Afro-Caribbean Immigrants Research Articles

THE CULTURE OF FAMILY CAREGIVING OF OLDER ADULTS AMONG AFRICAN AND AFRO-CARIBBEAN IMMIGRANTS TO THE US AND CANADA

Abstract An increasing number of African and Afro-Caribbean immigrants to the United States and Canada are aging. Older adults are dealing with various health conditions, which makes them increasingly dependent on family members and friends for their health and social needs. The assistance they receive includes help with physical care, transportation, medication assistance, and emotional and social support, amongst others. Caregivers play a pivotal role in maintaining the health of older adults of African and Afro-Caribbean immigrants in the United States and Canada. However, very little is understood about the expectations and culture of family caregiving within this group. This study explores the culture of family caregiving of older adults amongst African and Afro-Caribbean immigrants in the United States and Canada. We conducted a scoping review of the literature with the assistance of two experienced health science librarians using CINAHL, PubMed, Embase, and OVID MEDLINE. Preliminary findings show that while some articles discussed aspects of family caregiving on the African continent, none were specific to family caregivers of older adults living in the United States and Canada. While it is important to understand the cultural implications of family caregiving within African communities, there are nuances of the African and Caribbean diaspora that have serious implications for the health of older adults. This study adds to our understanding of family caregiving among African and Afro-Caribbean immigrants. It points to a need for tailored intervention for supporting family caregivers within African and Afro-Caribbean immigrant communities.

Physical Activity Engagement among Black Immigrants and African American Adults in the 2010 to 2018 NHIS Study.

High rates of physical inactivity persist in the United States, with higher rates among non-Hispanic Black adults than among their White peers. However, a comparison of physical activity engagement across nativity among Black adults in the United States has yet to be fully documented. The purpose of this cross-sectional study was to examine physical activity engagement rates among African immigrant and Afro-Caribbean immigrant adults compared with native-born African American adults using data from the 2010 to 2018 National Health Interview Survey. Using data from the 2010 to 2018 National Health Interview Survey, we used generalized linear models to compare levels of physical activity (meeting the moderate-to-vigorous physical activity [MVPA] recommendations) by ethnic subgroups of Black adults, sequentially adjusting for sociodemographic and health-related risk factors. Data from 38,037 adults (58.8% female, 21% college/graduate degree, and 41.4% with obesity) were included. Only 41.9% of all participants met the MVPA recommendations. In the fully adjusted models across the 9 years, higher levels of MVPA were seen among African Americans (42%) than among African immigrants (38%) and Afro-Caribbean immigrants (41%). Compared with African Americans, African immigrants were less likely to engage in physical activity that met the MVPA guidelines (prevalence ratio: 0.90; 95% confidence interval: 0.85, 0.96), whereas there were no differences in meeting the guidelines between Afro-Caribbean immigrants (prevalence ratio: 0.96; 95% confidence interval:0.90, 1.02) and African Americans. Culturally tailored interventions addressing socioenvironmental barriers and facilitators of physical activity may have important impacts on physical activity promotion and long-term disease burden among Black adults across nativity.

The perceived effects of migration on the mental health of Afro-Caribbean immigrants: A narrative synthesis of qualitative studies.

INTRODUCTION: There is evidence to support migration as a significant risk factor for psychiatric disorders in immigrants. Unfortunately, as an immigrant group, little is known about the mental health of Afro-Caribbean immigrants and the factors that threaten their mental health. To explore the perceived effects of migration on the mental health of Afro-Caribbean immigrants. A qualitative narrative synthesis was employed to interpretively integrate 13 primary qualitative research findings. Eleven of the primary studies were conducted in the U.K., one in the U.S. and one in Canada. The themes gleaned: (1) experiences of racism, (2) generational conflicts, (3) feelings of powerlessness, (4) limited socioeconomic resources, (5) unfulfilled expectations, (6) fragmented family and community and (7) ignoring cultural/ethnic identity. The findings broadened the understanding and experiences of Afro-Caribbean immigrants and their mental health vulnerabilities as they navigate through migration and acculturation. Addressing the mental health of Afro-Caribbeans will require health care providers to: (1) be cognizant of their immigrant status; (2) understand how migration and acculturation influence the mental health of immigrants; (3) be aware of the ethnocultural differences among Black subgroups.

Differences in psychosocial factors of mental health in an ethnically diverse Black adult population.

We conducted a cross-sectional analysis in a convenient sample of Black adults in the United States (n = 269, ages 18-65) from diverse ethnic backgrounds (African-Americans, African immigrants, Afro-Caribbean immigrants). We examined mean differences in self-reported medical mistrust, use of mental health services, depression symptom severity, mental health knowledge and stigma behavior (or a desire for separation away from people living with a mental illness) according to ethnicity, citizenship status, age group, and gender. African Americans with moderate to severe depression symptoms had greater stigma behavior (mean = 12.2, SD = 3.2) than African Americans who screened in the minimal to mild depression range (mean = 13.1, SD = 3.5). Across the spectrum of depression, immigrants showed greater stigma than African Americans (p = 0.037). This is a pilot study that explores heterogeneity in the Black population in depression symptom severity and psychosocial factors related to mental health. Understanding these differences may contribute to how we approach needs and health system practices and policies at the individual, systemic, and structural level of mental health care.

Black New Yorkers with Type 2 Diabetes: Afro-Caribbean Immigrants Have Lower BMI and Lower Waist Circumference than African Americans.

Using the 2013/2014 New York City (NYC) Health and Nutrition Examination Survey (NYCHANES) data, this exploratory study examined whether (a) type 2 diabetes (diabetes) prevalence differed between NYC Afro-Caribbeans and African Americans; (b) anthropometric, biochemical, and sociodemographic diabetes profiles differed between and within groups; and (c) diabetes odds differed between and within groups. Diabetes was defined as prior diagnosis, HbA1c ≥ 6.5% (7.8mmol/L), or fasting glucose ≥ 126mg/dL. Weighted logistic regression estimated diabetes odds by nativity and either waist circumference (WC) (cm) or BMI (kg/m2). All regression models controlled for age, hypertension, gender, education, income, marital status, physical activity, and smoking. Among Afro-Caribbeans (n = 81, 65% female, age (mean ± SE) 49 ± 2years, BMI 29.2 ± 0.7kg/m2) and African Americans (n = 118, 50% female, age 47 ± 2years, BMI 30.3 ± 0.9kg/m2), Afro-Caribbeans with diabetes had lower BMI (29.9 ± 0.8kg/m2 vs. 34.6 ± 1.7kg/m2, P = 0.01) and lower WC (102 ± 2cm vs. 114 ± 3cm, P = 0.002) than African Americans with diabetes. Afro-Caribbeans with diabetes had lower prevalence of obesity (33.2% vs. 74.7%) and higher prevalence of overweight (57.2% vs. 13.5%) (P = 0.02) than African Americans with diabetes. Odds of diabetes did not differ between Afro-Caribbeans and African Americans. In models predicting the effect of WC, diabetes odds increased with WC (OR = 1.07 (95% CI 1.02, 1.11), P = 0.003) and age (OR = 1.09 (95% CI 1.03-1.15), P = 0.003) for African Americans only. In models predicting the effect of BMI, diabetes odds increased for Afro-Caribbeans with age (OR = 1.06 (1.01, 1.11)*, P = 0.04) and hypertension (OR = 5.62 (95% CI 1.04, 30.42), P = 0.045), whereas for African Americans, only age predicted higher diabetes odds (OR = 1.08 (95% CI 1.03, 1.14), P = 0.003). In NYC, Afro-Caribbeans with diabetes have lower BMI and lower WC than African Americans with diabetes, but odds of diabetes do not differ. Combining African-descent populations into one group obscures clinical differences and generalizes diabetes risk.

Understanding the Association Between Mental Health Knowledge and Mental Health Service Utilization Among Black Adults.

Mental health knowledge limitations may contribute to the treatment gap among Black adults. We conducted an online cross-sectional study of Black adults in the United States (n = 262, aged 18-65years) from diverse ethnic backgrounds (African-Americans, African immigrants, Afro-Caribbean immigrants). Gamma regression using generalized linear models was used to estimate the associations between mental health knowledge and willingness to seek help from mental health professionals. After adjusting for age, education and ethnicity, participants with higher specific knowledge about mental health (such as recognition of schizophrenia as a mental illness) were 26% more likely to report willingness to seek help from a mental health professional for personal and emotional problems (RR = 1.26, CI 1.12-1.41, p < 0.001). Knowledge building interventions (such as psychoeducation) that seek to increase specific knowledge (rather than general knowledge) may correlate more strongly with utilization of mental health services among Black adults.

Cuban and Afro-Caribbean immigrants: an analysis of intermarriage and subsequent assimilation among second-generation Caribbean immigrants

ABSTRACT This paper uses the Children of Immigrants Longitudinal Study to examine the effects of race, class and gender on the intermarriage of Cuban and Afro-Caribbean second-generation immigrants in the United States. Results indicate that gender and racial identity are significantly related to intermarriage for this group of immigrants. Interestingly, the immigrants’ socioeconomic status and family’s social class have a very minimal impact on intermarriage. Using Cuban white, Cuban Hispanic and Caribbean black as racial categories, the study shows that Caribbean black men are the least likely group to intermarry, and Cuban white men are the most likely to intermarry. Cuban Hispanic men are less likely to intermarry compared to their Cuban white counterparts. Lastly, Cuban white women are the most likely to intermarrycompared to Cuban white males for this sample population. A structural explanation for these patterns posits that differences in the relative size of each racial group in marriage markets affect their chances for intermarriage. From an assimilation perspective, the literature also suggests that differences in social distance with whites influence the propensity for co-ethnic intermarriage.

985-P: Black New Yorkers with Type 2 Diabetes: Afro-Caribbean Immigrants Have Better Cardiometabolic Health than African Americans

Using the 2013/14 New York City Health and Nutrition Examination Survey population sample, this study compared Afro Caribbean immigrants and US-born African American New Yorkers to determine a) whether prevalence and odds of type 2 diabetes (T2DM) differed between ethnic groups; and b) whether cardiometabolic health profiles differed among those with T2DM. T2DM was defined by prior diagnosis, HbA1c≥6.5%, or fasting glucose ≥126mg/dL. Weighted logistic regression estimated odds of T2DM adjusting for BMI, waist circumference, age, sex, education, income, marital status and physical activity. T2DM prevalence in Afro Caribbeans (n=81, age (Mean±SE) 49±2y, BMI 29.2 ±0.7kg/m2) was 31%, and 21% in African Americans (n=118, age 46±2years, BMI 30.3±0.9kg/m2). Afro Caribbeans had more than three times greater odds of T2DM than African Americans [aOR=3.32 (95%CI 1.11-9.88), P=0.0313]. Compared to African Americans with T2DM (n=21, Age 60.3±3.3y, BMI 34.6±1.7kg/m2), Afro Caribbeans with T2DM (n=23, Age 57.9±2.5y, BMI 29.9±0.8kg/m2) were less likely to have obesity (33.2% vs. 74.7%) and had lower waist circumference (102±2cm vs. 114±3cm, P=0.002). Although fewer Afro Caribbeans with T2DM met HP2010 physical activity goals (42.9% vs. 75.5%, P=0.0335), their mean HDL levels tended to be higher than those of African Americans with T2DM (50.6±2.5 mg/dL vs. 42.5±3.2mg/dL, P=0.0519). Afro Caribbean immigrants in New York City have higher odds of T2DM than African Americans. Nevertheless, Afro Caribbeans with T2DM have better cardiometabolic health than African Americans with T2DM. Differences in anthropometrics, blood lipids and health behaviors illustrate important intraethnic variations which affect future risk of T2DM complications among populations of African descent. Disclosure M. Farag: None. L. Khosla: None. S. Bhat: None. F. A. Montiel ishino: None. F. Williams: None. M. F. Horlyck-romanovsky: None.

"Identity Negotiation and Alien Residency"

In her memoir, Not for Everyday Use (2014), and her novel Anna in Between (2009) and its sequel, Boundaries (2011), Elizabeth Nunez explores the nature of the migrant experience for first generation Afro-Caribbean immigrants to the USA. With specific reference to the use of language, characterization, history, imagery, and the interweaving of history, she analyzes the complexities of that reality as they attempt to adjust to a host locale (USA) that has had, from its inception, a very contentious relationship with blackness that fragments potential solidarity of blackness. Extrapolating from the lives her protagonists as filtered through the prism of her own migrant journey, Nunez sees them as existing in a permanent state of liminality from which there is no escape. Despite the finality of the act of migration, Caribbean-Americanlives are forever in a state of flux over which they can exert only limited control. Migration promises freedom and yet denies its full efflorescence; it offers the excitement of choice but only provides the exercise of it remains within the confines of fixed circumferences; it encourages belonging, yet castigates the complacency that belonging engenders. This paper will show that Nunez clearly represents the Afro-Caribbean immigrant life in America as uneasy existence in unsafe space, yet sends a firm message that the disillusionment of that reality is more palatable than the idea of return. The state of in-betweenity, therefore, while not static in essential nature, is as permanent and unavoidable as is the act of migration itself. In order to feel more at ease the migrant must quickly learn the balancing act of becoming yet never being; the migrant must come to appreciate the complex dance between commonality and contestation even within a diaspora of shared African origin.

“Limón Is Not Just Patí and Rice and Beans”. Elements That Make Up the Afro-Costa Rican Culture

Within Costa Rican society, a reduced vision of Afro-Costa Rican culture limited it to the culinary of rice and beans, patí (an empanada filled with spiced meat), and the so-called Calypso music. This Afro culture in Limón, Costa Rica, is a heritage of Afro-Caribbean immigrants from the late 19th century. The Afro-Costa Rican culture of the 21st century has inherited elements from these immigrants, particularly the Jamaicans. This article aims to provide a historical approach to achieve two objectives: first, to verify how many of these elements of immigrant culture have been preserved; and second, to contribute to the United Nations declaration of the Decade of Afro-descendants (2015-2024) by conducting research focused on the Afro community. For this purpose, primary sources used were the oral history of two Afro-Costa Ricans born in the mid-20 century, and general information a Jamaican provided through e-mails for a more contemporary view of Jamaica's culture. Some 20th-century newspapers were also reviewed, as well as other publications related to the subject. Among the principal conclusions drawn, the study highlighted the persistence of elements typical of Afro-Caribbean immigrant groups' culture in the 20th century's turn. Besides, it is evident the modification of the culinary traditions adapted to the current society, as well as other inherited cultural elements, which currently deserve recognition from this Afro-Costa Rican culture that has important cultural elements that should be appreciated and preserved.

Haitian and Cuban immigrants in Miami, Florida: are they more similar than they are different?

ABSTRACT There has been significant research done on the assimilation patterns of immigrants in the US, particularly immigrants of color. However, since fewer studies have focused on Afro-Caribbean and Cuban immigrants, this research extends the literature beyond its current scope by providing a comparative analysis of Haitian and Cuban immigrants, two immigrant groups in Miami, Florida, that have received very little attention comparatively regarding assimilation. Using data from approximately 100 Haitian and Cuban immigrants in and around Little Haiti and Little Havana, the research demonstrates that though both groups are racially and ethnically diverse, assimilation patterns do not prove to be distinctive. Interestingly, the results of this study will also show that for this sample of immigrants, their experiences are relatively similar economically, politically, and culturally. Further, findings challenge classical, segmented and new assimilation theories because they inadequately provide insight on the new wave of immigrants.

Cancer mortality among US blacks: Variability between African Americans, Afro-Caribbeans, and Africans

IntroductionAggregation of all Black populations in US cancer mortality profiles masks remarkable heterogeneity by place of birth. Comparing U.S-born African Americans with African and Afro-Caribbean immigrants may highlight specific cancer prevention and control needs and clarify global cancer epidemiology. Such a comparison has yet to be undertaken on a population basis. MethodsUsing 2012–2017 vital statistics data from California, Florida, Minnesota and New York, age-standardized cancer mortality rates were computed for distinct Black populations. Comparisons were made to the majority White population using mortality rate ratios (MRR) obtained from negative binomial regression. ResultsOf the 83,460 cancer deaths analyzed among Blacks, nearly 20 % were immigrants. African males and females had the lowest all-sites-combined cancer mortality rates (121 and 99 per 100,000, respectively), African Americans had the highest (232 and 163), while Afro-Caribbean were in between (140 and 106 respectively). The average Black:White MRR was significant for prostate (2.11), endometrial (2.05), stomach (2.02), multiple myeloma (1.87), premenopausal breast (1.66), liver (1.58) and cervical (1.56) cancers, (P < 0.05). ConclusionWhile, in aggregate, Blacks in the US have high cancer mortality rates, race itself is not the primary determinant of these disparities. Black immigrant populations show lower cancer mortality than both African Americans and Whites, especially for cancers where environmental factors feature more predominantly: lung, colorectal and breast. Even for cancers with high mortality among all African-descent groups, this study suggests a complex interplay between genetic and environmental factors. Endometrial cancer was unique; mortality rates were similarly high for all three analyzed Black groups.

Abstract P473: Social Determinants of Cardiovascular Health Among Afro-Caribbean Immigrants in New York City

Introduction: Research on cardiovascular health (CVH) and risk factors among immigrants has been well-documented. Less is known about social influences on CVH, among black immigrants. Despite having the largest population of black immigrants in the U.S., Afro-Caribbean (AC) immigrants have been underrepresented in health research. We examined the social determinants of CVH among AC immigrants (Guyanese, Haitian and Jamaican) in New York City (NYC). Hypothesis: We hypothesized that social determinants of CVH will vary among the three ethnic sub-groups of AC immigrants. Methods: We included 1691 AC immigrants who reported their race as non-Hispanic Black and country of birth (COB) as Guyana (n= 369), Haiti (n= 291) or Jamaica (n= 1031) in the 2010-2014 administrations of the New York City Community Health Survey. Logistic regression analysis was performed to assess the association between social determinants and CVH (ideal vs intermediate/poor) using AHA’s CVH metrics. Results: The majority of the sample was female (59.2%) and reported high school education or less (53.9%). Most AC immigrants reported to have ideal CVH (71.3%). Education was significantly associated with CVH only among Jamaican immigrants. Jamaican immigrants with ≤ high school education were more likely to have intermediate/poor CVH compared to those with ≥ some college education. Conclusions: These findings suggest that social determinants influencing CVH differ among AC immigrant sub-groups in NYC. These findings suggest that social determinants influencing CVH differ among AC immigrant sub-groups in NYC. National surveillance efforts should obtain more complete data on country of origin and oversample racial/ethnic minority groups in order to better understand their CVH outcomes. Future research should examine other social factors that may influence CVH among black immigrants.

콰메 퀘이-아마의 Elmina’s Kitchen에 나타난 영국 흑인의 정체성 구축의 딜레마

This paper explores the dilemmas of forging alternative Black British identities in Kwame Kwei-Armah’s 2003 play, Elmina’s Kitchen. Kwei-Armah, the established Black British playwright, presents the intergenerational differences in the community of Afro-Caribbean immigrants in London, encouraging the audience to examine the dilemmas involved in creating a sustainable community within the mainstream white society. Elmina’s Kitchen centres on the predicament of Deli, a reformed ex-con who tries in vain to stop Ashley, his rebellious son, from joining a local gang. The final scene finds him helplessly watching Ashley being killed in the gang warfare. Ashley’s murder is avoidable, and the play is intended as a serious warning to young black males drawn rapidly into the inner-city black-on-black crime.BR However, the play moves beyond its moral framework as Deli’s dilemma comes to the foreground. As a second-generation immigrant, Deli swerves away from the established stereotype of ‘irresponsible’ and ‘deviant’ black fathers, challenging the mainstream audience’s prejudice against Black Britons. He is the only character that aspires to instill a positive sense of black identity for the third-generation black youth. He has to re-define ‘blackness’ as well as to combat political and economic impotence, the negative legacy of the first-generation. Without the benefit of African cultural heritage and rejecting the ‘rube boy’ culture, the Caribbean subculture based on repressive black masculinity, he sometimes comes close to internalizing the idealized white norms and values. Deli’s failure to save Ashley is both personal and generational. It demonstrates a dilemma associated with the situation of the second-generation immigrants forging viable black identities in the poverty of the mainstream black culture.

Breaching the walls of academe: the case of five Afro-Caribbean immigrant women within United States institutions of higher education

While a growing tendency among researchers has been for the examination of diverse forms of discrimination against Afro-Caribbean immigrants within the United States (US), the types of ambiguities that these create for framing the personal and professional identities of Afro-Caribbean women academics who operate within that space remain relatively absent. The literature is also devoid of substantive explorations that delve into the ways and extent to which the cultural scripts of Afro-Caribbean women both constrain and enable their professional success in academe. The call therefore is for critical examinations that deepen, while extending existing examinations of the lived realities for Afro-Caribbean immigrants within the US, and, the specific trepidations that they both confront and overcome in the quest for academic success while in their host societies. Using intersectionality as the overarching framework for this work, we demonstrate, through the use of narrative inquiry, the extent to which cultural constructions of difference nuance the social axes of power, the politics of space and identity, and professional outcomes of Afro-Caribbean immigrant women who operate within a given context. These are captured within our interrogation of the structures of power that they confront and their use of culture to fight against and to break through institutional politics.

Abstract 3343: The Florida women’s cancer study: Breast cancer presentation among African American and Afro Caribbean women in south Florida, a 10-year cohort

Abstract Introduction: The Black population in the US constitutes about 4 million immigrants. Of this, 50% is from the Caribbean region. Jamaica is the largest contributing country, followed by Haiti and Trinidad and Tobago. Florida has the second largest Caribbean population in the USA. Breast cancer is the main cause of cancer death among females responsible for 14%-30% of cancer deaths in the Caribbean; this is up to two times higher than the USA. Little is known about the molecular subtypes of breast cancer and the demographics of Black Caribbean Immigrants. Objectives: Study the demographics of BC patients in the African diaspora, determine similarities and differences in cause, subtype and outcome of women with breast cancers in African American (AA) and Afro-Caribbean (AC) immigrants. Methods: Approved by the Ethics Committee of the University of Miami IRB. Patients treated for breast cancer between 2006 to 2016 were included. Abstracted data included sociodemographic factors, genetic testing results, and treatment histories. Results: A retrospective US-based cohort of 1369 women (self-identified as black), diagnosed with BC - the Florida Women’s Cancer Study (FLWCS), at Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital in Florida. This cohort contains data from 624 (46%) African-American (AA) women and 507 (37%) AC women diagnosed with breast cancer between 2006-2016. Ninety per cent (n=1232) of the cohort is of non-Hispanic ethnicity.FLWCS country distribution includes is composed of Haiti (18.3%), Jamaica (6.5%), Bahamas (3.1%), Cuba and Dominica Republic (2.8% each), Trinidad and Tobago (1%) and other nationalities from the Organization of Eastern Caribbean States (Antigua, St. Kitts and Nevis, Anguilla, Dominica, St. Lucia and Grenada) at 2.5%. ACwomen living in Miami were diagnosed at a younger age (53.7 years versus 54.9 years), than AA women.Twenty-eight percent of the AA women were premenopausal compared with 32% of the AC women. The AA women had a higher BMI, 32.1 vs 29.8 (p=0.0001), a lower proportion of HER2 positive breast cancer of 17.6% versus 23% (p=0.027), and more children 3.1 versus 2.8 (p=0.023), than the AC women. The rate of HER2 overexpression in the Caucasian population is12% while HER2 positivity was seen in 26.2% Jamaican women, 25.8% in Haitian women and 26.5% in Cuban women (p=0.043) respectively. Less than 5% of the cohort underwent genetic testing with less than 1% having a pathogenic germline mutation. Conclusion: African American (AA) and AC women have many similarities there are significant differences in terms of ancestral diversity, inherited genetic mutations, environmental exposures and access to medical care. Thus, it is imperative to gain an understanding of the causes of cancer in AC women in their own countries in order to better serve those immigrant populations once they reach the US. Citation Format: Priscila Barreto Coelho, Matthew Schlumbrecht, Danielle Cerbon, Carlos Parra, Judith Hurley, Sophia George. The Florida women’s cancer study: Breast cancer presentation among African American and Afro Caribbean women in south Florida, a 10-year cohort [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3343.

Abstract P126: The Cardiovascular Health of Afro-Caribbean Immigrants in New York City: a Cross Sectional Study

Introduction: Afro-Caribbean (AC) immigrants are the largest black immigrant group in the U.S. and generally display better physical health than United States (U.S.) born blacks. Cardiovascular health (CVH) disparities among AC immigrant sub-groups are poorly understood. We examined the prevalence of CVH factors among AC immigrants (Guyanese, Haitian and Jamaican) relative to U.S. born blacks residing in New York City. We hypothesized that some AC immigrant sub-groups will have higher rates of CVH factors than U.S. born blacks. Methods: We performed a cross-sectional analysis of pooled data from the 2010-2014 New York City Community Health Survey administrations to estimate the prevalence of CVH and differences among AC immigrant sub-groups. We included 7678 non-Hispanic black participants from Haiti (n=291), Jamaica (n=1031), Guyana (n=369) and U.S. born blacks (5987). Logistic regression was used to examine the association between country of birth and CVH factors. The CVH factors were determined from the AHA’s CVH metrics. We adjusted the models for significant covariates using backward sequential selection. Results: In final adjusted models, in comparison to U.S. born blacks, Jamaican immigrants were more likely to self-report diabetes but were less likely to be overweight/obese. Guyanese immigrants were also less likely to be overweight/obese than U.S. born blacks. There were no significant differences between Haitian immigrants and U.S. born blacks for CVH factors. Conclusions: Although AC immigrants depict superior health status compared to U.S. born blacks, ethnic differences exist in CVH among AC immigrant sub-groups. Efforts to address cardiovascular health factors among black populations in the U.S. should consider ethnic differences that may provide information about the most at-risk populations for disease-specific programmatic or policy interventions.

Length of Residence and Cardiovascular Health among Afro-Caribbean Immigrants in New York City.

Cardiovascular disease (CVD) disproportionately affects non-Hispanic blacks (NHB) in the United States (U.S.). Afro-Caribbean (AC) immigrants comprise over 50% of the immigrant black population and are critical in understanding the health trajectories of blacks in the U.S. We assessed the relationship between length of residence (proxy measure for acculturation) and cardiovascular health (CVH) based on the American Heart Association's (AHA) seven ideal cardiovascular health components among AC immigrants in New York City (NYC). CVH scores were categorized into poor/intermediate CVH (0-3 components) or ideal CVH (≥ 4 components). Multivariable logistic regression was used to examine the association between length of residence in the U.S. and poor/intermediate CVH. In adjusted models, the odds of poor/intermediate CVH were significantly higher for Guyanese (OR = 3.51; 95% CI 1.03-11.95) and Haitian immigrants (OR = 8.02; 95% CI 1.88-34.12) residing in the U.S. for ≥ 10years than for those living in the U.S. for < 10years. Length of residence was not significantly associated with CVH among Jamaican immigrants. We found evidence of ethnic differences in the association between acculturation and CVH among AC immigrants in a major metropolitan city. Culturally tailored interventions are needed to improve the CVH of AC immigrants as they become integrated into the U.S., with special consideration of country of birth.

I Am an African American: Distinguishing Between African American and African Applicants in Medical School Admissions Matters.

Ignoring the diverse and rich cultures and histories of Africa and the African diaspora by applying the term African American to anyone of sub-Saharan African ancestry in medical school admissions does a disservice to applicants, medical schools, and the communities they serve. To determine how applicants can contribute to a diverse educational environment, admissions decisions must go beyond racial and ethnic self-reporting and recognize the diversity that applicants bring to their medical school. Using a holistic approach, institutions can fairly evaluate applicants and strategically fill their incoming classes. What each medical school is looking for based on its mission and how each student reflects that mission and enhances the educational environment should be revisited as each application is considered. Medical schools must adopt practices that strategically enroll applicants who help achieve their mission and better the communities they serve. The benefits of diversity are not achieved in a linear fashion but require a critical mass for each diverse group. Different strategies are needed to enhance the educational environment, address underrepresentation in medicine, and eliminate health disparities. If racial justice and health equity are to be realized, diversity policies need to recognize the differences between African and Afro Caribbean immigrants and African Americans.In this Perspective, the author argues for distinguishing between these groups in medical school admissions. He explores the differences in their history, culture, and experiences and demonstrates their uniqueness. He concludes by discussing diversity in medicine and offering suggestions for considering diversity in medical school admissions.

Racial Identity and the Political Ideologies of Afro-Caribbean Immigrants

Although the number of Black immigrants in the United States is increasing, few studies have examined whether they assimilate into the liberal ideologies with which U.S.-born Blacks are typically affiliated. Using data from the National Survey on American Life, this study examines how identity formation and generational status among Black Caribbean immigrants moderate their ideological differences with U.S.-born Blacks. It shows that Black Caribbean immigrants are more likely to identify with more conservative ideologies as generational status increases. Furthermore, the analysis indicates that the adoption of a Black American racial identity is not by itself associated with an ideological convergence between Black Caribbean immigrants and U.S.-born Blacks. More assimilated Black immigrants who prefer Black American rather than non-Black identities are still more likely to be conservative compared with U.S.-born Blacks. The analysis further provides a nuanced understanding of the relationship between Black racial solidarity and the political ideologies of Caribbean immigrants. It finds that immigrants who both embrace a Black American identity and are members of Black advancement organizations are more likely to have similar political ideologies as U.S.-born Blacks. However, these similarities disappear as assimilation increases.