Racial Context and Health Behaviors Among Black Immigrants

Substance use among U.S. Black young adults: examining the influence of nativity, racial stressors and societal concerns

OBJECTIVE

There is increased ethnic diversity of Black Americans as a result of increasing migration. However, it is unclear whether the diverse sociocultural contexts and experiences of U.S.- and foreign-born Black young adults (YA) are similarly associated with substance use behaviors. With a rise in psychosocial stressors among YA in the U.S., this study examined whether there are nativity differences in the association of societal concern, experience of racist events, and discrimination with nicotine/tobacco, cannabis, and binge-drinking among U.S.- and foreign-born Black YA.

METHODS

This pilot study used data collected in 2023 from a nationwide, non-probability sample of 484 young adults (182 foreign-born and 302 U.S.-born) aged 18-25 years. Nativity differences in demographic characteristics, study predictors, and substance use were assessed using two sample t-tests and chi-squared tests. Multivariable logistic regression analyses were used to examine the association of societal concern, racism, and discrimination with nicotine/tobacco use, cannabis use, and binge drinking overall and stratified by nativity.

RESULTS

While foreign-born and U.S.-born Black YA had similar mean societal concern and racist experience scores, everyday discrimination was significantly higher among U.S.-born YA (p = 0.002). Societal concern was associated with reduced odds of nicotine/tobacco use in the overall sample (AOR = 0.90, 95% CI 0.83, 0.97) and among foreign-born Black YA (AOR = 0.79, 95% CI 0.66-0.94). Experience of racist events was consistently associated with increased odds of all substances assessed in the overall sample and among the sub-groups, with the exception of binge drinking among U.S.-born YA and cannabis and nicotine/tobacco use among foreign-born YA.

CONCLUSIONS

Despite similarities among foreign- and U.S.-born Black YA, exposure to these psychosocial stressors is associated with some distinct substance use patterns. These findings highlight the nuanced relationships between societal and discriminatory stressors and substance use, varying by nativity among Black YA.

Drinking patterns among US men and women: Racial and ethnic differences from adolescence to early midlife

BACKGROUND

Drinking patterns among young adult men and women in the United States have been understudied, especially among racial and ethnic groups such as Asian Americans and Hispanics. Because alcohol-related racial and ethnic health disparities persist or increase in midlife, identifying peak ages of hazardous drinking could help to reduce disparities.

METHODS

We used the National Longitudinal Study of Adolescent to Adult Health to examine: (1) past 12-month heavy episodic drinking (HED) and total alcohol volume consumption among non-Hispanic White (NHW), Black, Hispanic, and Asian men and women from ages 12 through 41, and (2) age-varying associations of race and ethnicity with drinking. Hispanic and Asian ethnic groups were disaggregated by historical drinking patterns. Time-varying effect models accounted for major demographic confounders.

RESULTS

NHW men and women experienced elevated drinking rates in their early 20s, with a second elevation in their 30s. Black men and women did not have elevated drinking until their 30s. Among Hispanic men and women, peak drinking periods varied by gender and subgroup drinking pattern. Peak HED and total consumption emerged in the early 30s for Asian men, while peak HED occurred in the early 20s for Asian women. Drinking at certain ages for some racial and ethnic minoritized men and women did not differ from that in their NHW counterparts.

CONCLUSIONS

Age periods during which subgroups in the U.S. population experience elevated alcohol consumption vary by ethnicity and gender. Recognition of these group differences could enhance our understanding of intervention timing.

Food Insecurity Disparities Among Immigrants in the U.S

Introduction

Food insecurity negatively impacts public health and costs the U.S. healthcare system $53 billion annually. Immigrants are at higher risk of food insecurity. We sought to (1) characterize the prevalence of food insecurity among immigrants (i.e., noncitizens and naturalized citizens) and U.S.-born citizens and (2) determine whether Supplemental Nutrition Assistance Program utilization and income-poverty ratio levels impact the relationship between immigration status and food insecurity.

Methods

Multivariable logistic regression models were used to determine the odds of food insecurity (dependent variables) using nationally representative data from the 2019-2020 National Health Interview Survey. Independent variables included immigration status, Supplemental Nutrition Assistance Program utilization, income-poverty ratio, and other important demographics. AORs with their 95% CIs are reported. Analysis was conducted in 2022.

Results

After controlling for independent variables, noncitizens had 1.28 (95% CI=1.02, 1.61) times higher odds of food insecurity than U.S.-born citizens. There was no food insecurity disparity between naturalized citizens and U.S.-born citizens. However, the association between immigration status and food insecurity varied significantly at different levels of Supplemental Nutrition Assistance Program utilization and income-poverty ratio. There were no food insecurity disparities between immigrants and U.S.-born citizens when they utilized the Supplemental Nutrition Assistance Program and when they had an income below 200% federal poverty level. Noncitizens who did not utilize the Supplemental Nutrition Assistance Program or those with an income above 200% federal poverty level were more likely to report food insecurity than their U.S.-born counterparts (AOR=1.32, 95% CI=1.01, 1.73 and AOR=1.88, 95% CI=1.24, 2.86, respectively). Moreover, naturalized citizens with an income above 200% federal poverty level were also more likely to report food insecurity than their U.S.-born counterparts (AOR=1.61, 95% CI=1.21, 2.14).

Conclusions

Supplemental Nutrition Assistance Program utilization may likely eliminate food insecurity disparities among immigrants and U.S.-born citizens. However, among non-Supplemental Nutrition Assistance Program utilizers, significant food insecurity disparities remained between noncitizens and U.S.-born citizens after adjusting for independent variables. In addition, among individuals with incomes above 200% federal poverty level, significant food insecurity disparities were observed between immigrants and U.S.-born citizens. More research is needed to further understand the role that fear of deportation, ineligibility or lack of awareness about eligibility for the Supplemental Nutrition Assistance Program, and other factors such as structural racism play in food insecurity disparities between immigrants and U.S.-born citizens.

Lung Cancer Incidence by Detailed Race-Ethnicity

Lung cancer (LC) incidence rates and tumor characteristics among (non-Hispanic) Black and Hispanic detailed groups, normally characterized in aggregate, have been overlooked in the US. We used LC data from the Florida state cancer registry, 2012-2018, to compute LC age-adjusted incidence rates (AAIR) for US-born Black, Caribbean-born Black, Mexican, Puerto Rican, Cuban, Dominican, and Central and South American populations. We analyzed 120,550 total LC cases. Among Hispanics, Cuban males had the highest AAIR (65.6 per 100,000; 95%CI: 63.6-67.6), only 8% [Incidence Rate Ratio (IRR): 0.92; 95%CI: 0.89-0.95] lower than Whites, but 2.7 (IRR 95%CI: 2.31-3.19) times higher than Central Americans. Among Blacks, the AAIR for US-born Black males was over three times that of those Caribbean-born (IRR: 3.12; 95%CI: 2.80-3.40) and 14% higher than White males (IRR: 1.14; 95%CI: 1.11-1.18). Among women, US-born Blacks (46.4 per 100,000) and foreign-born Mexicans (12.2 per 100,000) had the highest and lowest rates. Aggregation of non-Hispanic Blacks or Hispanics obscures inherent disparities within groups. Understanding the distinct LC rates in US populations is crucial for targeting public health measures for LC diagnosis, prevention, and treatment. Further LC research exploring detailed race-ethnicity regarding LC in never-smokers is necessary, particularly among females and considering pertinent environmental factors.