Duration of US Residence and Obesity Risk in NYC Chinese Immigrants

Understand nurse's perspectives on communication with Chinese-speaking cardiac patients

OBJECTIVES

To explore communication experiences, resource accessibility/quality, and communication strategies cardiac nurses use when caring for Chinese-speaking patients.

METHODS

In this exploratory qualitative study, nurses were recruited from professional association members and interviewed on communication barriers/facilitators, resource accessibility/quality, and communication strategies used when caring for Chinese-speaking cardiac patients. Transcripts were thematically analysed.

RESULTS

Nurses (n = 11) were primarily female (7/11), with 2/11 Chinese-speaking. The themes discussed centred on two areas that created difficulty in communication, including the lack of a common language and uncertainty of the Chinese culture. Dependence on interpreters was highlighted and challenges noted included limited availability and difficulty scheduling, variable quality and approaches, and lack of communication resources leading to a dependence on poor quality materials. Nurses were uncertain about Chinese culture and how to communicate, particularly in relation to family-centred beliefs, mental and sexual health, medication, and diet.

CONCLUSIONS

Health communication with Chinese-speaking patients needs to address multiple challenges to be effective.

PRACTICE IMPLICATIONS

The findings emphasise the need to optimise interpreting services and provide nurses with cultural competency training and tailored resources to improve their understanding of Chinese immigrants' needs. These recommendations will support nurses to address identified language and cultural uncertainties.

Experiences of victimization before resettlement and chronic disease among foreign-born people in the United States

Stressful experiences are common among migrants and may have health implications. With the only US nationally representative data set on migration, the New Immigrant Survey, we used survey-adjusted descriptive and multivariate regression methods to examine whether victimization prior to resettlement was associated with obesity, cardiovascular disease, diabetes, arthritis, cancer, and chronic lung disease. Among foreign-born people who obtained lawful permanent residence in the US in 2003-04, 6.7 per cent reported victimization before arriving in the US. Those who had experienced victimization more often suffered from chronic conditions than people without such experiences: they were 32 per cent more likely to suffer from at least one chronic condition (p < 0.05), especially cancer (4.36, p < 0.05), arthritis (1.77, p < 0.01), and cardiovascular disease (odds ratio 1.32, p < 0.05). These relationships were in part mediated by differences in healthcare access after arriving in the US between those who had experienced victimization and those who had not. Victimization may have consequences for integration and later-life chronic disease.

Unpacking the Association Between Length of Residence and Health Among Immigrants in Canada: A Moderated Mediation Approach

The present study examines (1) whether perceived life stress mediates the associations between length of residence in Canada and self-rated mental health and general health and (2) how these processes differ across levels of perceived local community belonging. Data are from the 2017-2018 Canadian Community Health Survey (N = 14,570)-a nationally representative survey collected by Statistics Canada. Simple mediation and moderated mediation models are employed. The simple mediated associations are evaluated first and found to be statistically significant for both self-rated mental health (b = 0.046, 95% PBCI = 0.035, 0.058) and general health (b = 0.045, 95% PBCI = 0.034, 0.056). Moderated mediation analysis then reveals that while perceived local community belonging does not moderate the effects of length of residence on perceived life stress, it does moderate the effects of perceived life stress on self-rated mental health (b = - 0.042, 95% PBCI = - 0.057, - 0.028) and general health (b = - 0.026, 95% PBCI = - 0.042, - 0.011), suggesting that the adverse associations between perceived life stress and self-rated mental health and general health are weaker among immigrants with greater perceived local community belonging. Consistent with the predictions, the indirect effects are significant at all levels of local community belonging. Findings from this study highlight the need to focus more research and policy interventions on community-based coping resources.

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

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

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

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

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

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

Acculturation, Physical Activity, and Metabolic Syndrome in Asian American Adults

INTRODUCTION

Asian Americans (AsAms) have a high prevalence of metabolic syndrome (MetS) and are one of the least physically active racial groups in America. The purpose of this study was to examine the relationship between MetS and moderate-to-vigorous physical activity (MVPA) among AsAm adults and whether acculturation modifies this relationship.

METHOD

Data were from 2,259 AsAms participating in the 2011-2016 National Health and Nutrition Examination Survey. Physical activity (PA) was self-reported as minutes of weekly MVPA. Acculturation included nativity, length of residency in America, and language preference. The International Diabetes Federation criteria was used to determine the presence of MetS.

RESULTS

About 64.4% of AsAms did not meet the PA recommendation (MVPA ≥150 min/week). The prevalence of MetS was 39.2%. The odds of having MetS were greater among AsAms who did not meet MVPA recommendations compared with those who did meet MVPA recommendations (odds ratio [OR] = 1.5, 95% confidence interval [CI] = [1.11, 2.07]). When stratified by acculturation, this association remained statistically significant in the groups who immigrated to America more than 15 years ago and who spoke English only.

CONCLUSION

MVPA reduces MetS risk in AsAm adults, especially among more acculturated AsAms. Culturally adapted programs are warranted to promote PA and adequate knowledge of disease prevention in this population.

Duration of US Residence And Resource Needs In Immigrant Families With Young Children

To mitigate the negative impact of resource needs on child health, practices serving low-income immigrant families have implemented screening programs to connect families to community resources. Little is known about how duration of US residence relates to patterns of resource needs and indicators of acculturation such as community resource knowledge/experience or self-efficacy. We conducted a cross-sectional analysis of a convenience sample of immigrant families with young children at an urban primary care clinic. These families were seen 5/2018-1/2020 for well child care, screening positive for ≥1 social need using a tool derived from Health Leads. Analysis of 114 families found that newly arrived families with a shorter duration of US residence (≤5 years) were more likely to report immediate material hardships like food insecurity and need for essential child supplies. Newly arrived families were also less likely to have access to technology resources such as a computer or smartphone. Long-term families with a longer duration of US residence (≥15 years) were more likely to report chronic needs like poor housing conditions, but also reported increased community resource knowledge/experience and increased self-efficacy. Primary care pediatric practices should assess immigration contextual factors to identify subgroups such as newly arrived families with young children to target resources (e.g., increase screening frequency) or enhance services (e.g., patient navigators) to relieve resource needs.

Cardiovascular Impact of Race and Ethnicity in Patients With Diabetes and Obesity: JACC Focus Seminar 2/9

Obesity and type 2 diabetes mellitus are highly prevalent and increasing in the United States among racial/ethnic minority groups. Type 2 diabetes mellitus, which is driven by many factors including elevated levels of adiposity, is an exemplar health disparities disease. Pervasive disparities exist at every level from risk factors through outcomes for U.S. racial/ethnic minority groups, including African American, Hispanic/LatinX American, and Asian American populations. Disparities in clinical care exist including hemoglobin A1c control, lower prescription rates of newer antihyperglycemic medications, along with greater rates of complications postbariatric surgery. Underpinning these disparities are the social determinants of health affecting provider-patient interactions, access to resources, and healthy built environments. We review the best practices to address cardiometabolic disparities in the current cardiovascular guidelines and describe recommendations for cross-cutting strategies to advance equity in obesity and type 2 diabetes across U.S. racial/ethnic groups.

Gender differences in acculturation and cardiovascular disease risk-factor changes among Chinese immigrants in Italy: Evidence from a large population-based cohort

Background

In recent decades, the Chinese presence in Southern Europe has grown rapidly but no data is available on the influence that residing in Mediterranean countries has on Chinese immigrants. In this study, we aim to examine the association between acculturation and cardiovascular risk factors among first-generation Chinese immigrants in Italy.

Design

Population-based, cross-sectional study.

Methods

A sample of 2589 Chinese first-generation immigrants (1599 women and 990 men) living in Prato, Italy, underwent blood pressure measurement, blood tests (with measurement of glucose, cholesterol, and triglycerides), and anthropometric measurements. The influence of length of residence (dependent variable) on hypertension, type 2 diabetes, overweight/obesity, and hyperlipidemia (high cholesterol) (independent variables) was investigated with multivariable logistic regression adjusted for age, sex, education and urban/rural home area in China before migration.

Results

Mean age of Chinese participants was 47.2 ± 10.7 years and 61.7% were women. Immigrants residing in Italy for ≥20 years were more likely to be hypertensive [odd ratio (OR) 1.84; 95% confidence interval (CI) 1.33 to 2.59], or diabetic (1.91; 1.26 to 2.86) than those residing in Italy for <10 years. Differently, prevalence of hypercholesterolemia (total cholesterol≥240 mg/dl) was lower in immigrants residing in Italy for ≥20 years than in those with <10 years of residence (0.52; 0.32 to 0.83). The association between indicators of acculturation and cardiovascular risk factors appeared to differ by sex.

Conclusion

Acculturation of Chinese immigrants in Italy was associated with hypertension and type 2 diabetes whereas a favorable effect on hypercholesterolemia was observed.

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.

Association among length of residence, physical activity, and obesity in the US immigrants: A regression-based mediation analysis

OBJECTIVES

To examine the mediated relationship between objectively measured obesity, accelerometer-based moderate-to-vigorous physical activity (MVPA), and length of residence among US immigrants.

METHODS

A total of 885 adults (≥18 years) who were born outside the United States from the 2003 to 2006 National Health and Nutrition Examination Survey were included in the analysis. The participants were categorized into two groups (i.e., living in the United States ≥15 years vs. <15 years). MVPA time (minutes/day) was measured by ActiGraph accelerometry. Obesity was defined as body fat percentage measured by dual-energy X-ray absorptiometry. Regression-based mediation analysis was conducted using SURVEY procedures in SAS version 9.4.

RESULTS

When controlling for covariates, immigrants living in the United States for ≥15 years were significantly less likely to spend time participating in MVPA (c; β = -4.50, p = .04), and more likely to be at high risk of obesity (a; β = 1.70, p = .01) compared to those living in the United States for <15 years. Also, the relationship between obesity and MVPA was statistically significant (b; β = -0.80, p = .003). Length of residence was indirectly associated with MVPA (ab; β = -1.37, p = .03), suggesting that obesity mediated the association of length of residence on MVPA (c'; β = -3.13, p = .20).

CONCLUSIONS

Obesity mediated the association between length of residence and MVPA in the US immigrants. These findings may encourage long-term US immigrants to prevent and treat obesity for increasing the amount of MVPA time.

Associations of Neighborhood Factors and Activity Behaviors: The Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study

Social and built environments may influence physical activity (PA). However, evidence for South Asian Americans (SAA), a group with low PA levels and high cardiometabolic risk, is lacking. We assessed the association between five neighborhood factors and PA behaviors in a community-based cohort of SAA. Data were from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study 2010-2013 (n = 906). Adjusted multivariable models stratified by sex regressing PA behaviors on neighborhood factors were run. Higher neighborhood social cohesion was associated with 17% more PA MET minutes/week in men (p < 0.01), but not in women. Having a park/playground near home was associated with meeting PA guidelines (odds ratio (95% CI): men: 3.14 (1.20-8.24); women: 3.67 (1.17-11.52). Neighborhood factors were associated with favorable PA behaviors in SAA. PA interventions for SAA that increase neighborhood social cohesion or focus on linking individuals with local resources may be effective.

Acculturation and Diet Among Chinese American Immigrants in New York City

BACKGROUND

There are limited data on the social and cultural determinants of dietary intake in Chinese Americans. Over 560,000 New York City residents are Chinese American, and there has been a growing trend over the past 30 y of permanent migration from China to the USA.

OBJECTIVES

The purpose of this secondary data analysis is to describe associations between diet, measured by self-report, and diet quality, with level of acculturation in a cross-sectional sample of urban-dwelling Chinese American immigrants.

METHODS

This was a cross-sectional study involving 2071 foreign-born Chinese American adults. Acculturation was assessed using the Stephenson Multigroup Acculturation Scale, diet using a Chinese-adapted FFQ, and diet quality using the Alternative Healthy Eating Index (AHEI). Multivariable regression was used to assess associations between ethnic (ESI; Chinese) and dominant (DSI; American) society immersion scores with self-reported dietary measures.

RESULTS

No significant associations were found between acculturation and overall AHEI score. Higher ESI and DSI scores were associated with higher vegetable, fruit, and nut/legume scores; a higher DSI score only was associated with higher whole grain and PUFA scores. A 1-unit increase in the ESI score was associated with a 0.005 (P = 0.009) lower red and processed meat component score, whereas a 1-unit increase in DSI score was associated with a 0.01 (P = 0.025) higher red and processed meat component score.

CONCLUSIONS

Assessment of acculturation level may help to tailor dietary strategies that are appropriate to what Chinese American immigrant communities are consuming to more effectively decrease the risk of chronic disease.

Dietary Patterns in Chinese Americans are Associated with Cardiovascular Disease Risk Factors, the Chinese American Cardiovascular Health Assessment (CHA CHA)

Little is known about the dietary patterns of Chinese Americans. Understanding their dietary patterns can provide insights for addressing cardiovascular disease (CVD) risk among Chinese American immigrants. The objective of this study was to identify dietary patterns among Chinese American immigrants living in New York City (NYC) and to describe associations with demographic and CVD risk factors. A validated Food Frequency Questionnaire assessed usual dietary intake in Chinese American immigrants living in NYC as part of the Chinese American Cardiovascular Health Assessment (CHA CHA) in 2010-2011 (n = 1973, age range 21-89 years). Principal components analysis with varimax rotation retaining three factors with eigenvalues > 1.5 identified dietary patterns. Multivariable linear regression models tested associations between CVD risk factors and dietary pattern scores. In multivariable analyses, each unit of increase in the Sweets factor was associated with 0.76 ± 0.33 (mean ± SD) mg/dL higher HDL cholesterol and a 6.2 ± 2.7% increase in HOMA-IR. In contrast, each unit increase in the Fried Noodles factor was associated with a 0.27 ± 0.11 inch greater waist circumference, - 0.89 ± 0.40 mg/dL lower HDL cholesterol, and also a 6.9 ± 2.6% increase in HOMA-IR. Each unit increase in the Vegetables factor was associated with a - 1.40 ± 0.43 mmHg and - 0.95 ± 0.27 mm Hg decrease in systolic and diastolic blood pressure, respectively. Dietary patterns are significantly associated with CVD risk factors among Chinese American immigrants in NYC. Future work will inform how dietary patterns relate to level of acculturation in order to guide the development of dietary interventions to reduce CVD risk.

Length of residence and obesity risk among North African immigrant women in Italy

Obesity is one of the major risks for chronic health conditions. Immigrants from low- and middle-income to high-income countries show a tendency to weight gain, with the country of origin, lifestyle habits, socioeconomic status and length of residence as the main factors involved. Thus, the aim of this study was to analyze the association between fat distribution and obesity with length of residence and other socio-demographic variables in a sample of North African women migrated to Italy. Socio-demographic variables were collected by structured face-to-face interview. For the assessment of weight status and body composition, various anthropometric traits were directly measured by an expert anthropometrist. Data were analyzed using ANCOVA adjusted for age to test the differences between length of residence (divided into three groups) and logistic regression models adjusted for covariates to test the association between overweight and/or obesity and length of residence. Significant differences between the three groups were observed in waist circumference (p = 0.004), waist-to-hip ratio (p = 0.001), and upper arm muscularity (p = 0.025), with higher values in those with longer duration of residence. In the crude logistic regression model length of residence resulted positively associated with obesity with the odds of being obese increased by 2.4 times in long term immigrants [OR 2.364 (0.766; 7.296)]. After adjusting for covariate the association remained significant [OR 3.584 (0.779; 16.480)], and being poorly educated [OR 5.737 (0.641; 51.363)], unemployed [OR 6.892 (0.940; 50.528)] and not practicing regular physical activity [OR 17.736 (1.569; 200.418)] increased the odds ratio of being obese. In conclusion, length of residence, socioeconomic status, and physical activity were significantly correlated with obesity, with a longer duration of residence being positively associated with central fat adiposity and upper arm muscle area in North African migrant women.

A cross-sectional analysis of dietary protein intake and body composition among Chinese Americans

Favourable body composition has been associated with higher dietary protein intake. However, little is known regarding this relationship in a population of Chinese Americans (CHA), who have lower BMI compared with other populations. The aim of the present study was to assess the relationship between dietary protein intake, fat mass (FM) and fat-free mass (FFM) in CHA. Data were from the Chinese American Cardiovascular Health Assessment (CHA CHA) 2010-2011 (n 1707); dietary intake was assessed using an adapted and validated FFQ. Body composition was assessed using bioelectrical impedance analysis. The associations between protein intake (% energy intake) and BMI, percentage FM (FM%), percentage FFM (FFM%), FM index (FMI) and FFM index (FFMI) were examined using multiple linear regression adjusted for age, sex, physical activity, acculturation, total energy intake, sedentary time, smoking status, education, employment and income. There was a significant positive association between dietary protein and BMI (B = 0·056, 95 % CI 0·017, 0·104; P = 0·005), FM (B = 0·106, 95 % CI 0·029, 0·184; P = 0·007), FM% (B = 0·112, 95 % CI 0·031, 0·194; P = 0·007) and FMI (B = 0·045, 95 % CI 0·016, 0·073; P = 0·002). There was a significant negative association between dietary protein and FFM% (B = -0·116, 95 % CI -0·196, -0·036; P = 0·004). In conclusion, higher dietary protein intake was associated with higher adiposity; however, absolute FFM and FFMI were not associated with dietary protein intake. Future work examining the relationship between protein source (i.e. animal) and body composition is warranted in this population of CHA.

Facilitators and Barriers to Healthy Eating in Aged Chinese Canadians with Hypertension: A Qualitative Exploration

Objectives: To determine the facilitators and barriers influencing healthy eating behaviours among aged Chinese-Canadians with hypertension. Methods: After attending five weeks of dietary educational training (Dietary Approach to Stop Hypertension with Sodium (Na) Reduction for Chinese Canadians; DASHNa-CC), 30 aged Chinese-Canadian participants partook in a telephone interview. Participants were asked to name three facilitators and three barriers that influenced their ability to follow the DASHNa-CC intervention. Telephone transcripts were then analyzed and coded using computer software and categorized into personal, familial, community, and societal facilitators or barriers. Results: Personal factors included health problems, motivation, effects of healthy diet, health-related careers, and dietary habits. Family factors included family structure, support from family members, and critical health events involving family members or relatives. Community factors consisted of educational materials, friends, primary care physicians, and online social networks. Societal factors included accessibility to grocery stores and restaurants. Conclusions: Aged Chinese-Canadian immigrants experience unique facilitators of and barriers to healthy eating, which may warrant further attention from healthcare professionals when educating patients in a culturally-sensitive manner.

Acculturation and activity behaviors in Chinese American immigrants in New York City

Asian Americans have lower levels of physical activity (PA) compared to other racial/ethnic groups; however, there is little understanding of the social and cultural determinants of PA in this population. Few analyses describe specific PA domains (occupation-, transportation-, recreation-related), focus on one Asian subgroup, or use validated scales. The study objective was to assess the association between acculturation and activity behaviors (meeting 2008 PA guidelines, activity minutes by PA domain, sitting time) in a cross-sectional sample of urban-dwelling, Chinese American immigrants. Data were from the Chinese American Cardiovascular Health Assessment (CHA CHA) 2010-11 among participants with valid reports of PA minutes, assessed by the WHO Global Physical Activity Questionnaire (n = 1772). Acculturation was assessed using the Stephenson Multigroup Acculturation Scale, a 32-item instrument which characterizes two acculturative dimensions: ethnic society (Chinese) immersion and dominant society (American) immersion (maximum possible scores = 4). Multivariable models regressing activity behaviors on acculturation were run, adjusting for age, sex, household income, education, and age at immigration. Ethnic society immersion was high (mean = 3.64) while dominant society immersion was moderate (mean = 2.23). Higher ethnic society immersion was associated with less recreation-related PA (- 40.7 min/week); higher dominant society immersion was associated with a higher odds of meeting PA guidelines (OR: 1.66 (1.25, 2.20), p < 0.001) and more recreation-related PA (+ 36.5 min/week). Given low PA levels in Chinese adults in China, results suggest that PA for leisure may increase and become a more normative behavior among Chinese American immigrants with acculturation. Understanding acculturation level may inform strategies to increase PA in Chinese Americans.