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      Length of Residence in the United States is Associated With a Higher Prevalence of Cardiometabolic Risk Factors in Immigrants: A Contemporary Analysis of the National Health Interview Survey

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          Abstract

          Background

          Cardiometabolic risk ( CMR) factors including hypertension, overweight/obesity, diabetes mellitus, and hyperlipidemia are high among United States ethnic minorities, and the immigrant population continues to burgeon.

          Methods and Results

          Hypothesizing that acculturation (length of residence) would be associated with a higher prevalence of CMR factors, the authors analyzed data on 54, 984 US immigrants in the 2010–2014 National Health Interview Surveys. The main predictor was length of residence. The outcomes were hypertension, overweight/obesity, diabetes mellitus, and hyperlipidemia. The authors used multivariable logistic regression to examine the association between length of US residence and these CMR factors.

          The mean ( SE) age of the patients was 43 (0.12) years and half were women. Participants residing in the United States for ≥10 years were more likely to have health insurance than those with <10 years of residence (70% versus 54%, P<0.001). After adjusting for region of birth, poverty income ratio, age, and sex, immigrants residing in the United States for ≥10 years were more likely to be overweight/obese (odds ratio [ OR], 1.19; 95% CI, 1.10–1.29), diabetic ( OR, 1.43; 95% CI, 1.17–1.73), and hypertensive ( OR, 1.18; 95% CI, 1.05–1.32) than those residing in the United States for <10 years.

          Conclusions

          In an ethnically diverse sample of US immigrants, acculturation was associated with CMR factors. Culturally tailored public health strategies should be developed in US immigrant populations to reduce CMR.

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          Most cited references30

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          Annual medical spending attributable to obesity: payer-and service-specific estimates.

          In 1998 the medical costs of obesity were estimated to be as high as $78.5 billion, with roughly half financed by Medicare and Medicaid. This analysis presents updated estimates of the costs of obesity for the United States across payers (Medicare, Medicaid, and private insurers), in separate categories for inpatient, non-inpatient, and prescription drug spending. We found that the increased prevalence of obesity is responsible for almost $40 billion of increased medical spending through 2006, including $7 billion in Medicare prescription drug costs. We estimate that the medical costs of obesity could have risen to $147 billion per year by 2008.
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            Defining and measuring acculturation: a systematic review of public health studies with Hispanic populations in the United States.

            In this systematic review we sought to identify how the public health literature focusing on Hispanic populations in the United States defined and measured the concept of acculturation. A review of 134 studies found considerable variation in the definition and measurement of this construct. The ten acculturation scales used provided little theoretical orientation. It was unclear the extent to which acculturative changes in attitudes, beliefs and behaviors were captured by current measurement tools, as these primarily measure linguistic elements. We suggest future research should refine existing tools, determine their validity and usefulness across ethnic and subethnic groups, and identify which aspects of acculturation these scales and indices reliably measure. Recommendations for use of acculturation instruments in public health practice with Hispanic populations are included.
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              How socio-economic status contributes to participation in leisure-time physical activity.

              The aim of this cross-sectional study was to identify individual, social, and environmental contributors (mediators) to individual- and area-level differences in leisure-time physical activity across socio-economic groups. A two-stage stratified sampling design was used to recruit 20-65 year old adults (N=2194) living in 154 census collection districts of Adelaide, Australia (overall response rate: 12%). Participants completed two surveys six months apart (response rate on the second survey: 83%). Individual-level socio-economic status (SES) was assessed using self-report measures on educational attainment, household income, and household size. Area-level SES was assessed using census data on median household income and household size for each selected census district. Bootstrap generalized linear models were used to examine associations between SES, potential mediators, and leisure-time physical activity. The product-of-coefficient test was used to estimate mediating effects. All SES measures were independently associated with potential individual and social mediators of the SES-activity relationships. Individual- and area-level income was also associated with perceived neighborhood attributes. Self-efficacy and social support for physical activity explained virtually all of the differences in physical activity across educational attainment groups. Physical barriers to walking and access to public open space contributed in part to the explanation of differences in recreational walking across income groups. Yet, self-efficacy and social support were the key mediators of the observed relationships between individual- and area-level income and physical activity. This study suggests that in order to increase physical activity participation in the more disadvantaged segments of the population, comprehensive, multilevel interventions targeting activity-related attitudes and skills as well as social and physical environments are needed.
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                Author and article information

                Contributors
                ycommod1@jhu.edu
                Journal
                J Am Heart Assoc
                J Am Heart Assoc
                10.1002/(ISSN)2047-9980
                JAH3
                ahaoa
                Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
                John Wiley and Sons Inc. (Hoboken )
                2047-9980
                04 November 2016
                November 2016
                : 5
                : 11 ( doiID: 10.1002/jah3.2016.5.issue-11 )
                : e004059
                Affiliations
                [ 1 ] Department of Community and Public HealthJohns Hopkins School of Nursing Baltimore MD
                [ 2 ] Counseling Psychology Department of PsychologyUniversity of Florida Gainesville FL
                [ 3 ]Emory University Rollins School of Public Health Atlanta GA
                [ 4 ] Department of SurgeryJohns Hopkins School of Medicine Baltimore MD
                [ 5 ] Department of Public Health Academic Medical CenterUniversity of Amsterdam the Netherlands
                [ 6 ] Nell Hodgson WoodruffSchool of Nursing Emory University Atlanta GA
                [ 7 ] Department of Epidemiology & BiostatisticsSchool of Public Health Georgia State University Atlanta GA
                Author notes
                [*] [* ] Correspondence to: Yvonne Commodore‐Mensah, PhD, RN, Johns Hopkins School of Nursing, Department of Community & Public Health, 525 North Wolfe Street, Room 419, Baltimore, MD 21205. E‐mail: ycommod1@ 123456jhu.edu
                Article
                JAH31866
                10.1161/JAHA.116.004059
                5210341
                27815269
                c04f2f18-6e9e-4228-a307-7c3d0fe52aaf
                © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

                This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 14 June 2016
                : 07 October 2016
                Page count
                Figures: 1, Tables: 6, Pages: 10, Words: 7739
                Categories
                Original Research
                Original Research
                Epidemiology
                Custom metadata
                2.0
                jah31866
                November 2016
                Converter:WILEY_ML3GV2_TO_NLMPMC version:4.9.8 mode:remove_FC converted:21.11.2016

                Cardiovascular Medicine
                cardiovascular research,ethnicity,hypertension,migration,obesity,epidemiology,diabetes, type 2,race and ethnicity,risk factors,primary prevention

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