US Nativity Research Articles

Healthcare expenditures among older immigrants in the US with Alzheimer's disease and related dementias: Population-based study between 2007 and 2020.

Using nationally representative datasets, this study examined differences in healthcare expenditures between US-born and foreign-born individuals aged 65 and above by the presence of Alzheimer's disease and related dementias (ADRD) and cognitive limitations (CL). This study further examined whether healthcare expenditures among foreign-born individuals vary by their duration of residence in the US. The study used the 2007-2020 Medical Expenditure Panel Survey (MEPS) and employed generalized linear regression models to estimate differences in healthcare expenditures between US-born and foreign-born older adults with ADRD, CL, and without ADRD or CL. Survey weights were applied to all estimates. Our study identified significant differences in healthcare expenditures among older adults by the presence of ADRD/CL and immigrant status. Having ADRD/CL had a more pronounced impact on high healthcare expenditures among foreign-born older adults than US-born adults with ADRD/CL, thereby diminishing the difference in healthcare expenditures by US nativity status for the older adults with ADRD or CL. In the analysis further distinguishing immigrants by their duration of residence, lower healthcare expenditures were primarily observed among foreign-born individuals with ADRD or CL who had lived in the US for less than ten years. Our results suggest potential shifts in costs resulting from delayed access to, and diagnosis or treatment of ADRD at a younger age, leading to increased healthcare needs and expenses among US foreign-born older adults.

Differences in modifiable cancer risk behaviors by nativity (US-born v. Non-US-born) and length of time in the US.

Previous studies have identified racial-ethnic disparities in modifiable risk factors for cancers. However, the impact of US nativity on these risks is understudied. Hence, we assessed the association between US nativity and length of time in the US on modifiable cancer risk factors. Utilizing the 2010 and 2015 National Health Interview Survey datasets, we analyzed 8,861 US-born and non-US-born adults. Key variables included age, sex, race-ethnicity, education, income, diet, body mass index, physical activity, alcohol consumption, and smoking. Statistical methods included descriptive statistics and regression. Most respondents were US-born (n = 7,370), followed by long-term (≥15 years, n = 928), and recent (<15 years, n = 563) immigrants. Moderate-to-vigorous physical activity was higher among US-born individuals (342.45 minutes/week), compared to recent (249.74 minutes/week) and long-term immigrants (255.19 minutes/week). Recent immigrants consumed more fruits (1.37 cups/day) and long-term immigrants more vegetables (1.78 cups/day) than US-born individuals. Multivariate analyses found recent immigrants had lower odds of consuming alcohol (AOR: 0.33, 95% CI: 0.21-0.50) and smoking (AOR: 0.30, 95% CI: 0.19-0.46), and higher odds of meeting fruit consumption guidelines (AOR: 2.80, 95% CI: 1.76-4.45) compared to US-born individuals. Long-term immigrants had lower odds of alcohol consumption (AOR: 0.56, 95% CI: 0.37-0.84) and smoking (AOR: 0.42, 95% CI: 0.30-0.59), and higher odds for meeting fruit (AOR: 1.87, 95% CI: 1.22-2.86) and fiber (AOR: 2.03, 95% CI: 1.02-4.05) consumption guidelines. Our findings illustrate the importance of considering the impact nativity and length of US residency has on health. Our findings underscore the need for culturally tailored public health strategies.

Dietary Acculturation Is Associated With Altered Gut Microbiome, Circulating Metabolites, and Cardiovascular Disease Risk in US Hispanics and Latinos: Results From HCHS/SOL.

Dietary acculturation, or adoption of dominant culture diet by migrant groups, influences human health. We aimed to examine dietary acculturation and its relationships with cardiovascular disease (CVD), gut microbiota, and blood metabolites among US Hispanic and Latino adults. In the HCHS/SOL (Hispanic Community Health Study/Study of Latinos), US exposure was defined by years in the United States (50 states and Washington, DC) and US nativity. A dietary acculturation pattern was derived from 14 172 participants with two 24-hour dietary recalls at baseline (2008-2011) using least absolute shrinkage and selection operator regression, with food groups as predictors of US exposure. We evaluated associations of dietary acculturation with incident CVD across ≈7 years of follow-up (n=211/14 172 cases/total) and gut microbiota (n=2349; visit 2, 2014 to 2017). Serum metabolites associated with both dietary acculturation-related gut microbiota (n=694) and incident CVD (n=108/5256 cases/total) were used as proxy measures to assess the association of diet-related gut microbiome with incident CVD. We identified an empirical US-oriented dietary acculturation score that increased with US exposure. Higher dietary acculturation score was associated with higher risk of incident CVD (hazard ratio per SD, 1.33 [95% CI, 1.13-1.57]), adjusted for sociodemographic, lifestyle, and clinical factors. Sixty-nine microbial species (17 enriched from diverse species, 52 depleted mainly from fiber-utilizing Clostridia and Prevotella species) were associated with dietary acculturation, driven by lower intakes of whole grains, beans, and fruits and higher intakes of refined grains. Twenty-five metabolites, involved predominantly in fatty acid and glycerophospholipid metabolism (eg, branched-chain 14:0 dicarboxylic acid** and glycerophosphoethanolamine), were associated with both diet acculturation-related gut microbiota and incident CVD. Proxy association analysis based on these metabolites suggested a positive relationship between diet acculturation-related microbiome and risk of CVD (r=0.70, P<0.001). Among US Hispanic and Latino adults, greater dietary acculturation was associated with elevated CVD risk, possibly through alterations in gut microbiota and related metabolites. Diet and microbiota-targeted interventions may offer opportunities to mitigate CVD burdens of dietary acculturation.

Abstract 2223: Cancer risk factors and nativity: Lifestyle and sociodemographic disparities among us-born and non-us-born residents and by length of residence in the US

Abstract Background: Previous studies have found racial/ethnic disparities in cancer and cancer-related risk factors. However, the relationship between US nativity status and cancer risk is not well understood. This study aimed to determine the relationship between cancer risk factors, including lifestyle behaviors, demographic characteristics, and nativity status, among US residents. Methods: We used data from the 2010 and 2015 National Health Interview Survey (NHIS). All analyses accounted for the NHIS complex survey design. Our sample consisted of 31,252 US-Born and non-US-born residents. Regression models were employed to assess the association of US nativity with various lifestyle and demographic variables, adjusting for potential confounders such as age, race, sex, education, income, and employment status. Results: In our sample, 25,153 (82.73%) were US-born. Among non-US-born respondents (n=6,099), 35.13% have resided in the US for less than 15 years, and 64.87% for greater than 15 years. 80.19% of US-born individuals identified as non-Hispanic White (NHW), followed by non-Hispanic Blacks (NHB) (11.71%), and Hispanics (8.10%). For non-US-born residents, 63.67% identified as Hispanic, followed by NHW (24.21%), and NHB (12.12%). Non-US-born individuals had lower odds of consuming red meat (aOR=0.60, 95% CI: 0.47-0.75), and processed meat (aOR=0.36, 95% CI: 0.31-0.43) compared to their US-born counterparts. Notably, non-US-born individuals had significantly higher odds of never smoking (aOR=1.58, 95% CI: 1.35-1.83), never drinking (aOR=2.45, 95% CI: 2.05-2.93), and consuming grains (aOR=1.45, 95% CI: 1.25-1.68) in comparison to US-born individuals. Conversely, non-US-born individuals had lower odds of meeting physical activity guidelines (aOR=0.77, 95% CI: 0.59-0.99), and consuming fruits (aOR=0.86, 95% CI: 0.74-0.99), and consuming vegetables (aOR=0.83, 95% CI: 0.71-0.97). Additionally, non-US-born respondents had higher odds of being overweight/obese compared to normal weight (aOR=1.36, 95% CI: 1.16-1.60) compared to US-born respondents. When considering the length of time in the US, non-US-born residents with greater than 15 years of residence had lower odds of being normal weight compared to overweight/obese (aOR=0.78, 95% CI: 0.63-0.97), and never drinking alcohol (aOR=0.73, 95% CI: 0.56-0.93). Discussion: These disparities highlight the association of nativity and length of residence on health-related behaviors and outcomes in the United States, and the need for targeted public health interventions considering nativity and residency duration to address these health disparities. Citation Format: LaShae D. Rolle, Melissa Lopez-Pentecost, Reanna Clavon, Atif Bhatti, Zuhair Khan, Tracy E. Crane. Cancer risk factors and nativity: Lifestyle and sociodemographic disparities among us-born and non-us-born residents and by length of residence in the US [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2223.

Reliability and validity of the Patient Health Questionnaire-4 scale and its subscales of depression and anxiety among US adults based on nativity

BackgroundThe burdens of anxiety and depression symptoms have significantly increased in the general US population, especially during this COVID-19 epidemiological crisis. The first step in an effective treatment for anxiety and depression disorders is screening. The Patient Health Questionnaire-4 (PHQ-4, a 4-item measure of anxiety/depression) and its subscales (PHQ-2 [a 2-item measure of depression] and Generalized Anxiety Disorder [GAD-2, a 2-item measure of anxiety]) are brief but effective mass screening instruments for anxiety and depression symptoms in general populations. However, little to no study examined the psychometric properties (i.e., reliability and validity) of the PHQ-4 and its subscales (PHQ-2 and GAD-2) in the general US adult population or based on US nativity (i.e., foreign-born vs. the US-born). We evaluated the psychometric properties of the PHQ-4 and its subscales in US adults, as well as the psychometric equivalence of the PHQ-4 scale based on nativity.MethodsWe conducted a cross-sectional survey of 5,140 adults aged ≥ 18 years. We examined the factorial validity and dimensionality of the PHQ-4 with confirmatory factor analysis (CFA). A multiple-group confirmatory factor analysis (MCFA) was used to evaluate the comparability of the PHQ-4 across nativity groups. Reliability indices were assessed. Also, the scales’ construct validities were assessed by examining the associations of both the PHQ-4 and its subscales’ scores with the sociodemographic characteristics and the 3-item UCLA Loneliness scale.ResultsThe internal consistencies were high for the PHQ-4 scale (α = 0.92) and its subscales of PHQ-2 (α = 0.86) and GAD-2 (α = 0.90). The CFA fit indices showed evidence for the two-factor structure of the PHQ-4. The two factors (i.e., anxiety and depression) were significantly correlated (r = 0.92). The MCFA demonstrated measurement invariance of the PHQ-4 across the nativity groups, but the model fits the data better in the foreign-born group. There were significant associations of the PHQ-4 scale and its subscales’ scores with the sociodemographic characteristics and the UCLA Loneliness scale (all p < 0.001).ConclusionsThe PHQ-4 and its subscales are reliable and valid measures to screen anxiety and depression symptoms in the general US adult population, especially in foreign-born individuals during the COVID-19 pandemic.

Abstract 15494: Racial and Ethnic Differences in Cardiovascular Health Among US Adults With a History of Cancer

Introduction: Evidence reports co-occurring risk factors between cardiovascular disease (CVD) and cancer and treatment-resultant cardiotoxicities amplifying CVD risks. Hypothesis: Given demographic disparities in CVD and cancer outcomes, we illustrated race and ethnicity-specific distributions of cardiovascular health (CVH) and quantified the contributions of socioeconomic factors to racial disparities in CVH among those with prior cancer. Methods: In the National Health Examination and Nutrition Survey 2011-2020, we identified 2628 adults aged ≥18 years with prior cancer. CVH was assessed based on the American Heart Association’s Life’s Essential 8 metrics. The Kitagawa-Blinder-Oaxaca decomposition quantified the magnitude of individual socioeconomic factors contributing to racial differences in CVH. Results: Of the 2628 US adults with prior cancer (mean[SD] age, 63.4[13.8] years; 57% women), 6.0% identified as Hispanic or Latino, 1.6% as non-Hispanic (NH) Asian, 5.2% as NH Black or African American, 84.1% as NH White, and 3.1% as uncategorized or multiple categories. NH Asian had the highest Life’s Essential 8 score (out of 100, women: 66.0; male: 69.2) in contrast to the poorest CVH in NH Black women (59.0) and Hispanic men (57.7). Overall, diet, physical activity, and body mass index were suboptimal. Across race, NH Black had the poorest blood pressure (women: 52.6, men: 41.8) and sleep (women: 74.3, men: 70.2), whereas uncategorized or multiracial group had high tobacco exposure (women: 43.6; men: 53.2). NH White women had the worst lipids (62.4), whereas NH Asian women (65.2) and Hispanic men (69.0) had the lowest glycemic score. Differences were partly explained by deprivation and low education contributing to poorer CVH among Hispanic and NH Black, whereas lower US nativity contributed to better CVH in NH Asian. Conclusions: CVH in US adults with prior cancer was suboptimal with significant racial disparities explained by socioeconomic factors.

COVID-19 Vaccination Among US-Born and Non-US-Born Residents of the United States From a Nationally Distributed Survey: Cross-sectional Study.

Extended literature has demonstrated that COVID-19 vaccination is crucial for the health of all individuals, regardless of age. Research on vaccination status in the United States (US) among US-born and non-US-born residents is limited. The objective of our study was to examine COVID-19 vaccination during the pandemic among US-born and non-US-born people, while accounting for sociodemographic and socioeconomic factors gathered through a nationally distributed survey. A descriptive analysis was conducted on a comprehensive 116-item survey distributed between May 2021 and January 2022 across the US by self-reported COVID-19 vaccination and US/non-US birth status. For participants that responded that they were not vaccinated, we asked if they were "not at all likely," "slightly to moderately likely," or "very to extremely likely" to be vaccinated. Race and ethnicity were categorized as White, Black or African American, Asian, American Indian or Alaskan Native, Hawaiian or Pacific Islander, African, Middle Eastern, and multiracial or multiethnic. Additional sociodemographic and socioeconomic variables included gender, sexual orientation, age group, annual household income, educational attainment, and employment status. The majority of the sample, regardless of whether they were US-born or non-US-born, reported being vaccinated (3639/5404, 67.34%). The US-born participants with the highest proportion of COVID-19 vaccination self-identified as White (1431/2753, 51.98%), while the highest proportion of vaccination among non-US-born participants was found among participants who self-identified as Hispanic/Latino (310/886, 34.99%). Comparing US-born and non-US-born participants showed that among those who were not vaccinated, the highest self-reported sociodemographic characteristics by proportion were similar between the groups, and included identifying as a woman, being straight or heterosexual, being aged 18 to 35 years, having an annual household income <$25,000, and being unemployed or taking part in nontraditional work. Among the 32.66% (1765/5404) of participants that reported not being vaccinated, 45.16% (797/1765) stated that they were not at all likely to seek vaccination. Examining US/non-US birth status and the likelihood to be vaccinated for COVID-19 among nonvaccinated participants revealed that the highest proportions of both US-born and non-US-born participants reported being not at all likely to seek vaccination. Non-US-born participants, however, were almost proportionally distributed in their likelihood to seek vaccination; they reported to be "very to extremely likely" to vaccinate (112/356, 31.46%); compared to 19.45% (274/1409) of US-born individuals reporting the same. Our study highlights the need to further explore factors that can increase the likelihood of seeking vaccination among underrepresented and hard-to-reach populations, with a particular focus on tailoring interventions for US-born individuals. For instance, non-US-born individuals were most likely to vaccinate when reporting COVID-19 nonvaccination than US-born individuals. These findings will aid in identifying points of intervention for vaccine hesitancy and promoting vaccine adoption during current and future pandemics.

Abstract P518: Distinctive Blood Metabolomic Profiles Between US-Born and Foreign-Born Hispanics/Latinos: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Introduction: US-born Hispanics have a worse cardiometabolic profile compared to foreign-born Hispanics, but the underlying mechanisms are not fully understood. Hypothesis: We hypothesize that, compared to foreign-born Hispanics, US-born Hispanics have a distinctive blood metabolomic profile, which might be related to diet/lifestyle and gut microbiota and associated with health outcomes. Methods: Serum levels of 634 metabolites were profiled in US Hispanics in the Hispanic Community Health Study/Study of Latinos (N=3941 in discovery dataset; N=2368 in replication dataset). We used multiple linear regression to identify metabolites associated with US nativity. Machine-learning algorithms were used to identify potential determinants of metabolites based on genetics, sociodemographic factors, diet, lifestyle, clinical parameters, and gut microbiota. We examined prospective associations of baseline metabolites with risk of incident diseases during a 6-year follow-up using Poisson regression. Results: We identified 158 metabolites associated with US nativity in discovery dataset (FDR&lt;0.05), 135 of which were validated in replication dataset (87 higher and 48 lower in US born vs foreign-born). A metabolomic score showed a high discriminatory ability for US-born vs foreign-born Hispanics (AUC = 0.84 and 0.82 in discovery and replication datasets, respectively) and a dose-response relationship with longer duration of US residence. Variations of these US-nativity related metabolites were explained more by nongenetic factors, especially diet and gut microbiota, compared to those unrelated to US nativity, while variations explained by genetics between these two groups of metabolites were similar. Specifically, the US-born related metabolomic profile was characterized by lower levels of many metabolites in amino acid and xenobiotic pathways (e.g., ergothioneine, phenylpropionate, indole propionate, β-cryptoxanthin, carotene diol). These metabolites were positively associated with plant-based food intake (e.g., whole grain, fruits, vegetables) and beneficial fiber-utilizing bacteria (e.g., Eubacterium, Roseburia, Oscillibacter). Cardiometabolic and kidney function traits showed stronger overall associations with US-nativity related metabolites compared to other clinical traits (e.g., liver function, lung function). Prospective analyses showed that metabolites higher in US-born Hispanics were generally associated with higher risk of server obesity, hypertension, diabetes, chronic kidney disease and asthma, while those higher in foreign-born Hispanics were generally associated with lower risk of these diseases. Conclusion: Compared to foreign-born Hispanics, US-born Hispanics showed an unfavorable blood metabolomic profile associated with multiple chronic diseases, which might be partially related to diet and gut microbiota acculturation.

Abstract P353: Association of United States Nativity With Cardiovascular Health Among Race and Ethnic Groups

Introduction: Lived experiences based on self-identified race and ethnicity or place of birth are important determinants of cardiovascular health (CVH). However, the association of US nativity with CVH among different race and ethnic subgroups is not well studied. Hypothesis: We hypothesized that CVH will be higher among adults born outside the US compared with adults born in the US. Methods: We included participants aged ≥18 years from the National Health Interview Survey from 2011 through 2018. CVH was calculated based on 5 available metrics: hypertension, diabetes, cholesterol, smoking, and body mass index calculated from self-reported height and weight. Scores ranged from 0 (low CVH) to 10 (high CVH). Nativity was classified as born in or outside the US. Survey-weighted linear regression models examined the association between CVH and US nativity, adjusting for age and sex and stratified by race and ethnic subgroups. Results: Of 117,894 participants (representing 120,295,032 US adults), 51% were female and the mean (SE) age was 45 (0.1) years. Overall, among all combined race and ethnic subgroups, participants born outside the US had significantly higher CVH compared with participants born in the US (beta +0.42; 95% CI: +0.38, +0.46). Hispanic adults (beta +40; 95% CI: +0.32, +0.49), Non-Hispanic Black adults (beta +0.89; 95% CI: +0.77, +1.01), Non-Hispanic Asian adults (beta +0.39; 95% CI: +0.24, +0.54), and Non-Hispanic White adults (beta +0.36; 95% CI: +0.28, +0.45) all had significantly higher CVH compared with adults who were born in the US. The age-and sex-adjusted CVH scores by U.S. nativity for overall race and ethnic groups, Hispanic American subgroups, and Asian American subgroups are shown in the Figure. Conclusion: Overall CVH is significantly higher among people born outside the US compared with those born in the US. Among race and ethnic subgroups, people born outside the US had higher CVH compared with those born within the US, except for Asian Indian adults. Figure. Age-and-sex adjusted CVH scores by US nativity.

Abstract 02: Intergenerational Socioeconomic Mobility is Associated With Adulthood All-Cause Mortality in the Hispanic Community Health Study/Study of Latinos

Introduction: Different patterns of socioeconomic mobility (SEM) across the life course may influence the risk of all-cause mortality in adulthood. Lifetime low socioeconomic status and downward social mobility may be associated with a higher risk of mortality. Hypothesis: SEM is associated with mortality, and persons with enduring intergenerational adversity or downward SEM have a higher risk of mortality compared to persons with enduring intergenerational advantage. Methods: This study included 13,459 participants, 18-74 years of age, from the Hispanic Community Health Study/Study of Latinos who participated in the baseline visit (2008-2011) and were not missing key covariate information. Socioeconomic position (SEP) was assessed as parental education in childhood (dichotomized at high school), and a 5-facet index of SEP in adulthood across education, income, employment status, longest held occupation type, and homeownership. The adulthood SEP index was dichotomized at the median value of 2 (range: 0-5). Childhood and adulthood SEP were then combined into a single 4-level measure of SEM (enduring advantage, upward mobility, downward mobility, and enduring adversity). Multivariable sampling weight-adjusted Cox proportional hazards regression was performed to estimate the association between SEM and all-cause mortality. Potential confounders included age, gender, Hispanic/Latino ethnic background, US nativity, years spent in the US, and study center, whereas alcohol and tobacco use, depression score, and BMI were considered potential mediators. Presence of mediation was assessed by calculating total and direct effects via modeling, then evaluating percent change from total to direct effects against a 10% guideline. Results: During the follow-up period of 2008-2019, 515 deaths were recorded. After adjusting for all potential confounders, a significant association was found between adulthood all-cause mortality and SEM overall (F = 7.62, p &lt; 0.0001). Downward mobility had significantly higher hazard of death compared to enduring advantage (aHR: 1.81, 95% CI: 1.17-2.81), although upward mobility and enduring adversity groups were not significant. The direct effect for downward mobility was reduced after adjustment for potential mediators (aHR: 1.49, 95% CI: 0.96, 2.30). Conclusions: Socioeconomic mobility, specifically downward mobility, is associated with all-cause mortality among a diverse cohort of Hispanic/Latino individuals residing in the United States. This association shows evidence of mediation by clinical and behavioral characteristics.

Influence of Foreign Versus US Nativity on the Trajectory of Functional Independence Over the 10 Years After Traumatic Brain Injury: A Model Systems Study.

Although racial/ethnic disparities have been documented in numerous outcomes after traumatic brain injury (TBI), research has yet to explore differences in rehabilitation outcomes based upon nativity (foreign-born vs US-born individuals). The purpose of this study was to compare the functional outcomes over the first 10 years after TBI for individuals born in the United States with those who were foreign-born. A sample of 10 695 individuals in the TBI Model Systems database with a coding for country of birth the United States ( n = 9435) versus other than the United States ( n = 1260) was used. Outcome measures at 1, 2, 5, and 10 years after TBI included the Motor and Cognitive subscales of the Functional Independence Measure and the Supervision Rating Scale. Foreign-born individuals exhibited lower motor functional independence trajectories than those born in the United States, even after controlling for demographic and injury-related covariates. However, foreign-born individuals generally showed a stronger upward quadratic trajectory in motor functional independence with the greatest gains between the 5- and 10-year time points, whereas those born in the United States improved more quickly but then plateaued between the 5- and 10-year time points; these differential effects over time dissipated with the addition of demographic and injury-related covariates. Foreign-born individuals also exhibited lower cognitive functional independence trajectories, as well as greater supervision needs trajectories, than those born in the United States, even after controlling for demographic and injury-related covariates. These findings dovetail with literature suggesting that racially/ethnically diverse groups exhibit reduced functional independence after TBI. The findings may also suggest potential systematic barriers such as healthcare access and language barriers that may influence the frequency, rate, and quality of care received. The results highlight the importance of uncovering cultural distinctions and can aid in facilitating research examining foreign nativity-based disparities following TBI.

Substance Use From Social Distancing and Isolation by US Nativity During the Time of COVID-19: Cross-sectional Study.

The COVID-19 pandemic had many unprecedented secondary outcomes resulting in various mental health issues leading to substance use as a coping behavior. The extent of changes in substance use in a US sample by nativity has not been previously described. This study aimed to design a web-based survey to assess the social distancing and isolation issues exacerbated by the COVID-19 pandemic to describe substance use as a coping behavior by comparing substance use changes before and during the pandemic. A comprehensive 116-item survey was designed to understand the impact of COVID-19 and social distancing on physical and psychosocial mental health and chronic diseases. Approximately 10,000 web-based surveys were distributed by Qualtrics LLC between May 13, 2021, and January 09, 2022, across the United States (ie, continental United States, Hawaii, Alaska, and territories) to adults aged ≥18 years. We oversampled low-income and rural adults among non-Hispanic White, non-Hispanic Black, Hispanic or Latino, and foreign-born participants. Of the 5938 surveys returned, 5413 (91.16%) surveys were used after proprietary expert review fraud detection (Qualtrics) and detailed assessments of the completion rate and the timing to complete the survey. Participant demographics, substance use coping behaviors, and substance use before and during the pandemic are described by the overall US resident sample, followed by US-born and foreign-born self-reports. Substance use included the use of tobacco, e-cigarettes or nicotine vapes, alcohol, marijuana, and other illicit substances. Marginal homogeneity based on the Stuart-Maxwell test was used to assess changes in self-reported substance use before and during the pandemic. The sample mostly included White (2182/5413, 40.31%) and women participants (3369/5406, 62.32%) who identified as straight or heterosexual (4805/5406, 88.88%), reported making ≥US $75,000 (1405/5355, 26.23%), and had vocational or technical training (1746/5404, 32.31%). Similarities were observed between the US-born and the foreign-born participants on increased alcohol consumption: from no alcohol consumption before the pandemic to consuming alcohol once to several times a month and from once to several times per week to every day to several times per day. Although significant changes were observed from no prior alcohol use to some level of increased use, the opposite was also observed and was more pronounced among foreign-born participants. That is, there was a 5.1% overall change in some level of alcohol use before the pandemic to no alcohol use during the pandemic among foreign-born individuals, compared with a 4.3% change among US-born individuals. To better prepare for the inadvertent effects of public health policies meant to protect individuals, we must understand the mental health burdens that can precipitate into substance use coping mechanisms that not only have a deleterious effect on physical and mental health but also exacerbate morbidity and mortality in a disease like COVID-19.

Evaluation of disparities in maintaining healthy lifestyle behaviors among female cancer survivors by race/ethnicity and US nativity

BackgroundThere are well-known racial/ethnic disparities in maintaining healthy lifestyle behaviors throughout cancer survivorship among US-born women. Less is known about these associations among women born outside the US, as these women may experience disparities in survivorship care due to the lack of access to culturally appropriate health services. We evaluated disparities in the associations between race/ethnicity and US nativity and the likelihood of meeting recommendations for maintaining a healthy lifestyle during cancer survivorship. Methods2044 female cancer survivors contributed data from the National Health and Nutrition Examination Survey (NHANES) (1999–2018). Adjusted odds ratios (aORs) and 95 % confidence intervals (CIs) were calculated with multivariable logistic regression models to measure the association between independent variables (race/ethnicity, US nativity, length of time in the US) and outcomes (obesity, meeting weekly physical activity (PA) recommendations, smoking history, alcoholic drinks/day) overall and by comorbidity. ResultsMost survivors were breast cancer survivors (27.6 %), non-Hispanic white (64.2 %), and US native (84.5 %). Compared to US native survivors, foreign-born survivors were less likely (aOR, 0.30, 95 % CI, 0.10–0.87) to not meet PA recommendations, while foreign-born survivors living in the US ≥ 15 years were 2.30 times more likely (95 % CI, 1.12–4.73) to not meet PA recommendations. Having at least one comorbidity modified (p-interaction< 0.05) the relationships between US nativity and length of time in the US. ConclusionOur findings provide new evidence for disparities in maintaining healthy lifestyle behaviors among female cancer survivors and can help inform lifestyle interventions for female cancer survivors from different racial/ethnic backgrounds.

Perceptions of Tap Water Safety in United States Latinx Adults

ObjectivesThe purpose of this investigation was to characterize the various factors that predict the perception that tap water is not safe in Latinx adults. Methods489 Latinx adults (37.2% female, 28 ± 7 y) were recruited from the Phoenix, AZ area. Participants completed an Adapted Survey of Water Issues in Arizona, which evaluates awareness, aptitudes, attitudes, and action toward water quality. They also completed household water security experience-based scales (i.e., water access, water quality and acceptability, and water distress) developed for low-income peri-urban and rural communities on the US-Mexico border. Binary logistic regression was conducted to determine odds ratios (OR) for the odds of Latinx adults perceiving their tap water to be unsafe. Results251 (51.1%) participants perceive their tap water to be unsafe. The odds of perceiving tap water to be unsafe were greater for those who believe bottled water tastes and smells better than tap water (OR = 2.37), had hard water or mineral deposits (OR = 2.32) or unpleasant taste (OR = 2.50) in their tap water over the past year, receive water quality information from citizens environmental groups (OR = 2.64), consume bottled water as their primary drinking water source (OR = 2.74), or have a drinking water system separate from their water supply system (OR = 2.259; P < 0.05). The odds of an unsafe perception were lower for those who have a greater annual income (OR = 0.20), have changed their mind about environmental issues because of classes or presentations (OR = 0.34), or receive water quality information from government environmental agencies (OR = 0.33) or universities (OR = 0.41; P < 0.05). Perceptions were not influenced by sex, age, race, education, US nativity, previous bad experiences with tap water, perceptions of ground or surface water quality, or household water security. ConclusionsPerceptions of tap water safety in Latinx adults appear to be influenced by income, organoleptic perceptions, sources of information about water, and household sources of drinking water. These factors should be considered when designing interventions to improve water consumption and hydration status in Latinx adults. Funding SourcesThis study was supported by the Graduate and Professional Student Association and the Graduate College at Arizona State University.

US Citizenship for our Mexican Children! US-born Children of Non-Migrant Mothers in Northern Mexico

ABSTRACT We analyze the presence of non-migrant US-born children aged 0–4 in the northern states of Mexico and associated factors by parental nativity. Based on the 2020 Mexican Census, we describe the location, population size, and sociodemographic profiles of these children. We also estimate regression models to examine factors associated with children’s US nativity. We found that US births to non-migrant mothers have become a more prevalent source of US-born children than return migration in recent years. Non-migrant US-born children slightly declined from 2010 to 2020 and continued to be concentrated in northern states, particularly in the border municipalities. Multivariate regression models reveal that, among children of Mexico-born parents, being non-migrant US-born was associated with higher levels of parental schooling, socioeconomic status, or cross-border employment. Births in the U.S. are more common among Mexican middle-upper status families suggesting a selection process that may contribute to social reproduction by increasing their children’s future socioeconomic opportunities relative to Mexico-born children. However, among those with US-born parents, US birth does not vary by socioeconomic status showing those with easier access to the United States and transnational social capital do not need additional resources to secure US citizenship.

The Effect of Maternal US Nativity on Racial/Ethnic Differences in Fetal Growth.

While racial/ethnic differences in fetal growth have been documented, few studies have examined whether they vary by exogenous factors, which could elucidate underlying causes. The purpose of this study was to characterize longitudinal fetal growth patterns by maternal sociodemographic, behavioral, and clinical factors and examine whether associations with maternal race/ethnicity varied by these other predictors. Between 2016 and 2019, pregnant women receiving prenatal care at NYU Langone Health (New York, New York) were invited to participate in a birth cohort study. Women completed questionnaires, and clinical data were abstracted from ultrasound examinations. Maternal characteristics were assessed in relation to fetal biometric measures throughout pregnancy using linear mixed models. Maternal race/ethnicity was consistently associated with fetal biometry: Black, Hispanic, and Asian women had fetuses with smaller head circumference, abdominal circumference, and biparietal diameter than White women. The associations between race/ethnicity and fetal growth varied by nativity for Asian women, such that the disparity between Asian and White women was much greater for US-born women than for foreign-born women. However, associations for Black and Hispanic women did not vary by nativity. While race/ethnicity-specific fetal growth standards have been proposed, additional work is needed to elucidate what could be driving these differences, including factors that occur in parallel and differentially affect fetal growth.

Demographic, Lifestyle, and Dietary Factors Associated with Red Meat Consumption Among A Cross-Section of New York City Residents

Introduction: Red meat reduction policies have become the focus of public policy in New York City (NYC). To inform on who might be impacted the most by these policies we sought to identify factors associated with red meat consumption among NYC residents.Methods: We studied non-institutionalized adults in the cross-sectional 2013-2014 NYC Health and Nutrition Examination Survey. The outcome was self-reported weekly red meat consumption. We used multivariable linear regression to assess the association of red meat consumption with age, gender, race/ethnicity, US nativity, education, marital status, percentage of ZIP-code in poverty, physical activity, smoking, alcohol, restaurant meals, and dietary components (dark-green vegetables, other vegetables, fresh fruit, poultry, fish/shellfish, sugar-sweetened soda (SSS), and sugar-sweetened fruit drink (SSFD)).Results: Among 1,495 subjects, higher frequency of red meat consumption was associated (-coefficient; p-value) with younger age (-0.08; p=.03), male gender (0.47; p&lt;.001), and greater weekly consumption of alcohol (0.08; p&lt;.001), poultry (0.16; p&lt;.001), fish/shellfish (0.15; p=.01), SSS (0.14; p&lt;.001), and SSFD (0.06; p=.005). Red meat consumption was also associated with race/ethnicity (p=.002), wherein Asian race/ethnicity had highest consumption and ZIP-code percent in poverty (p=.003) wherein those in ZIP-codes with ≥30% in poverty consumed the least red meat.Conclusion: Demographic, lifestyle, and dietary factors were associated with red meat consumption frequency in NYC. Public health efforts in NYC should consider these associations and differences from associations in national data when designing and evaluating outcomes from programs targeting reducing red meat consumption in NYC.

Disparities in healthcare utilization and access by length of cancer survivorship among population-based female cancer survivors.

The current study examined disparities in the associations between medically vulnerable populations and healthcare-related outcomes among population-based female cancer survivors and determined if these associations differed by length of cancer survivorship. One thousand eight hundred ninety-seven women with a cancer history from the National Health and Nutrition Examination Survey from 1999 to 2016 contributed data. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated with multivariable logistic regression models to measure the associations between the predictors (race/ethnicity, poverty status, education, comorbidity status, US nativity) and outcomes (perceived health, healthcare utilization and access outcomes), overall and by length of survivorship. There was an average of 14.3years (SD = 11.7; range = 2-84) since initial cancer diagnosis, with 25.1% being short-term and 74.9% being long-term survivors. Overall, racial/ethnic minority women were more likely to report poor/fair health status (OR, 2.68; 95% CI 1.73-4.15) and utilizing routine care other than a doctor's office/HMO (OR, 1.61; 95% CI 1.12-2.29) in comparison with NHW survivors. Length of survivorship significantly modified the association between race/ethnicity and odds of seeing a mental health provider in the last year (p-interaction = 0.003), with short-term minority survivors being significantly more likely (OR, 2.63; 95% CI 1.29-5.35) and long-term minority survivors being less likely (OR, 0.68; 95% CI 0.37-1.23). Racial/ethnic disparities exist among female cancer survivors for perceived health status and certain healthcare utilization outcomes, with some differences observed by length of cancer survivorship. This study can begin to inform cancer survivorship care for medically vulnerable women along the cancer continuum.

Nativity differences in lifecourse socioeconomic position and late‐life cognition among KHANDLE participants

AbstractBackgroundSocioeconomic position (SEP) in childhood and adulthood is associated with late‐life cognition. Less is known about how SEP changes may be associated with late‐life cognition in diverse cohorts.MethodsThe Kaiser Healthy Aging and Diverse Life Experiences Study (KHANDLE) is a cohort of community‐dwelling Kaiser Permanente members who reside in the San Francisco Bay area and Sacramento valley (n=1,708; Asians (24%), Blacks (26%), Latinos (20%) and Whites (30%)). KHANDLE aims to evaluate how lifecourse and sociocultural factors influence late‐life brain health and cognitive decline and contribute to race/ethnic disparities. We used linear regression to test the association between lifecourse SEP trajectories and late‐life cognition and tested if these associations differed by US vs. foreign nativity. Childhood SEP is a composite of parents’ education (≥HS vs. &lt;HS), childhood hunger, and self‐reported family financial status. Adult SEP included participants’ education (≥HS vs. &lt;HS), late‐life low income status (e.g. qualified for low‐income welfare programs), and self‐reported social status. Participants were classified as having consistently high SEP (HH), low childhood/high adult SEP (LH), high childhood/low adult SEP (HL), or consistently low SEP (LL). Executive function, semantic memory and verbal episodic memory measured with the Spanish and English Neuropsychological Assessment Scales (SENAS) were z‐standardized and averaged for overall cognition. Pooled analyses adjusted for age, race/ethnicity, gender, and foreign nativity.ResultsOverall, participants classified as LH did not differ from HH (ref.) in any cognitive domain, while those classified as HL and LL had lower cognition than HH in all domains (see table). We observed a significant interaction of US vs. foreign birth and lifecourse SES trajectory for semantic memory (p=0.01), but no other domain. Stratified analyses demonstrated a similar pattern to pooled. However, foreign‐born participants HL participants had significantly lower overall cognition (p=0.03), and verbal memory (p=0.02) than US‐born HL participants. By contrast, foreign‐born LH participants performed significantly better than US‐born LH in semantic memory (p=0.01).ConclusionsThose with high Adult SEP had the best cognitive function, regardless of childhood SEP or nativity. In some measures of cognition, foreign‐born HL participants performed worse than US‐born, while foreign‐born LH performed better.

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.