Abstract P301: Differences in Stress Related Behavior According to Age of Immigration: Insight From the Africans in America Study

Abstract

Background: Adjusting to the stress of life in the United States is associated with unhealthy assimilation behaviors, such as cigarette smoking and alcohol consumption. Allostatic load score (ALS) is a measure of the accumulative effect of stress due to overactivation of the hypothalamic-pituitary-adrenal (HPA) and sympathetic adrenal medullary (SAM) axes. It is unknown if stress related behaviors vary according to whether immigration occurred as a child (<18y) or as an adult (≥18y). Objective: Our goal was to measure stress by ALS in 382 African-born blacks living in the Washington, DC metropolitan area (age 39±10y, range 20 to 65y) and compare social and behavioral factors in Africans who migrated to the United States as children versus as adults. Methods: ALS was calculated using 10 biomarkers from the 3 physiological systems affected by the HPA and SAM axes: cardiovascular (systolic BP, diastolic BP, pulse, cholesterol, HDL, homocysteine), metabolic (BMI, A1C, albumin) and inflammatory (hsCRP). One point was assigned if a variable was determined to be in the high-risk range and 0 if not. High-risk was defined by being in the highest quartile for the population distribution of each variable, except for albumin and HDL, which required the lowest quartile. Results: Of the 382 enrollees, 18% (68/382) came to the United States as children and 82% (314/382) were adults. Compared to adulthood immigrants, childhood immigrants were younger (31±9 vs. 41±10y, P <0.001) and had been in the United States longer (22±9 vs.11±10y, P <0.001). After adjusting for age, ALS was similar in the child and adult immigrants (2.6±0.02 vs.2.6±0.01, P =0.84). Alcohol intake was higher in immigrants who came as children than immigrants who came as adults (40% vs. 25%, P =0.02). Cigarette smoking, sedentary behavior and number of meals outside of the home all tended to be higher in the childhood immigrants ( P <0.2). In addition, childhood immigrants were more likely to self-identify as African-Americans than Africans (16% vs. 7%, P =0.05). Conclusion: Independent of whether Africans came to the United States as children or adults, degree of stress as measured by ALS is similar. However, Africans who arrived as children were more likely to develop unhealthy assimilation behaviors. Whether these behaviors are due to longer duration of stay in the United States or a generational difference remains to be determined.