. HP genetic variation may have utility as a biomarker of insulin resistance and diabetes risk in Arab-Americans, however, future prospective studies are needed.
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Affiliation(s)
- Kyle J Burghardt
- Eugene Applebaum College of Pharmacy & Health Sciences, Wayne State University, Detroit, MI 48201, USA
| | - Dana El Masri
- Eugene Applebaum College of Pharmacy & Health Sciences, Wayne State University, Detroit, MI 48201, USA
| | - Sabrina E Dass
- Department of Chemistry, Kalamazoo College, Kalamazoo, MI 49006, USA
| | - Sara S Shikwana
- Eugene Applebaum College of Pharmacy & Health Sciences, Wayne State University, Detroit, MI 48201, USA
| | - Linda A Jaber
- Eugene Applebaum College of Pharmacy & Health Sciences, Wayne State University, Detroit, MI 48201, USA
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21
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Abboud S, De Penning E, Brawner BM, Menon U, Glanz K, Sommers MS. Cervical Cancer Screening Among Arab Women in the United States: An Integrative Review. Oncol Nurs Forum 2017; 44:E20-E33. [PMID: 27991600 PMCID: PMC5553625 DOI: 10.1188/17.onf.e20-e33] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PROBLEM IDENTIFICATION Arab American women are an ethnic minority and immigrant population in the United States with unique and nuanced sociocultural factors that influence preventive health behaviors. The aims of this article are to evaluate and synthesize the existing evidence on cervical cancer screening behaviors, as well as determine factors that influence these behaviors, among Arab American women.
. LITERATURE SEARCH Extensive literature searches were performed using PubMed, CINAHL®, Scopus, Embase, and Cochrane databases; articles published through October 2015 were sought.
. DATA EVALUATION Of 17 articles, 14 explicitly identified Arab and/or Muslim women and cervical cancer screening in either the title or the abstract; the remaining three focused on cancer attitudes and behaviors in Arab Americans in general but measured cervical cancer screening. Eleven articles reported different aspects of one intervention. Because of methodologic heterogeneity, the current authors synthesized results narratively.
. SYNTHESIS Key factors influencing cervical cancer screening were identified as the following. CONCLUSIONS Cervical cancer screening rates among Arab American women are comparable to other ethnic minorities and lower than non-Hispanic White women. Findings are inconsistent regarding factors influencing cervical cancer screening behaviors in this underrepresented group.
. IMPLICATIONS FOR RESEARCH Significant need exists for more research to better understand cervical cancer prevention behaviors in this group to inform culturally relevant interventions. Healthcare providers play a crucial role in increasing cervical cancer screening awareness and recommendations for Arab American women.
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23
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Siddiqui K, Tyagi S. Genetics, genomics and personalized medicine in Type 2 diabetes: a perspective on the Arab region. Per Med 2015; 12:417-431. [DOI: 10.2217/pme.15.11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Type 2 diabetes (T2D) is a wide-spread, chronic metabolic disorder, affecting millions of people worldwide. The epidemic of diabetes has placed a huge strain on public health, longevity and economy. T2D occurs as a result of both genetic and environmental factors and is heterogeneous in its presentation across individuals. This review gives an overview of the genetic variations identified by genome-wide association studies which predispose individuals to T2D and those which are responsible for variable drug response across patients, and the necessity to adopt a personalized approach to diabetes management. We also include a perspective on diabetes in Arabs, given the high incidence of T2D and consanguineous marriages, and the need to understand associated genetic components in this vulnerable population.
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Affiliation(s)
- Khalid Siddiqui
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, P.O. Box 245, Riyadh 11411, Kingdom of Saudi Arabia
| | - Shivani Tyagi
- Freelance writer, Al Rajhi Street, Sulaimaniyah District, Riyadh, Kingdom of Saudi Arabia
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24
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El-Sayed AM, Paczkowski MM, March D, Galea S. Trends in the Mexican infant mortality paradox over the past two decades. Ann Epidemiol 2014; 24:831-6. [PMID: 25282323 DOI: 10.1016/j.annepidem.2014.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 09/10/2014] [Accepted: 09/11/2014] [Indexed: 12/01/2022]
Abstract
PURPOSE Mexicans in the United States have lower rates of several important population health metrics than non-Hispanic whites, including infant mortality. This mortality advantage is particularly pronounced among infants born to foreign-born Mexican mothers. However, the literature to date has been relegated to point-in-time studies that preclude a dynamic understanding of ethnic and nativity differences in infant mortality among Mexicans and non-Hispanic whites. METHODS We assessed secular trends in the relation between Mexican ethnicity, maternal nativity, and infant mortality between 1989 and 2006 using a linked birth-death data set from one US state. RESULTS Congruent to previous research, we found a significant mortality advantage among infants of Mexican relative to non-Hispanic white mothers between 1989 and 1991 after adjustment for baseline demographic differences (relative risk = 0.78, 95% confidence interval, 0.62-0.98). However, because of an upward trend in infant mortality among infants of Mexican mothers, the risk of infant mortality was not significantly different from non-Hispanic white mothers in later periods. CONCLUSIONS Our findings suggest that the "Mexican paradox" with respect to infant mortality is resolving. Changing sociocultural norms among Mexican mothers and changes in immigrant selection and immigration processes may explain these observations, suggesting directions for future research.
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Affiliation(s)
- Abdulrahman M El-Sayed
- Department of Epidemiology, Columbia University, New York, NY; College of Physicians and Surgeons, Columbia University, New York, NY.
| | | | - Dana March
- Department of Epidemiology, Columbia University, New York, NY
| | - Sandro Galea
- Department of Epidemiology, Columbia University, New York, NY
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