US-born Hispanics Research Articles

US nativity and dietary acculturation impact the gut microbiome in a diverse US population.

Little is known regarding the impact of immigrant acculturation on the gut microbiome. We characterized differences in the gut microbiome between racially/ethnically diverse US immigrant and US-born groups, and determined the impact of dietary acculturation on the microbiome. Stool samples were collected from 863 US residents, including US-born (315 White, 93 Black, 40 Hispanic) and foreign-born (105 Hispanic, 264 Korean) groups. We determined dietary acculturation from dissimilarities based on food frequency questionnaires, and used 16S rRNA gene sequencing to characterize the microbiome. Gut microbiome composition differed across study groups, with the largest difference between foreign-born Koreans and US-born Whites, and significant differences also observed between foreign-born and US-born Hispanics. Differences in sub-operational taxonomic unit (s-OTU) abundance between foreign-born and US-born groups tended to be distinct from differences between US-born groups. Bacteroides plebeius, a seaweed-degrading bacterium, was strongly enriched in foreign-born Koreans, while Prevotella copri and Bifidobacterium adolescentis were strongly enriched in foreign-born Koreans and Hispanics, compared with US-born Whites. Dietary acculturation in foreign-born participants was associated with specific s-OTUs, resembling abundance in US-born Whites; e.g., a Bacteroides plebeius s-OTU was depleted in highly diet-acculturated Koreans. In summary, we observed that US nativity is a determinant of the gut microbiome in a US resident population. Dietary acculturation may result in loss of native species in immigrants, though further research is necessary to explore whether acculturation-related microbiome alterations have consequences for immigrant health.

Disparities in Sleep Health among Adolescents: The Role of Sex, Age, and Migration.

Background. Disparities in sleep disturbances have been described in adults; nevertheless, among adolescents, data have yielded conflicting results. Therefore, analyses of our cohort study of 500 urban, normally developed Hispanic adolescents (10–18 years), aim to determine if rates of sleep debt differ between: (a) male and female adolescents, (b) US-born Hispanics and first-generation immigrant ethnic counterparts, and (c) specific activities that these teens trade for sleep. Participants’ weekday and weekend sleep patterns, along with the reasons for sleeping less than the recommended hours were recorded. Standardized surveys were used to gather information regarding sociodemographics, migration, acculturation, and medical history. Using the criteria set forth by the National Sleep Foundation, analyses indicated that sleep deprivation is a pervasive problem, with 75% in the preadolescents and 45% of the late adolescents exhibiting sleep problems. Females slept on average at least one hour less per day than their male counterparts (7 vs. 8 hours). The sleep problems were rooted in several overlapping causes, including use of technology, video games, studying, and employment. Nevertheless, reasons for sleep loss differed by gender and by immigrant status. Multivariable adjusted logistic regression analyses showed that females, US-born teens, and preadolescents had higher odds of being sleep deprived. Pediatricians and sleep experts should be aware of gender-specific causes and responses of sleep problems. Cultural ecological frameworks need to be considered, and clearly indicate that findings may not generalize to youth from other cultural backgrounds.

Relationship Between Hispanic Nativity, Residential Environment, and Productive Activity Among Individuals With Traumatic Brain Injury: A TBI Model Systems Study.

To examine the influence of nativity and residential characteristics on productive activity among Hispanics at 1 year after traumatic brain injury (TBI). Acute rehabilitation facilities and community follow-up. A total of 706 Hispanic individuals in the TBI Model Systems National Database. Secondary data analysis from a multicenter longitudinal cohort study. Nativity (foreign born or US native), productive activity derived from interview questions regarding employment status, and other demographic information. Census data were extracted by zip code to represent residential characteristics of aggregate household income and proportion of foreign language speakers (FLS). Among foreign-born individuals with TBI, those living in an area with a higher proportion of FLS were 2.8 times more likely to be productive than those living in areas with a lower proportion of FLS. Among individuals living in an area with a lower proportion of FLS, US-born Hispanics were 2.7 times more likely to be productive compared with Hispanic immigrants. The relationship between nativity and productive activity at 1 year post-TBI was moderated by the residential proportion of FLS. Findings underscore the importance of considering environmental factors when designing vocational rehabilitation interventions for Hispanics after TBI.

Age-Period-Cohort Analyses of Tuberculosis Incidence Rates by Nativity, United States, 1996-2016.

To assess changes in US tuberculosis (TB) incidence rates by age, period, and cohort effects, stratified according to race/ethnicity and nativity. We used US National Tuberculosis Surveillance System data for 1996 to 2016 to estimate trends through age-period-cohort models. Controlling for cohort and period effects indicated that the highest rates of TB incidence occurred among those 0 to 5 and 20 to 30 years of age. The incidence decreased by age for successive birth cohorts. There were greater estimated annual percentage decreases among US-born individuals (-7.3%; 95% confidence interval [CI] = -7.5, -7.1) than among non-US-born individuals (-4.3%; 95% CI = -4.5, -4.1). US-born individuals older than 25 years exhibited the largest decreases, a pattern that was not reflected among non-US-born adults. In the case of race/ethnicity, the greatest decreases by nativity were among US-born Blacks (-9.3%; 95% CI = -9.6, -9.1) and non-US-born Hispanics (-5.7%; 95% CI = -6.0, -5.5). TB has been decreasing among all ages, races and ethnicities, and consecutive cohorts, although these decreases are less pronounced among non-US-born individuals.

Examining potential gaps in supportive medication use for US and foreign-born Hispanic women with breast cancer.

Compared to non-Hispanic Whites, Hispanic women are more likely to report pain, depression, and other mental health concerns. However, little is known about Hispanic women's use of supportive medications, and whether use differs depending on nativity (US- vs. foreign-born). This study's objectives were to examine patterns of supportive medication use and investigate potential differences by ethnicity/nativity among women with breast cancer. We used the Surveillance, Epidemiology, and End Results data linked with Medicare claims to identify women diagnosed with incident breast cancer between July 1, 2007, and December 31, 2011. Supportive medication use (opioid pain and non-opioid psychotropic medications) in the 90days after diagnosis was the primary outcome. We categorized ethnicity/nativity as US-Born non-Hispanic, US-born Hispanic, foreign-born non-Hispanic, and foreign-born Hispanic. Modified Poisson models examined associations between ethnicity/nativity and medication use, adjusting for tumor, treatment, and demographic characteristics. We included 23,091 women, of whom 88% were US-born non-Hispanics, 4% US-born Hispanics, 6% foreign-born non-Hispanics, and 2% foreign-born Hispanics. Supportive medication use varied by ethnicity/nativity. Compared to US-born non-Hispanics, foreign-born Hispanics and non-Hispanics were 5% (95% CI 0.92-0.98) and 10% (95% CI 0.85-0.96) less likely to receive supportive medications, respectively. US-born Hispanics were 5% (95% CI 1.02-1.09) more likely to receive supportive medications. Observed differences persisted when analyses were limited to stage I-III breast cancer cases. This work highlights potential disparities in the pharmacologic treatment of psychosocial needs of foreign-born breast cancer patients. Future studies should explore if differences observed here are reflective of health disparities or differential patient preferences.

Formal and parental sex education differences among Hispanic young women by nativity status

ABSTRACTThis study sought to investigate the association between nativity status and Hispanic young women’s formal sex education and parental sex education in the USA. We used data from a cross-sectional sample of 310 Hispanic young women aged 18–24 years old from the 2013–2015 US National Survey of Family Growth. We assessed 11 outcomes: four formal sex education topics; receiving any formal sex education; a formal sex education scale; four parental sex education topics; and receiving any parental sex education. The majority of our sample was US-born Hispanic versus foreign born (72.6% and 27.4% respectively). Foreign-born Hispanics were less likely to have received any type of formal sex education than US-born Hispanics (adjusted odds ratio = 0.81; 95% confidence interval: 0.24, 0.68, p < 0.01). Foreign-born Hispanics were less likely to have received parental HIV sex education than U.S.-born Hispanics (aOR = 0.36; 95% CI: 0.14, 0.97, p < 0.05). Nativity status did not have a significant effect on each unit increase on the scale (aB = –0.07, SE = 0.16; aβ = –0.42, p > 0.05). Our results indicate that having appropriate sex education knowledge is better than not being cognisant. Future studies should however examine the quality and content of sex education programmes so policymakers can better understand these young women’s sexual behaviours and decisions.

Contribution of previable live births to disparity in infant mortality of US-born Puerto Ricans compared with infants of other Hispanic origins.

Although US-born Hispanics experience infant mortality rates (IMRs) which are lower than the national rate, within the Hispanic population, infants of Puerto Rican origin experience higher IMRs than other Hispanics. We aimed to describe the contribution of deaths among previable live-born infants to disparity in IMRs comparing Puerto Rican infants to infants of other Hispanic origins. Retrospective, descriptive analysis. We analyzed data from the Centers for Disease Control and Prevention (CDC) WONDER online database representing linked US live births and infant deaths from 2005 to 2014. Data were stratified by race and ethnicity as well as by Puerto Rican and non-Puerto Rican Hispanic origin. Live births <23 weeks of gestation were classified as previable. Ten-year IMRs were calculated as the number of deaths divided by the number of live births for each group over the entire decade. Puerto Rican IMR of 7.34 (per 1000 live births) was higher than the US rate of 6.34 as well as the non-Puerto Rican Hispanic IMR of 5.15. Approximately 22% of US deaths were attributable to previable live births compared with 27% among Puerto Ricans and 20% among non-Puerto Rican Hispanics. The contribution to IMR of previable births among Puerto Ricans measuring 1.96 per 1000 total live births was 42% higher than the US rate of 1.38 and 90% higher than the non-Puerto Rican Hispanic rate of 1.03. Further research is needed to develop interventions to reduce disparity in previable birth rates, particularly among infants of Puerto Rican origin.

Abstract P122: Racial/Ethnic Variation in Incidence and Progression of Coronary Artery Calcification: Implications for Understanding the Hispanic Paradox

Background: Previous studies show that Hispanic persons have similar or lower levels of coronary artery calcium (CAC) and slower progression than non-Hispanic whites (NHW), even after adjustment for traditional risk factors. We examined whether this health advantage in CAC incidence and progression among Hispanic adults extends across all levels of risk factor (RF) burden, and whether associations vary by nativity (foreign-born, US-born) and by heritage group (Mexican, non-Mexican). Methods: We analyzed data on Hispanic and NHW participants aged 45-84 years from the Multi-Ethnic Study of Atherosclerosis (MESA). Follow-up CAC measurements and complete covariate data were available for 3694 participants with an average of 6.6 years between the follow-up and baseline scans (2000-2002). Baseline measures of the following traditional RFs were considered: current cigarette smoking, high total cholesterol, hypertension, diabetes, and obesity, with RF burden scores ranging from 0-5. Outcomes were incident CAC (any follow-up CAC &gt;0 Agatston units) among individuals without detectable CAC at baseline, and CAC progression (any positive increase in CAC) among all participants estimated using relative risk regression. All models were adjusted for age, sex, RF burden, race/ethnicity, education, income, and time between scans Results: Although a higher proportion of Hispanics had RF burden scores ≥3 compared to NHW (14.6% vs 8.9%, p&lt;0.0001), Hispanics had a lower adjusted incidence (risk ratio (RR) = 0.83, 95% CI: 0.72-0.96) and less progression of CAC (RR=0.90, 95% CI: 0.86-0.95) than NHW. However, there was evidence of heterogeneity in this pattern. For example, among individuals with no detectable baseline CAC, a Hispanic health advantage was only seen among individuals with RF burden scores of 0 (RR=0.66, 95% CI: 0.48-0.91 for Hispanics vs. NHW at RF=0), with race/ethnic differences getting progressively smaller with increasing RF burden (for RF ≥3: RR=1.01, 95% CI: 0.69-1.48). Compared to NHW, lower adjusted incidence and progression of CAC was evident to an even greater extent among foreign-born Hispanics, but a health advantage was still present for US-born Hispanics, and for both Hispanic heritage groups. However, these patterns also only remained among individuals with lower RF burden scores. Conclusions: The Hispanic health advantage in CAC incidence and progression was primarily evident among individuals with fewer traditional risk factors for CVD, but was present among different Hispanics groups. Future research is necessary to identify the factors underlying this advantage, and the dynamics that erode it as RF burden increases.

Investigating Hispanic disparities in supportive medication use among Medicare beneficiaries with breast cancer.

154 Background: Compared to their White counterparts, Hispanic women with breast cancer are more likely to report pain, depression, and other mental health concerns. As such, this group may benefit from supportive medication use following diagnosis. However, little is known about their uptake of supportive medication, relative to White patients. In particular, it is unknown if this varies by nativity. This study’s objectives were to assess supportive medication use and investigate potential disparities in use by ethnicity/nativity. Methods: We used the Surveillance, Epidemiology and End Results data linked with Medicare claims to identify women 65+ years diagnosed with incident breast cancer between July 1, 2007 and December 31, 2011. Use of supportive medications (defined as opioid pain and non-opioid psychotropic medications) within 90 days of diagnosis was the primary outcome. We categorized ethnicity/nativity as U.S-Born Non-Hispanic, U.S-Born Hispanic, Foreign-Born Non-Hispanic, and Foreign-Born Hispanic. Poisson models were used to examine associations between ethnicity/nativity and supportive medication use, adjusting for tumor, treatment, and demographic characteristics. We estimated adjusted risk ratios and 95% confidence intervals for all estimates. Results: This study included 23,091 women, of whom 88% were U.S-Born Non-Hispanics, 4% U.S-Born Hispanics, 6% Foreign-Born Non-Hispanics, and 2% Foreign-Born Hispanics. We observed significant adjusted differences in supportive medication use by ethnicity/nativity. Compared to US-Born Non-Hispanics, Foreign-Born Hispanics and Non-Hispanics were 5% (95% CI 0.92-0.98, p = 0.005) and 10% (95% CI 0.85-0.96, p = 0.0005) less likely to receive supportive medications, respectively. U.S-Born Hispanics were 5% (95% CI 1.02-1.09) more likely to receive supportive medications. Conclusions: This work highlights potential disparities in supportive care, and the need to address the psychosocial needs of Foreign-Born women to improve the equity of breast cancer care. Future studies should explore if differences observed in this study are reflective of true health disparities or differential patient preferences.

Hispanic Immigrant Father Involvement with Young Children in the United States: A Comparison with US-Born Hispanic and White non-Hispanic Fathers.

Objectives Fathering is known to foster child development and health, yet evidence on Hispanic immigrant fathers' involvement with their young children is sparse. This study assessed disparities in pregnancy intendedness and father involvement with children ages 0-4 among Hispanic immigrant co-resident fathers versus two reference groups: US-born Hispanic and US-born White fathers. We hypothesized that differentials in involvement were associated with socioeconomic and cultural factors. Methods Using 2011-2013 data from the National Survey of Family Growth (N = 598), we performed bivariate, logistic and linear regression analyses to assess disparities in pregnancy intendedness and five father involvement outcomes (physical care, warmth, outings, reading and discipline). The models controlled for socio-economic, structural, health and cultural covariates. Results Pregnancy intendedness did not differ significantly between Hispanic immigrant fathers and the two reference groups. Compared with US-born Hispanics, unadjusted models showed that immigrant fathers were less likely to engage in physical care, warmth and reading, (p ≤ 0.05) though the differences were attenuated when controlling for covariates. Hispanic immigrant fathers were less likely than US-born White fathers to engage in each of the father involvement outcomes (p ≤ 0.05), with the disparity in reading to their child persisting even after controlling for all covariates. Conclusions for Practice We found marked socio-economic and cultural differences between Hispanic immigrant and US-born Hispanic and White fathers which contribute to disparities in father involvement with their young children. Hispanic immigrant status is an important determinant of involved fathering and should be taken into account when planning public health policies and programs.

Examining HPV- and HPV vaccine-related cognitions and acceptability among US-born and immigrant hispanics and US-born and immigrant non-Hispanic Blacks: a preliminary catchment area study.

Disparities in HPV vaccination exist. Therefore, we investigated the distinction and disparities in HPV- and HPV vaccine-related cognitions and acceptability among US-born African Americans (AA) and Black immigrants, and between US-born Latinas and Latina immigrants. Secondary data analyses were conducted with 383 female adults divided into non-Hispanic Blacks-(1) AA born in the US (n = 129) and (2) Black immigrants (n = 53), and Hispanics-(3) Latinas born in the US (n = 57) and (4) Latina immigrants (n = 144). HPV-related cognitions are assessed by measuring HPV-related knowledge and HPV vaccine-related awareness, beliefs, accessibility, and acceptability. Black and Latina immigrants were less likely to know where they can get/refer for HPV vaccine (p = .007) than their US-born counterparts. Latina immigrants were less likely to have heard of HPV vaccine (p = .033), know where they can get more information about HPV vaccine (p = .045), and know where they can get/refer for HPV vaccine (p = .001) than US-born Latinas. Both immigrant groups (Black: p = .046; Latina: p = .044) were more likely to report cost concerns than their counterparts. US-born AA were the least likely to endorse HPV vaccine safety (31.0%) and efficacy (39.7%), whereas US-born Latinas endorsed efficacy (63.2%) but less safety (44.6%). Overall, vaccine acceptability was low across all groups. Group disparities in HPV vaccine cognitions emerged, but they all had notable HPV vaccine acceptability (safety and efficacy) barriers. HPV vaccine safety and efficacy were highly unfavorable in US-born AA. The HPV vaccine safety concerns are demonstrated with only 31-54% reporting that the "HPV vaccine is safe"-potentially increasing their risk of HPV vaccine negation. With regards to HPV vaccine efficacy, only 40-63% of this study population endorsed HPV vaccine efficacy. Additionally, immigrants reported greater HPV vaccine cost barriers and healthcare access concerns-increasing their risk for HPV vaccine naiveté. Therefore, our findings on HPV vaccine cognitions and acceptability can inform targeted strategies to increase vaccination among US and immigrant Hispanics and non-Hispanic Blacks who are at elevated risk for HPV-related cancers.

JessicaVasquez‐Tokos, Marriage Vows and Racial Choices, New York: Russell Sage Foundation, 2017. xi + 272 p. $26.00.

JessicaVasquez‐Tokos, Marriage Vows and Racial Choices, New York: Russell Sage Foundation, 2017. xi + 272 p. $26.00.

Hispanic Segregation and Poor Health: It's Not Just Black and White.

Despite the importance of understanding the fundamental determinants of Hispanic health, few studies have investigated how metropolitan segregation shapes the health of the fastest-growing population in the United States. Using 2006-2013 data from the National Health Interview Survey, we 1) examined the relationship between Hispanic metropolitan segregation and respondent-rated health for US-born and foreign-born Hispanics and 2) assessed whether neighborhood poverty mediated this relationship. Results indicated that segregation has a consistent, detrimental effect on the health of US-born Hispanics, comparable to findings for blacks and black-white segregation. In contrast, segregation was salutary (though not always significant) for foreign-born Hispanics. We also found that neighborhood poverty mediates some, but not all, of the associations between segregation and poor health. Our finding of divergent associations between health and segregation by nativity points to the wide range of experiences within the diverse Hispanic population and suggests that socioeconomic status and structural factors, such as residential segregation, come into play in determining Hispanic health for the US-born in a way that does not occur among the foreign-born.

Abstract IA13: Multilevel studies for better understanding the Hispanic immigrant paradox across the cancer continuum

Abstract The “Hispanic paradox” refers to observed favorable health outcomes among U.S. Hispanics relative to non-Hispanic Whites, which is unexpected due to the generally lower socioeconomic status among Hispanics compared to non-Hispanic Whites. Likewise, the “Hispanic immigrant paradox” refers to more favorable health outcomes among immigrant Hispanics relative to US-born Hispanics. These paradoxes have been observed for a number of cancer sites, across the cancer continuum, from incidence to mortality. This presentation will highlight evidence of the Hispanic and Hispanic immigrant paradox, specifically observed for breast, prostate, lung, and cervical cancer survival, and for breast cancer risk. By considering neighborhood context, specifically residence in an ethnic enclave, insights can be gleaned for whether the health advantage among Hispanic immigrants might be most attributable to individual's health behaviors and exposures, contextual-level influences like social and built environments or co-ethnic social networks and support, or a synergistic effect of these factors. Methodological considerations, such as differential loss to follow-up and survival bias, will be explored. Citation Format: Scarlett Lin Gomez. Multilevel studies for better understanding the Hispanic immigrant paradox across the cancer continuum. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr IA13.

Measuring brand loyalty among the US Hispanic population: A within-group study in the carbonated soft drink (CSD) category

Brand loyalty has been extensively researched over the last 30 years, but few studies have examined the drivers of brand loyalty among the growing US Hispanic population. Furthermore, the relationship between brand loyalty and the Hispanic consumer has been largely based on the measurement of ‘repeat purchase’ by business practitioners. The current study adapts an existing multidimensional brand loyalty scale, which was validated against a representative sample of US Hispanic consumers. Specifically, our study examines the relationship between three independent variables — nativity, language use and ethnic identification within the Hispanic population — and brand loyalty. Our study finds that brand loyalty is higher among US-born Hispanics, Hispanics whose language of preference is English, and who identify with the American culture more than the Hispanic culture. Results confirm that brand loyalty across all Hispanics is more a myth than reality. Further research is warranted to help determine if brands across different product categories (other than carbonated soft drinks) trigger different dimensions of brand loyalty and help shed light on the theoretical underpinnings of the construct.

Differences in Fruit and Vegetable Intake by Race/Ethnicity and by Hispanic Origin and Nativity Among Women in the Special Supplemental Nutrition Program for Women, Infants, and Children, 2015

IntroductionThe objective of this exploratory study was to determine whether fruit and vegetable consumption differed by race/ethnicity, by origin and nativity among Hispanics, and by language preference (as an indicator of acculturation) among foreign-born Hispanics.MethodsWe recruited 723 women enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) and orally administered a questionnaire containing demographic items, validated measures of food security status and social desirability trait, and the Behavioral Risk Factor Surveillance System fruit and vegetable module. Differences in intakes of 100% fruit juice, fruit, cooked or canned beans, and dark green, orange-colored, and other vegetables were assessed by using analysis of covariance with Bonferroni post hoc tests. Analyses were controlled for age, pregnancy status, breastfeeding status, food security status, educational attainment, and social desirability trait.ResultsThe frequency of vegetable intake differed by race/ethnicity (cooked or canned beans were consumed more often among Hispanic than non-Hispanic black and non-Hispanic white or other participants, orange-colored vegetables were consumed more often among Hispanics than non-Hispanic black participants, and other vegetables were consumed more often among non-Hispanic white or other than among non-Hispanic black and Hispanic participants), origin (other vegetables were consumed more often among Columbian and other Hispanics than Dominican participants) and nativity (orange-colored vegetables were consumed more often among foreign-born than US-born Hispanics). Fruit and vegetable intake did not differ by language preference among foreign-born Hispanics.ConclusionDifferences in fruit and vegetable consumption among WIC participants by race/ethnicity and by Hispanic origin and nativity may have implications for WIC nutrition policies and nutrition education efforts.

Exposure to Flood Hazards in Miami and Houston: Are Hispanic Immigrants at Greater Risk than Other Social Groups?

Although numerous studies have been conducted on the vulnerability of marginalized groups in the environmental justice (EJ) and hazards fields, analysts have tended to lump people together in broad racial/ethnic categories without regard for substantial within-group heterogeneity. This paper addresses that limitation by examining whether Hispanic immigrants are disproportionately exposed to risks from flood hazards relative to other racial/ethnic groups (including US-born Hispanics), adjusting for relevant covariates. Survey data were collected for 1283 adult householders in the Houston and Miami Metropolitan Statistical Areas (MSAs) and flood risk was estimated using their residential presence/absence within federally-designated 100-year flood zones. Generalized estimating equations (GEE) with binary logistic specifications that adjust for county-level clustering were used to analyze (separately) and compare the Houston (N = 546) and Miami (N = 560) MSAs in order to clarify determinants of household exposure to flood risk. GEE results in Houston indicate that Hispanic immigrants have the greatest likelihood, and non-Hispanic Whites the least likelihood, of residing in a 100-year flood zone. Miami GEE results contrastingly reveal that non-Hispanic Whites have a significantly greater likelihood of residing in a flood zone when compared to Hispanic immigrants. These divergent results suggest that human-flood hazard relationships have been structured differently between the two MSAs, possibly due to the contrasting role that water-based amenities have played in urbanization within the two study areas. Future EJ research and practice should differentiate between Hispanic subgroups based on nativity status and attend to contextual factors influencing environmental risk disparities.

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.

Abstract C70: Disparity in liver cancer incidence and chronic liver disease mortality by US nativity in Hispanics: The Multiethnic Cohort

Abstract Background and Aims: Hispanics have experienced the greatest increase in hepatocellular carcinoma (HCC) incidence and mortality among ethnic/racial groups during the last two decades in the US. Chronic liver disease (CLD) is a major cause of morbidity and mortality in Hispanics. HCC risk in US-born Hispanics is reportedly higher than that in foreign-born Hispanics. Few studies, however, have examined the extent to which detailed individual risk factors for HCC could account for the observed risk disparity by nativity. The objective of the present study was to evaluate the difference in risk of HCC and CLD, respectively, by nativity in Hispanics, and to assess the extent to which risk factors can account for the risk differences. Methods: A prospective analysis was conducted among 36,864 Hispanics who participated in the Multiethnic Cohort (MEC). Nativity was categorized into US-born (N=18,485) and foreign-born (N=18,379; 74% Mexican-born, 26% Central/South American-born). Demographic and potential risk factors were assessed at baseline using self-administered questionnaire. Hepatitis B and C viral (HBV/HCV) status were determined using the Medicare claim files in a subset of participants (N=16,436). Incident HCC cases were identified through linkages to the SEER registries and CLD deaths were determined through linkages to state death certificate files in California and Hawaii and the National Death Index. Hazard ratios (HRs) and 95% confidence intervals (CIs) for HCC incidence and CLD deaths associated with nativity were calculated using Cox proportional hazard models adjusted for age, risk factors and potential confounders. Results: During a median follow up of 19.6 years, 189 Hispanics (118 US-born, 71 foreign-born) were diagnosed with HCC and 298 Hispanics (194 US-born, 104 foreign-born) died of CLD. The age-adjusted HCC incidence rate (per 100,000) was almost twice as high in US-born as in foreign-born Hispanic men (44.7 vs. 23.1), but comparable for US- and foreign-born Hispanic women (14.5 vs. 13.4). US-born Hispanic men and women had an 89% to 114% higher CLD mortality rate compared to their foreign-born counterparts, respectively. HBV/HCV and diabetes were the strongest risk factors for HCC in both US- and foreign-born Hispanics. Heavy alcohol consumption, current smoking status, diabetes, and HBV/HCV were associated with risk of CLD deaths in US- and foreign-born men. HBV/HCV, diabetes and body mass index (BMI) were associated with risk of CLD death in US- and foreign-born women. After adjustment for age, level of education, BMI, alcohol intake, smoking status, and history of diabetes, the HRs (95% CIs) of HCC incidence and CLD death were 1.77 (1.21, 2.59) and 1.78 (1.29, 2.43), respectively for US-born compared to foreign-born Hispanic men. The corresponding figures were 1.01 (0.60, 1.70) and 1.89 (1.27, 2.81) for women. The results were similar in the subgroup of Medicare study participants with further adjustment for HBV/HCV infection status. Conclusions: US-born Hispanic men are at greater risk of developing HCC and CLD than their foreign-born counterparts. In Hispanic women, while the risk of developing HCC is similar between the nativity groups, the risk of CLD death is much greater in US-born than in foreign-born women. Overall known difference in demographic and risk factors do not account for the observed disparities in HCC and CLD risk between US- and foreign-born Hispanics. Future studies are warranted to identify factors that contribute to the elevated risk of HCC and CLD in US-born Hispanics. Citation Format: Veronica Wendy Setiawan, Pengxiao C. Wei, Brenda Y. Hernandez, Shelly C. Lu, Kristine R. Monroe, Loic Le Marchand, Jian Min Yuan. Disparity in liver cancer incidence and chronic liver disease mortality by US nativity in Hispanics: The Multiethnic Cohort. [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 C70.

Disparity in liver cancer incidence and chronic liver disease mortality by nativity in Hispanics: The Multiethnic Cohort.

Hepatocellular carcinoma (HCC) and chronic liver disease (CLD) are major causes of morbidity and mortality among Hispanics. Disparities in the incidence of HCC and in CLD deaths by nativity in Hispanics have been reported. Whether individual-level risk factors could explain these disparities was assessed in a prospective study of 36,864 Hispanics (18,485 US-born and 18,379 foreign-born) in the Multiethnic Cohort. Risk factors were assessed with a baseline questionnaire and Medicare claim files. During a 19.6-year follow-up, 189 incident cases of HCC and 298 CLD deaths were identified. The HCC incidence rate was almost twice as high for US-born Hispanic men versus foreign-born Hispanic men (44.7 vs 23.1), but the rates were comparable for women (14.5 vs 13.4). The CLD mortality rate was about twice as high for US-born Hispanics versus foreign-born Hispanics (66.3 vs 35.1 for men and 42.2 vs 19.7 for women). Heavy alcohol consumption was associated with HCC and CLD in foreign-born individuals, whereas the current smoking status, hepatitis B/C viral infection, and diabetes were associated with both HCC and CLD. After adjustments for these risk factors, the hazard rate ratios for HCC and CLD death were 1.58 (95% confidence interval, 1.00-2.51) and 1.85 (95% confidence interval, 1.25-2.73), respectively, for US-born Hispanics versus foreign-born Hispanics. US-born Hispanics, particularly males, are at greater risk for HCC and death from CLD than foreign-born Hispanics. Overall known differences in risk factors do not account for these disparities. Future studies are warranted to identify factors that contribute to the elevated risk of HCC development and CLD death in US-born Hispanics. Cancer 2016;122:1444-1452. © 2016 American Cancer Society.