California Health Interview Survey Research Articles

Health Conditions, Outcomes, and Service Access Among Filipino, Vietnamese, Chinese, Japanese, and Korean Adults in California, 2011-2017.

Objectives. To determine the impact of data disaggregation on the ability to identify health disparities and needs for future research for Filipino, Vietnamese, Chinese, Japanese, and Korean adults in California.Methods. Using available data from the 2011-2017 California Health Interview Survey, we conducted bivariate and multivariable analyses to assess disparities in health conditions, outcomes, and service access compared with non-Hispanic Whites for Asians as an overall group and for each individual subgroup.Results. As an aggregate category, Asians appeared healthier than did non-Hispanic Whites on most indicators. However, every Asian subgroup had at least 1 disparity disguised by aggregation. Filipinos had the most disparities, with higher prevalence of fair or poor health, being obese or overweight, and having high blood pressure, diabetes, or asthma compared with non-Hispanic Whites (P < .05) in multivariable analyses.Conclusions. Failure to disaggregate health data for individual Asian subgroups disguises disparities and leads to inaccurate conclusions about needs for interventions and research.

Examining Psychological Distress Across Intersections of Immigrant Generational Status, Race, Poverty, and Gender.

While many studies have documented the health outcomes of immigrants, little is known about the direct and intersectional influences of generational status on mental health. We conducted a population-based cross-sectional study using data from the California Health Interview Survey from 2015 to 2016 (N = 41,754) to compare the prevalence of psychological distress among first-generation immigrants and non-immigrants relative to second-generation immigrants, overall and across intersections of race, poverty status, and gender. Second-generation and non-immigrant respondents had a significantly higher prevalence (10.1% and 9.4%, respectively) of psychological distress compared to first-generation immigrants (5.9%). Prevalence ratios comparing first-generation to second-generation immigrants were suggestive of an association where first-generation immigrants had lower prevalence of psychological distress compared to second-generation, though not statistically significant (0.81, 95% Confidence interval 0.63, 1.04). Prevalence ratios of non-immigrants relative to second-generation immigrants were not statistically significant (1.12, 95% Confidence interval 0.84, 1.50).

Abstract P6-08-39: Hereditary cancer risk assessment using a chatbot in women presenting to obstetrics and gynecology practices across the U.S.

Abstract Background: Hereditary cancer risk assessment is standard of care in the obstetrics and gynecology (ob/gyn) practice. Historical data indicates 1 in 12 individuals have a family history consistent with hereditary cancer(1), however recent data from a small community practice found that 1 in 4 women met National Comprehensive Cancer Network (NCCN) criteria for genetic testing(2). The aim of this study was to assess the number of women who meet NCCN criteria for genetic testing in a diverse population across the United States (US) by using a computer program that conducts conversations with patients (a.k.a. chatbot) for risk assessment(3). Method: We partnered with Clear Genetics Inc. (San Francisco, CA) to use a HIPAA compliant chatbot for collecting personal and family history of cancer from women in 28 ob/gyn practices across the US. Patients received a text message or email asking them to complete the chatbot five days before their scheduled appointment. Reminders were sent at three days and again one day prior if not completed. After history collection was complete, an algorithm determined if the patient had a known familial variant or met NCCN guidelines for hereditary cancer testing, including BRCA-Related Breast and/or Ovarian Cancer, Lynch, and Polyposis syndromes(3). Incomplete chats, minors under age 18 or those who declined to provide information were excluded. Additionally, some ob/gyn practices elected to exclude pregnant patients. Results: Over 15,000 chatbots were sent to patients. Overall, 65% of patients completed the chatbot and 26% of these patients met NCCN criteria or had a known familial variant(3). 14.5% of completed assessments were excluded (1.2% declined, 1.4% minors and 11.9% pregnant patients). Some patients received the chatbot less than five days before their appointment due to administrative delays at the ob/gyn practice, and 15% of intended recipients did not receive the chatbot due to incorrect contact information. Patients reviewed their experience with an average rating of 4.6 out of 5. Conclusions: A novel chatbot tool was used to collect pertinent cancer history and provide NCCN criteria assessment to identify patients for inherited cancer risk. This study population was nearly four times the size of the most recent study identifying 1 in 4 women met NCCN criteria for genetic testing. In addition, this study was more diverse - examining multiple ob/gyn practices across the US compared to a single community practice. Results of this study were consistent with newly reported data indicating 1 in 4 patients meet NCCN criteria for hereditary cancer testing. There is a need for increased education and tools to help ob/gyn practices identify these patients consistent with ACOG Practice Guideline 634(4), in light of a higher number of patients who need genetic testing.

How structural racism can kill cancer patients: Black patients with breast cancer and other malignancies face historical inequities that are ingrained but not inevitable. In this article, the second of a 2-part series, we explore the consequences of and potential solutions to racism and inequality in cancer care.

How structural racism can kill cancer patients: Black patients with breast cancer and other malignancies face historical inequities that are ingrained but not inevitable. In this article, the second of a 2-part series, we explore the consequences of and potential solutions to racism and inequality in cancer care.

Parents’ functional health literacy is associated with children’s health outcomes: Implications for health practice, policy, and research

ObjectivesLow health literacy has been identified as an important factor linked to negative health outcomes. However, little research has analyzed the relationship between parental health literacy and children’s health outcomes. This is particularly true regarding subgroups of immigrant families, which often face a greater risk of low health literacy and high health disparities. The present study aimed to address this gap by investigating the functional health literacy levels of immigrant and US-born parents and the relation of these functional health literacy levels to child health status. MethodsThe 2007 California Health Interview Survey (CHIS) was used to identify 5877 parents and their children aged 4–10 years. Parental functional health literacy level was assessed using two proxy items. Children’s health outcomes were measured by parents’ self-report. Weighted univariate, bivariate, and multivariate analyses were conducted using STATA 12.0. ResultsLatino US-born, Latino immigrant, and Asian immigrant parents reported significantly lower health literacy levels than their Asian US-born and non-Latino white US-born peers, who reported the highest health literacy levels. Higher parental functional health literacy was a significant correlate of positive child health outcomes only for children of Latino US-born, Latino immigrant, and Asian immigrant parents. ConclusionsParental functional health literacy levels varied significantly between groups. However, parental health literacy was significantly related to child health only for the groups that reported lower parental health literacy levels. Customized health literacy educational messages and intervention strategies should be developed to raise parental health literacy regarding their children in Latino US-born, Latino immigrant, and Asian immigrant parents.

Impact of gentrification on adult mental health

To estimate the net effect of living in a gentrified neighborhood on probability of having serious psychological distress. We pooled 5years of secondary data from the California Health Interview Survey (2011-2015) and focused on southern California residents. We compared adults (n=43815) living in low-income and gentrified, low-income and not gentrified, middle- to high-income and upscaled, and middle- to high-income and not upscaled neighborhoods. We performed a probit regression to test whether living in a gentrified neighborhood increased residents' probabilities of having serious psychological distress in the past year and stratified analyses by neighborhood tenure, homeownership status, and low-income status. Instrumental variables estimation and propensity scores were applied to reduce bias arising from residential selection and simultaneity. An endogenous treatment effects model was also applied in sensitivity analyses. Adults who completed the survey on their own and lived in urban neighborhoods with 500 or more residents were selected for analyses. Survey respondents who scored 13 and above on the Kessler 6 were categorized as having serious psychological distress in the past year. We used eight neighborhood change measures to classify respondents' neighborhoods. Living in a gentrified and upscaled neighborhood was associated with increased likelihood of serious psychological distress relative to living in a low-income and not gentrified neighborhood. The average treatment effect was 0.0141 (standard error=0.007), which indicates that the prevalence of serious psychological distress would have been 1.4 percentage points less if none of the respondents lived in gentrified neighborhoods. Gentrification appears to have a negative impact on the mental health of renters, low-income residents, and long-term residents. This effect was not observed among homeowners, higher-income residents, and recent residents. Gentrification levies mental health costs on financially vulnerable community members and can worsen mental health inequities.

Low Human Papillomavirus Literacy Among Asian-American Women in California: an Analysis of the California Health Interview Survey.

Asian-Americans are one of the fastest growing minority groups in the USA, and the literature notes high rates of human papillomavirus (HPV). In this study, we aimed to address whether key social determinants of health, especially health literacy, in combination with English language proficiency, and immigration status, were key factors in HPV knowledge and awareness among Asian-Americans. The data was collected from the California Health Interview Survey (CHIS). The study population consisted of Asian adult females from 18 to 65years of age, with a sample size of 2050 representing a population of 1,552,710. Survey-weighted descriptive, bivariate, and multivariable Poisson regression were conducted with alpha less than .05 to denote significance. Nearly 45% of the population reported that they never heard of HPV, while 14% reported thinking HPV can cause AIDS, and 13% reported that HPV can go away on its own. HPV knowledge, however, was varied by Asian-American ethnicity as well as being foreign-born. Survey-weighted multivariable robustPoissonregression results show that, when compared with Japanese subgroup, Chinese, South Asians, and Koreans were less likely to have heard of HPV. Having heard of HPV was 31% lower among Asian-Americans who were foreign-born, as compared with those who were US-born. Foreign-born Asian-Americans were 196% more likely to think HPV causes AIDS. Ever having heard of HPV was also associated with low English language proficiency (70% lower), low health literacy (45% lower), and a combination of both (55%). While, those with low English language proficiency understood HPV is a sexually transmitted infection, a substantially high number associated it with AIDS. Interventions towards increasing health literacy among Asian Americans are imperative in order increase HPV vaccination rates to reduce cervical cancer rates/deaths.

The Role of the Medicaid Expansion in the Use of Preventive Health Care Services in California Men.

Men’s use of preventive care services may be constrained due to a number of factors including lack of health care insurance. California used the Medicaid expansion provisions of the Affordable Care Act (ACA) to enroll low-income men between the ages of 18 and 64 years in publicly funded health insurance. Most studies on the effect of the ACA on health care services have focused on racial/ethnic differences rather than gender. Data from the California Health Interview Survey for the 2015–2016 survey period were used to model the use of preventive health care services in the year prior to interview. Population weights were used in the analysis which was done using PROC SURVEY LOGISTIC in SAS software, version 9.4. The sample consisted of men between the ages of 18 and 64 years (N = 6,180). Of these 66% (n = 4,088) reporting receiving any preventive care services in the year prior to interview. The largest proportions of respondents fell into the youngest group aged 18–25 (17%) followed by the oldest group aged 60–64 (16.9%); 43% reported they were married, 57% had incomes at greater than 300% of the federal poverty level. There was no effect of race or ethnicity on receiving preventive care services. Having a chronic condition such as hypertension or diabetes was associated with a greater odds of receiving preventive care. Expanding Medicaid to include low-income men below the age of 65 is associated with increased use of preventive health care, especially among those with chronic conditions.

Excessive Absenteeism Due to Asthma in California Elementary Schoolchildren.

Previous studies of asthma-related school absenteeism have reported absenteeism dichotomously (ie, any school days missed vs none). However, schools use higher thresholds to identify and intervene for students at risk of chronic absenteeism (18 days or ≥10% schoolyear missed), which is associated with negative health and educational outcomes. We sought to identify factors associated with excessive absenteeism (EA) due to asthma (≥9 days missed), a threshold based on a convention defined by Attendance Works for absenteeism risk, and is linked to decreased academic performance and increased risk of chronic absenteeism. We examined responses for asthma-related absenteeism from the 2011 to 2014 California Health Interview Survey for children ages 5-11. Multivariate logistic regression modeled odds ratios of EA for demographic, healthcare utilization, and asthma-related factors. Sensitivity analysis was performed modeling a ≥1 threshold (any absenteeism). 715 respondents represent an estimated 314,200 California schoolchildren with asthma. 50.3% of students missed ≥1 day, and 11.7% missed ≥9 days of school due to asthma. Odds of EA were significantly higher for younger children, lower-income families, and rural students, but not significant for any absenteeism. Indicators of greater asthma severity and poorer control were significantly associated with both EA and any absenteeism. This study identified factors significantly associated with EA that were not significant for lower absence thresholds. This may help direct school-based asthma interventions for which limited resources must target students at higher risk of chronic absenteeism.

Adolescent sleep and technology-use rules: results from the California Health Interview Survey

ObjectivesThis study reports on adolescent sleep, technology-use rules at home, and their potential association using the 2017 California Health Interview Survey (CHIS). MethodsCHIS cross-sectional, representative survey data was collected between June-December 2017 via telephone. Weekday bedtimes, rise times, and night time in bed in the past week, as well as whether technology-use rules were implemented at home, were examined among 448 adolescent residents of California (mean age = 14.5, range = 12-17; 48% women). ResultsThe average weekday nightly time in bed was 9.04 hours among 12- to 13-year-olds and 7.89 hours among 14- to 17-year-olds. The majority reported having technology-use rules and those who did, spent 35 more minutes in bed. Although a significant relationship was found between having technology-use rules and earlier bedtime, one was not found for time in bed, when controlling for demographics. ConclusionsMany California adolescents do not meet recommended sleep guidelines. Yet, technology-use rules appear to be associated with earlier bedtime. Results have implications for policy-making and adolescent sleep interventions.

American Indian/Alaska Native Smokers' Utilization of a Statewide Tobacco Quitline: Engagement and Quitting Behaviors From 2008 to 2018.

The objective of this study was to examine access, engagement, and quitting behaviors of American Indian/Alaska Native (AIAN) callers to the California Smokers' Helpline. Telephone counseling is the primary function of the quitline. The overarching theoretical framework for California's quitline is social cognitive theory, although it also utilizes motivational interviewing and cognitive-behavioral strategies. AIAN (n = 16 089) and White (n = 173 425) California quitline callers from 2009 to 2018 were compared on their characteristics, engagement, and quitting behaviors. Quitline callers responded to a telephone survey at intake. A random selection was called for evaluation 7 months later (White n = 8194, AIAN n = 764). Data from the 2009 to 2017 California Health Interview Survey (CHIS) were used as a reference point for AIANs (AIAN n = 1373). The quitline and CHIS had similar proportions of AIANs (4.6% vs. 4.3%, respectively). AIAN smokers were more likely than White smokers to report physical (53.6% vs. 44.9%) and mental (65.7% vs. 57.8%) health conditions at intake. AIANs were more likely to participate in counseling than White callers (67.1% vs. 65.7%). Among those who received counseling, AIANs had greater odds than White smokers of making a quit attempt (adjusted odds ratio = 1.39 [1.06, 1.81]) and similar odds of quitting for 180 days (adjusted odds ratio = 0.95 [0.69, 1.31]). Rates of access, engagement, and quitting suggest that individualized quitline counseling was as effective with AIANs as it was with White smokers. Increasing efforts to refer AIANs to existing state quitlines can help more smokers quit. This study showed that AIAN smokers were well represented among California quitline callers, even without a targeted campaign. It also found that AIAN smokers engaged in quitline services and were as able to quit as their White counterparts were, even after adjusting for other baseline characteristics. One implication is that public health programs can promote quitlines using broad-based campaigns knowing that they will still motivate AIAN smokers to seek help. Another implication is that a standard, individualized counseling protocol delivered by culturally competent quitline staff can effectively help AIAN smokers to quit.

CAREGIVING ACROSS GENERATIONS AND CULTURES

Utilizing data from the California Health Interview Survey (CHIS) 2009, we examine caregiving activities among foreign born and US born Latinos, and US born Non-Hispanic whites ages 18 to 80 who are caring for an adult age 60 or older. Utilizing OLS regression, we first examine the relationship between race, ethnicity, nativity, and age and the amount of caregiving, types of caregiving, and use of long-term care (LTC) services among the population. Next we examine the health, mental health, and economic status of the three caregiver populations. The results find that middle aged and younger foreign born Latinos provide the greatest amount of care and also present with the greatest amount of economic challenges. US born middle- aged Latino caregivers also provide relatively high levels of care and also are more likely than other caregivers to experience health challenges including diabetes, obesity, depression and social isolation.

MEASUREMENT EQUIVALENCE OF THE KESSLER 6 PSYCHOLOGICAL DISTRESS SCALE FOR OLDER ASIAN IMMIGRANT SUBGROUPS

The Kessler 6 (K6) Psychological Distress Scale is a well-known screening instrument to screen for psychological distress of general population. While some studies (e.g., Mitchell & Beals, 2011) concluded that the K6 was appropriate for capturing psychological distress of diverse racial/ethnic groups, other studies (e.g., Andersen et al., 2011) reported that it was less successful in screening for psychological distress of diverse racial/ethnic groups. Few studies conducted measurement equivalence test across older Asian immigrant subgroups. Using Multiple Group Analysis, this study examined whether parameters of the single factor model (items: nervous, hopeless, restless or fidgety, so depressed, everything was an effort, and worthless) is equivalent across the two Asian immigrants (≥65 years; Chinese [n=175] and Korean [n=300] immigrants). Data were generated from the California Health Interview Survey. The configural model showed good fit (X2=41.70 [df=16, p<.001], X 2/df=2.61, CFI=.98, GFI=.97, RMSEA=.06 [90% CI=.04-.08], and SRMR=.04). When all factor loadings were constrained, it indicated measurement non-invariance status between Chinese and Koran (ΔX 2=17.86, Δdf=5, p=.003, CFI=.972, ΔCFI=.009). Given findings of non-invariance on the full constrained model, the invariance test of each factor loading was performed additionally. It was focused on evaluating which items were similar or different across the two groups. The three items, ‘hopeless,’ ‘restless,’ and ‘depress,’ were significantly nonequivalent between the two groups. Clinicians/researchers should aware of the potential risk for misclassification when they try to screen for psychological distress in older Chinese or Korean immigrants. Professionals should pay attention to cross-cultural comparability when interpreting results from the K6.

ETHNIC DIFFERENCES IN THE RELATIONSHIP BETWEEN SOCIAL CAPITAL AND PSYCHOLOGICAL DISTRESS IN OLDER CALIFORNIANS

Seniors aged 65 and older are at great risk of psychological distress given their functional decline, which is known to limit participation and engagement in community life. The purpose of this study is to examine whether higher indices of social capital have a positive impact on the mental health of older, ethnic Californians. We conducted a secondary analysis of data for 7,485 Californians 65 and older from the 2016 California Health Interview Survey (CHIS). A principal components analysis generated two social capital measures; one measuring safety and social cohesion, the other civic engagement. Hierarchical linear regression analyses were conducted to assess the independent effects of social capital subscales on the severity of psychological distress as measured by the Kessler-6 (K6).Respondents were on average moderately distressed, with small yet significantly higher K6 scores observed among African Americans, Asians, and Native Americans. The addition of our social capital variables in subsequent steps resulted in little yet significant change in explaining psychological distress (ΔR2 = .02, p < .001) with only neighborhood safety and social cohesion being inversely associated with K6 (β = -.15, p < .001). The interaction between ethnicity and neighborhood safety and social cohesion resulted in non-significant associations with K6 scores for all ethnic minority subgroups; however, for African Americans the relationship with psychological distress actually increased significantly (β = .24, p < .001). Our findings suggest that specific types of social capital may be helpful in remediating psychological distress for certain ethnic minority groups.

Predictors of never having a mammogram among Chinese, Vietnamese, and Korean immigrant women in the U.S.

BackgroundBreast cancer is the most common cancer among Asian women in the U.S. The first objective was to investigate predictors (including ethnicity) of never having a mammogram in middle-aged and older Chinese, Vietnamese, and Korean immigrant women (main effects). The second objective was to explore whether relationships between predictors and never having a mammogram varied across the three groups (moderation effects of ethnicity).MethodsMerged (2005-2007-2009-2011) California Health Interview Survey data were utilized. Unweighted sample was 3,710 Asian women ages 40 years and older (Chinese = 1,389; Vietnamese = 1,094; Korean = 1,227). Replicate weighted total sample size was 1,710,233 (Chinese = 940,000; Vietnamese = 410,000; Korean = 360,000). Replicate-weighted multivariate logistic regression was applied. Interaction effects (moderator role of ethnicity) were also examined, using multivariate logistic regression, for the second objective.ResultsFor the first objective, odds of never having a mammogram were higher for women who were Korean (Ref = Vietnamese), unmarried, or a non-U.S. citizen. Odds were lower in women ages 50–59 or 60–69 (Ref = 70–85). Regarding the second objective, only for Chinese women, odds of never having a mammogram were lower as the number of physician visits got higher.ConclusionCulturally-sensitive outreach and services should be developed to target higher-risk groups. Patient-centered healthcare strategies tailored for the three groups could be effective. For Chinese women, in particular, regular information sessions or education programs could be provided for enhancing their physician visits.

Using Machine Learning to Uncover Hidden Heterogeneities in Survey Data

Survey responses in public health surveys are heterogeneous. The quality of a respondent’s answers depends on many factors, including cognitive abilities, interview context, and whether the interview is in person or self-administered. A largely unexplored issue is how the language used for public health survey interviews is associated with the survey response. We introduce a machine learning approach, Fuzzy Forests, which we use for model selection. We use the 2013 California Health Interview Survey (CHIS) as our training sample and the 2014 CHIS as the test sample. We found that non-English language survey responses differ substantially from English responses in reported health outcomes. We also found heterogeneity among the Asian languages suggesting that caution should be used when interpreting results that compare across these languages. The 2013 Fuzzy Forests model also correctly predicted 86% of good health outcomes using 2014 data as the test set. We show that the Fuzzy Forests methodology is potentially useful for screening for and understanding other types of survey response heterogeneity. This is especially true in high-dimensional and complex surveys.

Worse Mental Health Among More-Acculturated and Younger Immigrants Experiencing Discrimination: California Health Interview Survey, 2015-2016.

Experiences of discrimination harm mental and physical health, with the strongest penalty on mental health. Among immigrants, it remains unclear how acculturation-the process by which immigrants acquire the beliefs and practices of a host culture-influences the mental health burden of navigating discrimination. On the one hand, acculturation can be associated with upward social mobility. Conversely, the acculturative process may increase exposure to, and recognition of, discrimination. We examined the relationship between discrimination and mental illness across racial/ethnic groups, and pathways by which acculturation and age relate to the discrimination-mental health relationship. A secondary data analysis using population data from the 2015-2016 California Health Interview Survey. The Kessler 6-item Psychological Distress Scale (K6) assessed symptoms of psychological distress, with K6 score ≥ 13 associated with severe mental illness. Discrimination was measured using a self-reported measure of lifetime experience of unfair treatment in getting medical care. We used a 5-point acculturation index (constructed by measures of nativity, years living in the USA, and home language use). A weighted logistic regression model predicted mental illness as a function of discrimination. We ran mediational analysis using the Karlson-Holm-Breen method and used predictive margins to present predicted probabilities of mental illness for people reporting discrimination at different acculturation and age levels. There were independent effects on mental illness associated with increased discrimination (OR 3.85, 95% CI = 2.46, 6.03, p < 0.001) and increased acculturation (OR 1.72, 95% CI = 1.24, 2.38, p = 0.001), including when stratified across racial/ethnic groups. Higher levels of acculturation led to a significant increase in discrimination's association with mental illness. There was a higher probability of mental illness in younger age groups than in older age groups. While discrimination is associated with poor mental health, a stronger link between discrimination and mental illness exists among younger immigrants and immigrants with increased acculturation. Health practitioners should not overlook the mental health needs of younger immigrants and immigrants who may seem more integrated into US society.

Weekly Working Hours and Mental Health Status in Different Occupations: Evidence From the 2015 to 2016 California Health Interview Survey.

The aim of this paper was to identify shapes of the curves between weekly working hours (WWH) and mental health status (MHS) and determine WWH for the best MHS in 13 occupations. This cross-sectional study applied public data of the 2015 to 2016 California Health Interview Survey. Restricted cubic spline regression was used to determine non-linear trends. A statistically significant nearly V-shaped curve was demonstrated between WWH and MHS in total population, men and management, business and finance occupations. WWH for the best MHS were 42, 45, and 46 hours, respectively. These results suggest MHS be susceptible to WWH in total population, men and management, business and finance occupations. WWH for the best MHS for relevant populations could provide evidence for better work hours regulations in California.

Role of food insecurity in prescription delay among adults with asthma: results from the California health interview survey

Background: Food insecurity remains a major public health concern in the United States. Studies have noted that food insecurity can lead to lower healthcare utilization and poorer health status. Despite the continuous burden of asthma, little research has shown whether food insecurity serves as a social determinant to poor asthma care. In this study, we specifically focused on whether food insecurity can lead to delay in prescription medication for adults with asthma in California.Methods: We utilized the California Health Interview Survey. Survey weighted descriptive, univariate, and multivariable logistic regression analyses were conducted. A total of 11,645 observations, representing an average annual population size of 1,085,481 was included in this study.Results: Nearly 15% and 8% of participants were food insecure and had current asthma, respectively. Based on adjusted odds ratio, food insecure adults were 148% more likely to report delay in asthma prescription, as compared to those who were food secure (adjusted odds ratio =2.48; 95% CI: 1.58, 3.89).Conclusions: Given the delay in prescription, and thus appropriate health care, demonstrated in our study, targeted measures at point of care should be implemented to identify such at-risk patients early and provide resources for food aid to ensure optimal health outcomes.

Relevance of the "Immigrant Health Paradox" for the Health of Arab Americans in California.

Objectives. To assess the validity of the immigrant health paradox among Arab Americans in California.Methods. We used data from the 2003 to 2017 California Health Interview Survey (n = 1425). We used survey-weighted χ2 and logistic regression analyses to compare Arabs by immigrant generation on socioeconomic indicators, health behaviors, and health outcomes.Results. Second-generation Arab Americans had higher odds of binge drinking (adjusted odds ratio [AOR] = 3.26; 95% confidence interval [CI] = 1.53, 6.94) in the past year than did first-generation Arab Americans. Third-generation Arab Americans had greater odds of receiving the influenza vaccine in the past year (AOR = 3.29; 95% CI = 1.09, 9.98) than did second-generation Arab Americans. Third-generation Arab Americans had increased odds of being overweight or obese when compared with first- (AOR = 2.59; 95% CI = 1.02, 6.58) and second-generation Arab Americans (AOR = 3.22; 95% CI = 1.25, 8.29), respectively.Conclusions. Alcohol use increased across immigrant generations, and we observed no differences in health outcomes, other than obesity. The immigrant health paradox does not appear to apply to Arab Americans in California; mechanisms that generate health in this population should be studied further.