Foreign-born Blacks Research Articles

Foreign-Born Blacks Experience Lower Odds of Obesity but Higher Odds of Diabetes than US-Born Blacks in New York City.

Research is limited on the health of foreign-born Blacks (FBBs), who are often grouped with African Americans. This study compared obesity and diabetes odds in FBBs and US-born Blacks (USBBs) in NYC. Analyzing the 2009-2013 NYC Community Health Survey (3701 FBBs and 6297 USBBs), weighted multivariate logistic regression examined odds of obesity and diabetes, adjusting for age, gender, education, income, marital status, children < 18, BMI (for diabetes only) and duration of residence. FBBs had lower odds of obesity [OR 0.62 (95% CI 0.54, 0.72)] and greater odds of diabetes [OR 1.24 (95% CI 1.01, 1.52)] compared to USBBs. FBBs had 1.4 times the odds of diabetes at overweight status, compared to USBBs [OR 1.40 (95% CI 1.01, 1.95)]. Living in the US ≥ 10years was not associated with odds of obesity and diabetes. Future research should seek to uncover unique risk profiles of sub-ethnic groups in the African diaspora.

Deconstructing a disparity: explaining excess preterm birth among U.S.-born black women

PurposeTo determine components of excess preterm birth (PTB) rates for U.S.-born black women relative to both foreign-born black women and U.S.-born white women attributable to differences in observed sociodemographic, behavioral, and medical risk factors. MethodsUsing the 2013 U.S. natality files, we used Oaxaca-Blinder decomposition on the absolute scale to estimate the contribution of the group differences in the prevalence of PTB predictors between U.S.- and foreign-born black women and U.S.-born black and U.S.-born white women. ResultsU.S.-born blacks had a 3.2 (95% confidence interval: 3.0–3.5) and 4.4 (95% confidence interval: 4.3–4.5) percentage point higher risk of PTB than foreign-born blacks and U.S.-born whites, respectively. The variables in the models explained between 18% and 27% of the PTB disparities. Differences in paternal acknowledgment (about 12%), maternal hypertension (about 7%–11%), and maternal education (about 6%–10%) explained the largest proportion of these disparities. ConclusionsPrograms and policies that address both distal and proximate factors, including the social determinants of health and the prevention and management of hypertension, may reduce the higher rates of PTB among U.S.-born black women compared to foreign-born black women and U.S.-born white women.

Black Immigration, Occupational Niches, and Earnings Disparities Between U.S.-Born and Foreign-Born Blacks in the United States

Using data from the 2000 U.S. census and the 2010 to 2014 waves of the American Community Survey, we examine the importance of occupational niches in explaining earnings disparities between U.S.-born blacks and black immigrants in the United States. Our results show that, relative to U.S.-born blacks, most black immigrant subgroups have similar or greater representation in occupational niches. Employment in a niche occupation has a small but positive association with earnings, and the returns to niche employment are greater for black immigrants, particularly black immigrant women. Niche employment does not, however, explain earnings disparities between U.S.-born and immigrant blacks.

From the West Indies to Africa: A universal generational decline in health among blacks in the United States

Research shows that foreign-born blacks have better health profiles than their U.S.-born counterparts. Less is known, however, regarding whether black immigrants’ favorable health outcomes persist across generations or whether these patterns differ across the diverse sending regions for black immigrants. In this study, we use data from the 1996–2014 waves of the March Current Population Survey (CPS) to investigate generational differences in self-rated health among blacks with West Indian, Haitian, Latin American, and African ancestry. We show that first-generation black immigrants have a lower probability of reporting fair/poor health than third/higher generation blacks. The health advantage of the first generation over the third/higher generation is slightly more prounced among the foreign-born who migrated to the United States after age 13. Second-generation immigrants with two foreign-born parents are generally less likely to report their health as fair/poor than the third/higher generation. However, we find no evidence that self-reported fair/poor health varies between second-generation immigrants with mixed nativity parents (only one foreign-born parent) and the third/higher generation. These general patterns hold across each of the ancestral subgroups in the study sample. In summary, our findings highlight a remarkable convergence in health across immigrant generations among blacks in the United States.

Hypertension among US-born and foreign-born non-Hispanic Blacks: National Health and Nutrition Examination Survey 2003-2014 data.

Non-Hispanic Blacks in the United States have the highest reported prevalence of hypertension (44%) worldwide. However, this does not consider the heterogeneity of Blacks within the United States, particularly comparing US-born to long-standing or recent (foreign-born) immigrants. The objective of this study is to compare odds of hypertension between US-born and foreign-born Blacks in the United States. We assessed the prevalence of hypertension among US-born (n = 4511) vs. foreign-born (n = 522) non-Hispanic Black adults aged 22-79 years, based on pooled nationally representative data (2003-2014); as well by length of US residency among immigrants. Multivariable-adjusted logistic regression was used to investigate the association between nativity and hypertension odds. Nearly half (42.8%) of US-born Blacks but only 27.4% of foreign-born Blacks had hypertension. After adjusting for major covariates, foreign-born Blacks were 39.0% less likely (odds ratio 0.61 95% confidence interval 0.49, 0.77) to have hypertension than their US-born counterparts. Among foreign-born Blacks, length of US residency was not significantly associated with odds of hypertension. Foreign-born vs. US-born non-Hispanic Blacks have substantially lower prevalence of hypertension. Considering nativity among US Blacks in clinical research and public health efforts may improve accuracy of characterizing health disparities and facilitate development of targeted interventions to reduce hypertension in this diverse population.

Foreign-born blacks no different from whites for odds of stroke

BackgroundBlacks have higher risk for stroke than whites. However, combining foreign-born and US-born blacks could mask important health differences. We examined the relationship between nativity and stroke risk in US...

Diabetes Knowledge, Management, and Prevention Among Haitian Immigrants in Philadelphia.

Purpose Guided by the PEN-3 Cultural Model, the purpose of this study is to generate culturally framed insight into diabetes knowledge, management, and prevention among Haitians. Despite the disproportionate distribution of type II diabetes mellitus among US minorities, limited research explores outcomes within racial ethnic groups. It is particularly important to disaggregate the large racial-ethnic groups of black given the population growth among foreign-born blacks, such as Haitians, whose population has more than quadrupled in recent decades. Methods Focus group interviews were employed to understand diabetes knowledge, management, and prevention in the Haitian immigrant population in Philadelphia. Interviews were conducted in 2 groups: (1) people living with diabetes and (2) an at-risk sample for diabetes (defined as 30 and older with self-reported family history of diabetes). Interviews were recorded and transcribed verbatim in preparation for content analysis. Results Of the 10 participants, who were recruited through a Philadelphia church-based population, ages ranged from 41 to 91, with an average of 65. Content analysis revealed 3 emergent themes across: (1) cultural identity, including person, extended family, and neighborhood; (2) relationships and expectations, including perceptions, enablers, and nurturers; and (3) cultural empowerment, including positive, existential, and negative. Conclusions Results may inform culturally appropriate diabetes interventions for Haitians. Future research should explore compliance with food recommendations as well as the cultural competency of health care professional's information delivery.

Retention in HIV Care and Viral Suppression: Individual- and Neighborhood-Level Predictors of Racial/Ethnic Differences, Florida, 2015

The objective of this study was to estimate racial/ethnic differences in retention in HIV care and viral suppression and to identify related individual and neighborhood determinants. Florida HIV surveillance records of cases aged ≥13 years diagnosed during the years 2000-2014 were analyzed. Retention in care was defined as evidence of ≥2 or more laboratory tests, receipts of prescription, or clinical visits at least 3 months apart during 2015. Viral load suppression was defined as a viral load of <200 copies/mL for the last test in 2015. Multi-level logistic regressions were used to estimate adjusted odds ratios (AORs). Of 65,735 cases, 33.3% were not retained in care, and 40.1% were not virally suppressed. After controlling for individual and neighborhood factors, blacks were at increased odds of nonretention in HIV care [AOR 1.29, 95% confidence interval (CI) 1.23-1.35] and nonviral suppression (AOR 1.55, 95% CI 1.48-1.63) compared with whites. Black and Latino males compared with their female counterparts had higher odds of nonretention and nonviral suppression. Compared with their US-born counterparts, foreign-born blacks and whites, but not Latinos, had higher odds of nonretention and nonviral suppression. Blacks and whites in urban compared with rural areas had higher odds of both outcomes. Disparities in retention in care and viral suppression persist and are not accounted for by differences in age, sex, transmission mode, AIDS diagnosis, neighborhood socioeconomic status, rural/urban residence, or neighborhood racial composition. Further, predictors of poor retention in care and viral suppression appear to differ by race/ethnicity.

Abstract P086: The Association between Psychological Distress and Diabetes Prevalence among Foreign-Born Blacks in the United States: An Examination of the 2010-2014 National Health Interview Survey

Background: Psychological distress, a leading cause of disability globally, is highly prevalent in people diagnosed with diabetes. Blacks in the U.S. are disproportionately affected by chronic conditions such as diabetes. Taken together, psychological distress and diabetes constitute an immense health burden and result in poor health outcomes, increased mortality and decreased quality of life. While the association between psychological distress and diabetes is documented among U.S.-born Blacks, this relationship remains poorly examined among the growing foreign-born Black population in the U.S. Hypothesis: We hypothesized that psychological distress (non-specific) would be associated with a higher prevalence of diabetes among a sample of foreign-born Blacks in the U.S. Methods: We analyzed data on adult foreign-born Blacks in the 2010-2014 National Health Interview Survey which is a national in-person survey of non-institutionalized persons in the U.S. The main independent variable was psychological distress which was defined as a score of ≥ 12 on the Kessler Psychological Distress Scale (K-6 Scale) . The main outcome variable was diabetes. Multivariable logistic regression was performed to examine the association between psychological distress and diabetes prevalence adjusting for known confounders. Results: A total of 2,974 foreign-born Blacks were included in this study. The mean age (±SE) was 43.9 (±15.3)and nearly half (53.3%) were female. Among the individuals who received the K-6 Scale, 13.3% indicated experiencing symptoms of depression within the last 30 days and 10% had diabetes. After adjusting for age, sex, body mass index, poverty status, and marital status, we observed that foreign-born Blacks with higher levels of psychological distress had 2.30 (95% CI: 1.69-3.12) higher odds of being diabetic in comparison to those without psychological distress. Conclusion: In a sample of contemporary foreign-born Blacks in the U.S., we observed that psychological distress was associated with prevalence of diabetes, such that individuals with elevated levels of psychological distress were twice as likely to be diabetic. Additional barriers may be associated with managing diabetes when a co-morbid mental health condition such as depression is present. Thus, culturally-tailored behavioral health interventions should be developed and utilized among foreign-born Black sub-populations to help promote adherence to complex behavioral and medical regimens associated with diabetes management.

Abstract 12144: Heterogeneity Between Rates of Hypertension Among Immigrant and U.S.-born Blacks: Pooled NHANES, 2003-2014 Data

Introduction: Epidemiological data suggest that Blacks in the U.S. experience the highest prevalence of hypertension (44%) worldwide. It is unclear, however, if there are differences between U.S.-born and foreign-born immigrant Blacks. Since the passage of the Immigration and Nationality Act of 1965, a growing proportion of the U.S. Black population is made up of Black immigrants and it is predicted that by 2060, 16.5% of U.S. Blacks will be immigrants. Within the Black population, there are pronounced cultural differences in food preferences and physical activity habits, as well as social experiences, which are important risk factors for hypertension. Methods: Pooled NHANES data (2003-2014) for non-Hispanic immigrant Black adults aged 22-79y (n=515) and their US-born counterparts (n=4,249) were analyzed. Multivariable-adjusted logistic regression was used to investigate the association between nativity and odds for hypertension (defined as diagnosed hypertension, use of medication, or measured blood pressure ≥140/90mmHg). We also examined the association between length of U.S. residency among Black immigrants and hypertension. Results: Nearly half (48%) of US-born Blacks and 31% of immigrant Blacks had hypertension. Black immigrants were 42.4% less likely (OR 0.58, 95% CI 0.46, 0.72) to have hypertension than their U.S.-born counterparts. Length of U.S. residency was not associated with hypertension among Black immigrants. Conclusions: The likelihood of hypertension differs for immigrants versus U.S.-born Blacks. Considering place of birth among U.S. Blacks in epidemiological and public health research studies may help accurately characterize health disparities and develop targeted interventions to effectively address hypertension in this population.

Did the Great Recession Downsize Immigrants and Native-Born Americans Differently? Unemployment Differentials by Nativity, Race and Gender from 2007 to 2013 in the U.S.

We use data from the Current Population Survey from 2007 and 2013 to investigate demographic differentials in unemployment during the Great Recession in the U.S. Although our analysis is primarily exploratory and descriptive, our major research objective is to illuminate the unemployment differential between the foreign born and the native born. The findings indicate that during the height of the Great Recession, the foreign born had higher unemployment rates than the native born. However, this differential is statistically explained by their observed characteristics, such as race/ethnicity, gender, age and education. With the net of those variables and a few other demographic covariates, foreign born workers as an overall group actually had somewhat lower chances of being unemployed than native born workers. This finding is discussed in terms of the selectivity of immigrant workers and the possibility that they are somewhat more immediately dependent on having a job. After breaking down the foreign born into major racial/ethnic groups, the results suggest that foreign-born blacks and foreign-born Hispanics are particularly selective with the net of their observed characteristics. The possible sources of such differentials by race/ethnicity and by gender are discussed.

Racial/ethnic disparities in self-reported short sleep duration among US-born and foreign-born adults

ABSTRACTObjective. Racial/ethnic health disparities are infrequently considered by nativity status in the United States, although the immigrant population has practically doubled since 1990. We investigated the modifying role of nativity status (US- vs. foreign-born) on racial/ethnic disparities in short sleep duration (<7 h), which has serious health consequences.Design. Cross-sectional data from 23,505 US-born and 4,326 foreign-born adults aged ≥ 18 years from the 2012 National Health Interview Survey and multivariable log-linear regression were used to estimate prevalence ratios (PR) for reporting short sleep duration and their corresponding 95% confidence intervals (CI).Results. After controlling for sociodemographic covariates, short sleep was more prevalent among blacks (PR 1.29, 95% CI: 1.21-1.37), Hispanics (PR 1.18, 95% CI: 1.08, 1.29), and Asians (PR 1.37, 95% CI: 1.16-1.61) than whites among US-born adults. Short sleep was more prevalent among blacks (PR 1.71, 95% CI: 1.38, 2.13) and Asians (PR 1.23, 95% CI: 1.02, 1.47) than whites among the foreign-born.Conclusion. Among both US- and foreign-born adults, blacks and Asians had a higher likelihood of short sleep compared to whites. US-born Hispanics, but not foreign-born Hispanics, had a higher likelihood than their white counterparts. Future research should aim to uncover mechanisms underlying these disparities.

Successful black immigrants narrow black–white achievement gaps

Foreign-born blacks have become a large part of the American black population. Compared to native-born blacks, they are more likely to be high-earning, employed, educated, and not institutionalized. The systematic outcome differences have masked the widening of black–white achievement gaps.

Abstract A40: Untangling the ethnic differences among black men relative to prostate cancer burden: The Florida CaPCaS study

Abstract Background and Objective: Without a doubt, foreign-born Blacks continue to transform the ethnic composition of the Black population in the US. Unfortunately, native-born and foreign-born Blacks are often grouped together in health disparities research. This practice limits our ability to effectively address health disparities, especially with respect to prostate cancer (CaP). One of the goals of the Florida Prostate Cancer Disparity group is to untangle the ethnic differences in CaP disparities. As part of a large-scale study to develop a model of CaP care and survivorship (CaPCaS model) for Black men (BM), the primary objective of this study is to explore the ethnic differences in CaP incidence/morbidity among BM. Research Strategy: The study population is Florida BM diagnosed with CaP in 2010. Our primary objective is to estimate the ethnic differences in the incidence of CaP among Native-born BM (NBBM), Caribbean-born BM (CBBM) and African-born BM (ABBM). Following appropriate Human Subjects approvals, participants (only BM) were identified through the Florida Cancer Data System (FCDS). The FCDS has collected the number of new cancer cancers diagnosed in the state of Florida annually since 1981. Since the country of birth is not collected as part of cancer registry data, the primary strategy was to contact all the men identified through the FCDS database. Using the published standard procedure by FCDS for recruitment, all BM diagnosed with CaP were contacted to participate in the study. Participant recruitment included: (i) initial patient contact mailing with patient response form; (ii) second mailing with telephone opt-out card; and (iii) telephone call. Following the Florida Department of Health standard procedure, we did not disclose that the patient is being contacted for a study specific to cancer on the cover of study mailings. For participants who agreed to participate in the study, structured telephone survey was employed to collect data on their demographics, including ethnicity and country of birth. Trained Community Health Workers who were African Americans conducted the phone survey. An incentive of $5 Walmart card was sent to all participants. Results: The FCDS provided a database of 1,813 participants identified as BM diagnosed with CaP in 2010 (most recent completed database). The FCDS does not extract data on patients with a death certificate, thus quite a number of the men were reported to be deceased. In addition, there were bad addresses. A total of 212 completed responses were obtained by phone. Majority of the participants were between 60 and 69 years (48.2%), had only high school diploma (26.1%), and currently married (65.3%). Relative to ethnicity, 67% of participants classified themselves as African-American of American origin (born and grew up in America), 20% as African-American of Caribbean origin (born in one of the Caribbean Islands but now American), 4% as Caribbean, 3.5% as African-American of African origin (born in Africa but now American), 0% as African, and 5.5% as Other/Don't know/Refused. For the CBBM, the most common country of birth are Jamaica, Haiti and Guyana, respectively. For Africa, the most common country of birth is Nigeria. Conclusion: This study explored the ethnic differences among BM relative to CaP diagnosis in Florida. The findings suggest that the burden of CaP may be lowest among African-born BM compared to CBBM and NBBM. This conclusion is similar to our previously published review of the global burden of CaP in BM. Given the fact that Black populations of African ancestry share ancestral genetic factors that increase their susceptibility to CaP, the question of exogenous factors in the origin, cause, recurrence and survivorship of CaP among Blacks need to be further explored, especially through migration and global studies. Another implication of this study is the importance of studying CaP in US immigrants, especially immigrants from Jamaica, Haiti and Nigeria. Citation Format: Folakemi Odedina, Mary Ellen Young, Getachew Dagne, Christopher Williams, Deidre Pereira, Lauren Gilbert, Eva Egensteiner, Kenneth Stokes, Christopher Hill, Community Advisory Board CaPCaS. Untangling the ethnic differences among black men relative to prostate cancer burden: The Florida CaPCaS study. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A40.

Effect of birthplace on cardiometabolic risk among blacks in the Metabolic Syndrome Outcome Study (MetSO).

BackgroundMetabolic syndrome poses an increased global burden of disease and causes immense financial burden, warranting heightened public health attention. The present study assessed the prevalence and severity of cardiometabolic risk among foreign-born versus US-born blacks, while exploring potential gender-based effects.MethodsA total of 1035 patients from the Metabolic Syndrome Outcome Study (Trial registration: NCT01946659) provided sociodemographic, medical history, and clinical data. General Linear Model (GLM) was used to assess the effects of birthplace and gender on cardiometabolic parameters, adjusting for age differences in the sample.ResultsOf the sample, 61.6 % were foreign-born blacks (FBB) and 38.4 % were US-born blacks (USB). FBB had significantly lower BMI compared with USB (32.76 ± 0.35 vs. 35.41 ± 0.44, F = 22.57), but had significantly higher systolic blood pressure (136.70 ± 0.77 vs. 132.83 ± 0.98; F = 9.60) and fasting glucose levels than did USB (146.46 ± 3.37 vs. 135.02 ± 4.27; F = 4.40). Men had higher diastolic BP (76.67 ± 0.65 vs. 75.05 ± 0.45; F = 4.20), glucose (146.53 ± 4.48 vs. 134.95 ± 3.07; F = 4.55) and triglyceride levels (148.10 ± 4.51 vs. 130.60 ± 3.09; F = 10.25) compared with women, but women had higher LDL-cholesterol (109.24 ± 1.49 vs. 98.49 ± 2.18; F = 16.60) and HDL-cholesterol levels (50.71 ± 0.66 vs. 42.77 ± 0.97; F = 46.01) than did men.ConclusionsResults showed that birthplace has a significant influence on cardiometabolic profiles of blacks with metabolic syndrome. Patients’ gender also had an independent influence on cardiometabolic profile.

Park-Use Behavior and Perceptions by Race, Hispanic Origin, and Immigrant Status in Minneapolis, MN: Implications on Park Strategies for Addressing Health Disparities.

The study examines the connections between minority status, park use behavior, and park-related perceptions using recent survey data from three low-income neighborhoods in Minneapolis, MN. Blacks and foreign-born residents are found to underutilize parks. Blacks, Asians, and American Indians perceive fewer health benefits of parks than whites, including the benefits of parks for providing exercise/relaxation opportunities and family gathering spaces. Foreign-born residents, blacks, and Hispanics perceive greater and unique barriers to park use in terms of not feeling welcome, cultural and language restrictions, program schedule and pricing concerns, and/or facility maintenance and mismatch concerns. When designing park strategies for addressing health disparities, we recommend to focus the efforts on increasing awareness of park-related health benefits and removing specific park use barriers among minority and foreign-born communities.

HIV/AIDS among African Immigrants in the U.S.: The Need for Disaggregating HIV Surveillance Data by Country of Birth

The goals of the United States' National HIV/AIDS Strategy are reducing HIV infections, increasing linkage to care, and reducing health disparities. To accomplish these, it is imperative to have accurate data about HIV prevalence, especially in high-burden populations, including immigrants, ethnic/racial minorities and other minority populations. However, recent increases in HIV prevalence among Black migrants from sub-Saharan Africa has drawn attention to the need to examine the epidemiological diversity of the Black population, and accurately account for HIV prevalence within it. In most HIV surveillance data, a single category, Black/African American, is used to combine data for U.S.-born and foreign-born Blacks, including migrants from sub-Saharan Africa. Such categorizations result in under-estimation of HIV prevalence in the African immigrant population, making it difficult to allocate resources appropriately for HIV prevention and treatment. This paper highlights and provides recommendations regarding the importance of disaggregating HIV surveillance data on Blacks by country of birth.

HIV counseling and testing in tuberculosis contact investigations in the United States and Canada

Determining the human immunodeficiency virus (HIV) status of tuberculosis (TB) patients and contacts is important. Despite existing guidelines, not all patients are tested, and testing of contacts is rarely performed. In a study conducted at nine US/Canadian sites, we introduced formal procedures for offering HIV testing to TB patients and contacts. Data were collected via interviews and medical record review. Characteristics associated with offering and accepting HIV testing were examined. Of 651 TB patients, 601 (92%) were offered testing, 511 (85%) accepted, and 51 (10%) were HIV-infected. Of 4152 contacts, 3099 (75%) were offered testing, 1202 (39%) accepted, and 24 (2%) were HIV-infected. Contacts aged 15-64 years, non-Whites, foreign-born persons, smokers, those with positive TB screening, and household contacts were more likely to be offered testing, whereas contacts exposed to HIV-negative patients were less likely to be offered testing. Contacts aged 15-64 years, smokers, drug/alcohol users, diabetics, and those with positive TB screening were more likely to accept testing. Foreign-born persons, Blacks, Hispanics, and contacts exposed to HIV-positive patients were less likely to accept testing. High rates of HIV were detected among patients and contacts. Despite structured procedures to offer HIV testing, some patients and most contacts did not accept testing. Strategies are needed to improve testing acceptance rates.

Obesity Among U.S.- and Foreign-Born Blacks by Region of Birth.

Large, recent migration streams from the non-Hispanic Caribbean islands and Africa have increased the share of U.S. blacks born outside of the U.S. Little is known about health patterns in these foreign-born populations. The purpose of this study is to compare obesity levels among self-identified U.S. blacks across birth regions and examine potential explanations for subgroup differences. Data were from the 2000-2013 National Health Interview Surveys. Three birthplace subgroups were examined: individuals born in the U.S., Caribbean/South America, and Africa, aged 25-59 years. Data were analyzed in 2013-2014. Compared to U.S.-born participants, foreign-born participants had significantly lower obesity (BMI ≥30) odds. The AORs were 0.51 (Caribbean/South American-born, 95% CI=0.44, 0.58) and 0.41 (African-born, 95% CI=0.34, 0.50) with reference to U.S.-born individuals. Education, income, and cigarette smoking did not explain the favorable weight pattern of the foreign born. Among the foreign born, those residing in the U.S. for ≥15 years had 51% (95% CI=10%, 108%) higher obesity odds compared with those residing for <5 years. No statistically significant differences in obesity odds between those born in the Caribbean/South America and Africa were detected. Foreign-born blacks generally had lower obesity levels compared to their U.S.-born counterparts, which was not explained by SES or smoking behaviors. Despite this advantage, obesity prevalence among foreign-born black women was around 30%, suggesting that obesity poses a significant health risk this population.

Diabetes among US- and foreign-born blacks in the USA

Objective. Little is known about diabetes status among US blacks by nativity. This study aims to measure differences in diabetes among US blacks by region of birth and examines potential explanations for subgroup differences.Design. Data from 47,751 blacks aged 25–74 pooled from the 2000–2013 waves of the National Health Interview Survey were analyzed. Logistic regression models predicted self-reported diabetes. The roles of education, income, body mass index (BMI), smoking, and duration of US residence were explored.Results. Compared to the US-born, foreign-born blacks had significantly lower reported diabetes prevalence (8.94% vs. 11.84%) and diabetes odds ratio [OR: 0.75; 95% confidence interval (CI): 0.62, 0.89], adjusting for socio-demographic characteristics. Further inclusion of education, income, household size, and smoking did not appreciably change the OR (0.77; 95% CI: 0.61, 0.86). Including an adjustment for BMI entirely eliminated the foreign-born advantage (OR 0.93; 95% CI: 0.78, 1.11). The foreign-born from the Caribbean/Americas had similar diabetes odds compared to the African-born. Among the foreign-born, an increased duration of US residence was associated with a higher diabetes odds, but these associations did not reach statistical significance (p > 0.05).Conclusion. The healthy immigrant advantage extended to diabetes among US blacks, a finding that is explained by lower levels of overweight/obesity among the foreign-born compared to the US-born. Nonetheless, more than 71.4% of the foreign-born were overweight or obese. Understanding the mechanisms through which exposure to the US environment leads to higher obesity and diabetes risk may aid prevention efforts for the rapidly growing foreign-born black subpopulation.