The influence of acculturation on breast-feeding initiation and duration in low-income women in the US

While the 'immigrant health paradox' posits better health behaviours and outcomes for immigrants upon arrival to the US, research suggests that this advantage may deteriorate over time. This study analysed the relationship of acculturation and breast-feeding initiation and duration among a sample of predominantly Latina, low-income women in the US. The four measures of acculturation included: mother's nativity (foreign born vs US born), mother's parents' nativity (foreign born vs US born), years of US residence (<8 years vs > or =8 years) and a dichotomous measure of language acculturation adapted from three items on Marin's acculturation scale (preferred language spoken at home, reading language and writing language) as exclusive use of native language versus non-exclusive use (mixed or English only) (Marin et al., 1987; Marin & Gamba, 1996). Final multivariable models showed that mothers who exclusively used their native language were more likely to initiate breast-feeding as well as breast-feed for longer duration compared with mothers with non-exclusive use, whereas years of US residence and mother's nativity were not significantly associated with breast-feeding initiation or duration. Mother's parents' nativity also emerged as a significant predictor of breast-feeding duration, both within final models for immigrants and across study participants. Programmes providing nutrition education to low-income women may wish to consider the role of language as an important determinant of breast-feeding. The role of mother's parents' nativity on breast-feeding practices deserves exploration in future studies, as the cultural practices taught by family members born outside the US may exert strong pressure within immigrant families now living in the US.     

Birthplace, years of residence in the United States, and obesity among Mexican-American adults

Objective: To evaluate the association between birthplace (Mexico or U.S.) and obesity in men and women and to analyze the relationship between duration of U.S. residency and prevalence of obesity in Mexican immigrants. Research Methods and Procedures: We used cross‐sectional data from 7503 adults of Mexican descent residing in Harris County, TX, to evaluate the relationships among BMI, birthplace, and years of residency in the U.S., controlling for demographic characteristics, physical activity level, and acculturation level. Results: U.S.‐born adults had an increased risk (between 34% and 65%) of obesity compared with their Mexican‐born counterparts. After controlling for recognized confounders and risk factors, this association was maintained in the highly acculturated only. Among highly acculturated obese U.S.‐born men, 6% of the cases were attributable to the joint effect of birthplace and acculturation; in women, this proportion was 25%. Among Mexican‐born women, there was an increasing trend in mean BMI with increasing duration of residency in the U.S. Compared with immigrants who had lived in the U.S. for <5 years, Mexican‐born women who had resided in the U.S. for ≥15 years had an adjusted BMI mean difference of 2.12 kg/m² (95% confidence interval, 1.53–2.72). Discussion: Mexican‐born men and women have a lower risk of obesity than their U.S.‐born counterparts, but length of U.S. residency among immigrants, especially in women, is directly associated with risk of obesity. Development of culturally specific interventions to prevent obesity in recent immigrants may have an important public health effect in this population.     

Acculturation process and its effects on dietary habits, nutritional behavior and body-image in adolescents

Previous studies have indicated that the acculturation process may contribute to psychosocial and health problems among immigrants through the mediation of acculturation stress. This study focuses on adolescents with immigrant background permanently settled in the Croatian region of Dalmatia and the influences of the acculturation process on their dietary habits, nutritional behavior and perceived body-image. The survey was conducted on the total sample of 510 adolescents (aged 14-19) including 52 first generation and 248 second generation immigrants. The analysis included dietary habits and questions of restrictive diet as indicators of unhealthy influence on physical health. Psychological factors (stress and self-esteem) have been found to be associated with dietary habits, diet behavior and dissatisfaction with body-image among adolescents with significant differences by immigrant status. Immigrant status is viewed as a risk factor for psychological distress and unhealthy dieting behavior. Research stresses the need to study the interaction between acculturation and health not only from an individual perspective, but also from the broader socio-ecological context of population subgroups.     

Immigration and obesity among lower income blacks

Objective: Our objective was to examine the associations of nativity, immigrant generation, and language acculturation with obesity among lower income black adult men and women. Research Methods and Procedures: Data from 551 black adult men and women were collected from participants in the Healthy Directions‐Health Centers Study. Race/ethnicity and nativity were self‐reported. Language acculturation was defined using participants’ first language, preferred reading language, and language spoken at home. Mixed model logistic regression models were estimated to account for within‐health center clustering. Results: Foreign‐born blacks had a lower obesity risk, compared with all U.S.‐born participants, in multivariable analyses [odds ratio (OR) = 0.57, 95% confidence interval (CI), 0.38, 0.84]. Among U.S.‐born participants, those with foreign‐born parents were significantly less likely to be obese than individuals with U.S.‐born parents (OR = 0.54; 95% CI, 0.37, 0.80). Low‐moderate language acculturation also decreased the odds of being obese (OR = 0.45; 95% CI, 0.23, 0.88). Discussion: Our findings suggest a protective effect of foreign‐born status and low‐moderate language acculturation on obesity risk among lower income black immigrants. These data highlight the importance of more frequently examining nativity in obesity‐related research conducted among blacks.     

Immigrants’ acculturation and changes in Body Mass Index

We study Body Mass Index (BMI) changes among immigrants from Iran, Pakistan, Sri Lanka, Turkey, and Vietnam relative to native Norwegians in Oslo. We assess the effect of acculturation on BMI changes. We hypothesize that acculturation reduces the gap of BMIs between natives and immigrants. Acculturation is measured by immigrants’ language skills. Our data come from two surveys in Oslo 2000–2002. Weights and heights were measured at the surveys; participants were asked to recall weights when they were 25 years old. Norwegian language skills and socio-economic data were collected. Our findings support our hypothesis. Acculturation, as measured by proficiency in the Norwegian language, has the predicted effects on BMI changes. We do not find any effect of immigrants’ time of residency on BMI changes.     

The longer you stay, the bigger you get: length of time and language use in the U.S. are associated with obesity in Puerto Rican women

This cross-sectional study examined whether length of time in the U.S., language use, and birthplace (proxy measures of acculturation) were associated with body mass index (BMI) and obesity in a sample of 174 low-income Puerto Rican women from Hartford, Connecticut. The mean BMI for the total sample (N = 174) was 27.39 (S.D. = 5.07), and nearly 34% of the sample was considered obese (BMI > or = 30). There was a statistically significant increase in BMI with length of time in the U.S. (P = 0.012) and these differences were even greater among women born in Puerto Rico (P = 0.003). Moreover, obesity prevalence was highest among women who had been in the U.S. for 10 years or more (40%), as compared to those who had been in the U.S. less than 1 year (29%; P = 0.045). There were no statistically significant associations between language and BMI for the total sample. However, among bilingual speakers born in Puerto Rico, there were significant differences in BMI according to their level of English fluency. Those who spoke fluent or very good English had a significantly higher BMI (mean = 29.72; SD = 4.12) than women whose English was good to not-so-good (mean = 26.8; SD = 5.24; P = 0.016). The findings from this study point to the need for more research on the acculturation process and obesity, in order to design culturally tailored obesity prevention programs.     

Konnichiwa: Japanese scientists and their struggle to speak English: More research careers in Japan need less English

Japanese students’ seeming low proficiency of English is not caused by lack of efforts to internationalize, but rather changing career preferences. Subject Categories: S&S: Careers & Training, S&S: Economics & Business, S&S: Ethics

It seems every generation of academics complains about the poor skills of their incoming students: “They are lazy. Unprepared. Spoiled”. In fact, older people lamenting about the perceived faults and shortcomings of the next generation is probably as old as human civilization itself (Protzko & Schooler, 2019). Professors in Japan are no different in claiming that their students lack many skills, including a sufficient proficiency in speaking English.However, when the same observation is made by an outsider, such as the Chief Editor of this journal, it deserves more consideration. At a meeting of the Molecular Biology Society of Japan (MBSJ), Bernd Pulverer was struck by how effortlessly senior Japanese scientists engaged in discussions, whereas their junior colleagues appeared intimidated by the prospect of speaking aloud in English. The experience left the editor worried if there were a generation gap in communication skills that could hamper international collaborations.While English has long been a primary language for science, it has only recently become the primary language. Consider the Solvay Conference in 1927, epitomized by the photo of legendary scientists such as Einstein, Curie, and Bohr, which was a Babylonian debate. Even in the 1990s, the University of Toronto encouraged students in its mathematics program to study French, German, or Russian. Today, however, anyone aspiring to become a scientist is obliged to have a strong grasp of the English language, a point that is not lost on Japanese students.     

The conditional relationship between English language proficiency and earnings among US immigrants

Using the 2000 US census data for immigrants of twenty language groups resided in metropolitan areas, we test the hypothesis that the rate of returns (in earnings) to English proficiency is not constant but varies with the language environment (as defined by group size, segregation, linguistic heterogeneity and inequality) in which immigrants are embedded. Results from our hierarchical model indicate that while an increase in the size and segregation of the language group diminishes returns to English proficiency, a rise in linguistic heterogeneity and inequality in the metropolitan area has the opposite effects. This study expands the scope of the previous studies by identifying conditions under which returns to English proficiency among immigrants are modified by a set of contextual factors often overlooked.     

United States Acculturation and Cancer Patients’ End-of-Life Care

Background

Culture shapes how people understand illness and death, but few studies examine whether acculturation influences patients’ end-of-life treatment preferences and medical care.

Methods and Findings

In this multi-site, prospective, longitudinal cohort study of terminally-ill cancer patients and their caregivers (n = 171 dyads), trained interviewers administered the United States Acculturation Scale (USAS). The USAS is a 19-item scale developed to assess the degree of “Americanization” in first generation or non-US born caregivers of terminally-ill cancer patients. We evaluated the internal consistency, concurrent, criterion, and content validity of the USAS. We also examined whether caregivers’ USAS scores predicted patients’ communication, treatment preferences, and end-of-life medical care in multivariable models that corrected for significant confounding influences (e.g. education, country of origin, English proficiency). The USAS measure was internally consistent (Cronbach α = 0.98); and significantly associated with US birthplace (r = 0.66, P<0.0001). USAS scores were predictive of patients’ preferences for prognostic information (AOR = 1.31, 95% CI:1.00–1.72), but not comfort asking physicians’ questions about care (AOR 1.23, 95% CI:0.87–1.73). They predicted patients’ preferences for feeding tubes (AOR = 0.68, 95% CI:0.49–0.99) and wish to avoid dying in an intensive care unit (AOR = 1.36, 95% CI:1.05–1.76). Scores indicating greater acculturation were also associated with increased odds of patient participation in clinical trials (AOR = 2.20, 95% CI:1.28–3.78), compared with lower USAS scores, and greater odds of patients receiving chemotherapy (AOR = 1.59, 95% CI:1.20–2.12).

Conclusion

The USAS is a reliable and valid measure of “Americanization” associated with advanced cancer patients’ end-of-life preferences and care. USAS scores indicating greater caregiver acculturation were associated with increased odds of patient participation in cancer treatment (chemotherapy, clinical trials) compared with lower scores. Future studies should examine the effects of acculturation on end-of-life care to identify patient and provider factors that explain these effects and targets for future interventions to improve care (e.g., by designing more culturally-competent health education materials).     

Evaluating the frequency of English language requirements in clinical trial eligibility criteria: A systematic analysis using ClinicalTrials.gov

BackgroundA number of prior studies have demonstrated that research participants with limited English proficiency in the United States are routinely excluded from clinical trial participation. Systematic exclusion through study eligibility criteria that require trial participants to be able to speak, read, and/or understand English affects access to clinical trials and scientific generalizability. We sought to establish the frequency with which English language proficiency is required and, conversely, when non-English languages are affirmatively accommodated in US interventional clinical trials for adult populations.Methods and findingsWe used the advanced search function on ClinicalTrials.gov specifying interventional studies for adults with at least 1 site in the US. In addition, we used these search criteria to find studies with an available posted protocol. A computer program was written to search for evidence of English or Spanish language requirements, or the posted protocol, when available, was manually read for these language requirements. Of the 14,367 clinical trials registered on ClinicalTrials.gov between 1 January 2019 and 1 December 2020 that met baseline search criteria, 18.98% (95% CI 18.34%–19.62%; n = 2,727) required the ability to read, speak, and/or understand English, and 2.71% (95% CI 2.45%–2.98%; n = 390) specifically mentioned accommodation of translation to another language. The remaining trials in this analysis and the following sub-analyses did not mention English language requirements or accommodation of languages other than English. Of 2,585 federally funded clinical trials, 28.86% (95% CI 27.11%–30.61%; n = 746) required English language proficiency and 4.68% (95% CI 3.87%–5.50%; n = 121) specified accommodation of other languages; of the 5,286 industry-funded trials, 5.30% (95% CI 4.69%–5.90%; n = 280) required English and 0.49% (95% CI 0.30%–0.69%; n = 26) accommodated other languages. Trials related to infectious disease were less likely to specify an English requirement than all registered trials (10.07% versus 18.98%; relative risk [RR] = 0.53; 95% CI 0.44–0.64; p < 0.001). Trials related to COVID-19 were also less likely to specify an English requirement than all registered trials (8.18% versus 18.98%; RR = 0.43; 95% CI 0.33–0.56; p < 0.001). Trials with a posted protocol (n = 366) were more likely than all registered clinical trials to specify an English requirement (36.89% versus 18.98%; RR = 1.94, 95% CI 1.69–2.23; p < 0.001). A separate analysis of studies with posted protocols in 4 therapeutic areas (depression, diabetes, breast cancer, and prostate cancer) demonstrated that clinical trials related to depression were the most likely to require English (52.24%; 95% CI 40.28%–64.20%). One limitation of this study is that the computer program only searched for the terms “English” and “Spanish” and may have missed evidence of other language accommodations. Another limitation is that we did not differentiate between requirements to read English, speak English, understand English, and be a native English speaker; we grouped these requirements together in the category of English language requirements.ConclusionsA meaningful percentage of US interventional clinical trials for adults exclude individuals who cannot read, speak, and/or understand English, or are not native English speakers. To advance more inclusive and generalizable research, funders, sponsors, institutions, investigators, institutional review boards, and others should prioritize translating study materials and eliminate language requirements unless justified either scientifically or ethically.

Akila Muthukumar and coauthors, systematically analyze ClinicalTrials.gov to evaluate the frequency of English language requirements in clinical trial eligibility criteria.     

Low-Income US Women Under-informed of the Specific Health Benefits of Consuming Beans

Background

Bean consumption can reduce chronic disease risk and improve nutrition status. Consumer knowledge of bean health benefits could lead to increased intakes. Low-income women have poorer health and nutrition, but their level of knowledge about bean health benefits is unknown. Beans are a familiar food of reasonable cost in most settings and are cultural staples for Hispanics and other ethnicities. Study objectives were to assess awareness of bean health benefits among low-income women, and to evaluate any differences by acculturation status for Hispanic women in the Southwestern United States.

Methods

A convenience sample of 406 primarily Mexican-origin (70%) low-income women completed a survey on knowledge of bean health benefits and general food behaviors. Principal components analysis of responses identified two summary scale constructs representing “bean health benefits” and “food behaviors.” Acculturation level was the main independent variable in chi-square or ANOVA.

Results

The survey completion rate was 86% (406/471). Most women agreed or strongly agreed that beans improved nutrition (65%) and were satiating (62%). Over 50% answered ‘neutral’ to statements that beans could lower LDL cholesterol (52%), control blood glucose (56%) or reduce cancer risk (56%), indicating indifference or possible lack of knowledge about bean health benefits. There were significant differences by acculturation for beliefs that beans aid weight loss and intestinal health. Scores on the bean health benefits scale, but not the food behavior scale, also differed by acculturation.

Conclusions

Limited resource women have a favorable view of the nutrition value of beans, but the majority did not agree or disagreed with statements about bean health benefits. Greater efforts to educate low-income women about bean health benefits may increase consumption and improve nutrition.     

Migration Surrogates and Their Association With Obesity Among Within‐Country Migrants

Limited studies have evaluated the link between acculturation and health outcomes of within‐country migrants. The objective of this study was to evaluate whether well‐known acculturation surrogates were associated with obesity among Peruvian rural‐to‐urban migrants. We performed a cross‐sectional survey, the PERU MIGRANT study, using single‐stage random sampling. Evaluation included weight, height, and waist circumference (WC) as well as acculturation surrogates. Obesity was assessed using BMI and WC. Length of residence, age at migration, language proficiency, and language preferences (Spanish or Quechua) were assessed in logistic regression models to calculate odd ratios and 95% confidence intervals adjusting for potential confounders. A total of 589 rural‐to‐urban migrants were enrolled. The mean age was 47.8 (s.d.: 11.7, range: 30–92), and 280 (47.5%) were men. Obesity prevalence assessed using BMI was 30.4% among women and 10.7% among men (P < 0.001), whereas abdominal obesity assessed using WC was 29.1% among women and 19.1% among men (P < 0.01). Obesity was associated with older age at first migration, language speaking proficiency, and language preferences. The association between obesity and acculturation surrogates is variable in this population. Thus, acculturation per se can explore positive channels associated with better health outcomes. The patterns shown in this report suggest a more complex association for these factors.     

Poor knowledge of methotrexate associated with older age and limited English-language proficiency in a diverse rheumatoid arthritis cohort

Introduction

Our objective was to determine rheumatoid arthritis (RA) patients’ understanding of methotrexate and assess whether knowledge varies by age, education, English language proficiency, or other disease-related factors.

Methods

Adults with RA (n = 135) who were enrollees of an observational cohort completed a structured telephone interview in their preferred language between August 2007 and July 2009. All subjects who reported taking methotrexate were asked 11 questions about the medication in addition to demographics, education level, and language proficiency. Primary outcome was a total score below the 50^th percentile (considered inadequate methotrexate knowledge). Bivariable and multivariable logistic regressions were performed. Covariates included demographics, language proficiency, education, and disease characteristics.

Results

Of 135 subjects, 83% were female, with a mean age of 55 ± 14 years. The majority spoke English (64%), followed by 22% Spanish and 14% Cantonese or Mandarin. Limited English language proficiency (LEP) was reported in 42%. Mean methotrexate knowledge score was 5.4 ± 2.6 (range, 0 to 10); 73 (54%) had a score lower than 5 (of 10). Age older than 55, less than high school education, LEP, better function, and biologic use were independently associated with poor knowledge.

Conclusions

In a diverse RA cohort, overall methotrexate knowledge was poor. Older age and limited proficiency in English were significant correlates of poor knowledge. Identification of language barriers and improved clinician-patient communication around methotrexate dosing and side effects may lead to improved safety and enhanced benefits of this commonly used RA medication.     

The Expression of Emotions in 20th Century Books

We report here trends in the usage of “mood” words, that is, words carrying emotional content, in 20th century English language books, using the data set provided by Google that includes word frequencies in roughly 4% of all books published up to the year 2008. We find evidence for distinct historical periods of positive and negative moods, underlain by a general decrease in the use of emotion-related words through time. Finally, we show that, in books, American English has become decidedly more “emotional” than British English in the last half-century, as a part of a more general increase of the stylistic divergence between the two variants of English language.     

Temperament and Impulsivity Predictors of Smoking Cessation Outcomes

Aims

Temperament and impulsivity are powerful predictors of addiction treatment outcomes. However, a comprehensive assessment of these features has not been examined in relation to smoking cessation outcomes.

Methods

Naturalistic prospective study. Treatment-seeking smokers (n = 140) were recruited as they engaged in an occupational health clinic providing smoking cessation treatment between 2009 and 2013. Participants were assessed at baseline with measures of temperament (Temperament and Character Inventory), trait impulsivity (Barratt Impulsivity Scale), and cognitive impulsivity (Go/No Go, Delay Discounting and Iowa Gambling Task). The outcome measure was treatment status, coded as “dropout” versus “relapse” versus “abstinence” at 3, 6, and 12 months endpoints. Participants were telephonically contacted and reminded of follow-up face to face assessments at each endpoint. The participants that failed to answer the phone calls or self-reported discontinuation of treatment and failed to attend the upcoming follow-up session were coded as dropouts. The participants that self-reported continuing treatment, and successfully attended the upcoming follow-up session were coded as either “relapse” or “abstinence”, based on the results of smoking behavior self-reports cross-validated with co-oximetry hemoglobin levels. Multinomial regression models were conducted to test whether temperament and impulsivity measures predicted dropout and relapse relative to abstinence outcomes.

Results

Higher scores on temperament dimensions of novelty seeking and reward dependence predicted poorer retention across endpoints, whereas only higher scores on persistence predicted greater relapse. Higher scores on the trait dimension of non-planning impulsivity but not performance on cognitive impulsivity predicted poorer retention. Higher non-planning impulsivity and poorer performance in the Iowa Gambling Task predicted greater relapse at 3 and 6 months and 6 months respectively.

Conclusion

Temperament measures, and specifically novelty seeking and reward dependence, predict smoking cessation treatment retention, whereas persistence, non-planning impulsivity and poor decision-making predict smoking relapse.     

Acculturation and Plasma Fatty Acid Concentrations in Hispanic and Chinese-American Adults: The Multi-Ethnic Study of Atherosclerosis

Background

Acculturation to the U.S. is associated with increased risk of cardiovascular disease, but the etiologic pathways are not fully understood. Plasma fatty acid levels exhibit ethnic differences and are emerging as biomarkers and predictors of cardiovascular disease risk. Thus, plasma fatty acids may represent one pathway underlying the association between acculturation and cardiovascular disease. We investigated the cross-sectional relationship between acculturation and plasma phospholipid fatty acids in a diverse sample of Hispanic- and Chinese-American adults.

Methods and Findings

Participants included 377 Mexican, 320 non-Mexican Hispanic, and 712 Chinese adults from the Multi-Ethnic Study of Atherosclerosis, who had full plasma phospholipid assays and acculturation information. Acculturation was determined from three proxy measures: nativity, language spoken at home, and years in the U.S., with possible scores ranging from 0 (least acculturated) to 5 (most acculturated) points. α-Linolenic acid, linoleic acid, eicosapentaenoic acid, docosahexaenoic acid, and arachidonic acid were measured in fasting plasma. Linear regression models were conducted in race/ethnicity-stratified analyses, with acculturation as the predictor and plasma phospholipid fatty acids as the outcome variables. We ran secondary analyses to examine associations between acculturation and dietary fatty acids for comparison. Covariates included age, gender, education, and income. Contrary to our hypothesis, no statistically significant associations were detected between acculturation and plasma phospholipid fatty acids for Chinese, non-Mexican Hispanic, or Mexican participants. However, acculturation was related to dietary total n-6 fatty acids and dietary n-3/n-6 ratios in expected directions for Mexican, non-Mexican Hispanic, and combined Hispanic participants. In Chinese individuals, acculturation was unexpectedly associated with lower arachidonic acid intake.

Conclusion

Absence of associations between acculturation and plasma phospholipid fatty acids suggests that changes in the plasma phospholipid fatty acids studied do not account for the observed associations of acculturation to the U.S. and cardiovascular disease risk. Similar findings were observed for eicosapentaenoic acid and docosahexaenoic acid, when using dietary intake. However, the observed associations between dietary n-6 fatty acids and acculturation in Hispanic individuals suggest that dietary intake may be more informative than phospholipids when investigating acculturation effects. In Chinese individuals, acculturation may have a possible protective effect through decreased arachidonic acid intake. Further research on dietary fatty acids and other cardiovascular disease biomarkers is needed to identify possible etiologic mechanisms between acculturation and cardiovascular disease.     

Disability status differentials across fifteen Asian and Pacific Islander groups and the effect of nativity and duration of residence in the U.S

This study examines disparities in disability status across 15 Asian and Pacific Islander American (API) subpopulations and how nativity and duration in the U.S. influence these differences. Employing three disability questions (work limitations, mobility limitations, and self-care limitations) from the 1990 PUMS, the authors find substantial heterogeneity in disability status across API subgroups: while Japanese American adults have the most favorable outcomes, Other Southeast Asian adults (Laotians, Hmong, and Cambodians), followed by Vietnamese and Pacific Islander adults, suffer from a high risk of disabilities. Many of the disparities in disability status across API subpopulation adults are attributable to differentials in demographic characteristics and SES. The inclusion of an interaction term of age and nativity/duration of residence in the U.S. in multivariate regression analyses demonstrates that the effect of nativity/duration plays a different role across age, net of demographic, and SES risk factors. The overall findings are also consistent with previous studies on the relationship between immigrant health and nativity/duration. That is, immigrants with short duration in the U.S. have superior health status, measured by risk of disability, than longer-term immigrants and their U.S.-born counterparts.     

Cultural Differences in Donation Decision-Making

Decisions to help those in need are essential for human development and survival. Previous studies have demonstrated the “identified effect”, in which one identifiable individual typically invokes stronger feelings of compassion and receives greater aid than statistical victim. However, this preference might be influenced by cultural differences. In the current study, Chinese respondents’ ratings of distress and sympathy and their willingness to contribute are greater for a group of sick children than an individual. In the U.S., greater willingness to help and sympathy are elicited by an identified victim in comparison with an unidentified one. The different results may demonstrate the importance of cultural differences when trying to understand people’s prosocial behavior.     

Age at arrival and risk of obesity among US immigrants

Although immigrants are a rapidly growing subgroup, little is known about overweight/obesity among the foreign-born in the United States, especially regarding the effect of age at arrival. This study determined whether overweight/obesity prevalence is associated with age at arrival of immigrants to the United States. We analyzed data on 6,421 adult immigrants from the New Immigrant Survey (NIS), a study that is nationally representative of adult immigrants with newly acquired legal permanent residence (LPR). Multiple regression analyses tested the effects of duration of residence and age at arrival on overweight/obesity, defined by BMI of > or = 25 kg/m(2), and self-reported dietary change score. We found the relationship between duration of residence and overweight/obesity prevalence varied by age at arrival (P < 0.001). Immigrants < or = 20-years old at arrival who had resided in the United States > or = 15 years were 11 times (95% confidence interval: 5.33, 22.56) more likely to be overweight/obese than immigrants < 20-years old at arrival who had resided in the United States < or = 1 year. By comparison, there was no difference in overweight/obesity prevalence by duration among immigrants who arrived at >50 years of age. Higher self-reported dietary change is also associated with overweight/obesity. In conclusion, immigrants younger than 20 at arrival in the United States may be at higher risk of overweight/obesity with increasing duration of residence than those who arrive at later ages. Obesity prevention among young US immigrants should be a priority.     

Health Insurance Status as a Barrier to Ideal Cardiovascular Health for U.S. Adults: Data from the National Health and Nutrition Examination Survey (NHANES)

Background

Little is known about the association between cardiovascular (CV) health and health insurance status. We hypothesized that U.S. adults without health insurance coverage would have a lower likelihood of ideal cardiovascular health.

Methods and Results

Using National Health and Nutrition Examination Survey (NHANES) data from 2007–2010, we examined the relationship between health insurance status and ideal CV health in U.S. adults aged ≥19 years and <65 (N = 3304). Ideal CV health was defined by the American Heart Association (AHA) as the absence of clinically manifested CV disease and the simultaneous presence of 6–7 “ideal” CV health factors and behaviors. Logistic regression modeling was used to determine the relationship between health insurance status and the odds of ideal CV health. Of the U.S. adult population, 5.4% attained ideal CV health, and 23.5% were without health insurance coverage. Those without health insurance coverage were more likely to be young (p<0.0001), male (p<0.0001), non-white (p<0.0001), with less than a high school degree (p<0.0001), have a poverty-to-income ratio less than 1 (p<0.0001) and unemployed (p<0.0001) compared to those with coverage. Lack of health insurance coverage was associated with a lower likelihood of ideal CV health; however, this relationship was attenuated by socioeconomic status.

Conclusions

U.S. adults without health insurance coverage are less likely to have ideal CV health. Population-based strategies and interventions directed at the community-level may be one way to improve overall CV health and reach this at-risk group.