www.Healthycity.orgFacebook.com/HealthyCityCA@HealthyCityCAinfo@healthycity.org

www.AdvancementProjectCA.orgFacebook.com/AdvancementProjectCAinfo@advanceproj.org

Taisha BonillaTraining & Communications

Coordinator tbonilla@advanceproj.org

Wednesday, September 10th11:00am – 12:00pm

Jose CuchillaHealthy City Data Analystjcuchilla@advanceproj.org

Investigating the Immigrant Health Paradox in California

Healthy City is a program of

Championing the struggle for greater equity and opportunity for all, Advancement Project California fosters upward mobility in communities most impacted by economic and racial injustice.We build alliances and trust, use data-driven policy solutions, create innovative tools and work alongside communities.

We ignite social transformation!

Integrity * Innovation * Capacity-Building * Collaboration * Audacity * Equity *

What We Do

DIRECT TECHNICAL ASSISTANCE:

Work ON-THE-GROUND to develop

targeted research/policy

strategies and web tools.

COMMUNITY RESEARCH LAB

Engages, trains, and provides tools for

community groups to lead and sustain action-oriented

research

ONLINE MAPPING TECHNOLOGY

www.HealthyCity.org

Fuel social change and empower communities!

HealthyCity.orgWebsite

Service Provider

Case Manager

Policy Advocate

Funder

Community Organizer

Researcher

Who Uses HealthyCity.org?

Grant Writer

CHAT:Where in CA do you work (city or county), and what populations do you serve?

Please use the interactive ‘CHAT’ feature throughout the webinar.

We will read out your comments and answer any questions.

• Learn about the Immigrant Health Paradox

• Examine diabetes hospitalization rates among US and Foreign-Born Hispanics/Latin@s

• Using the Social Determinants of Health framework, we will explore potential contributing factors

• Live demonstration of how to access and map related data on other communities of interest on HealthyCity.org

Webinar Agenda:

Exploring the Association between Acculturation and Diabetes among

US/foreign-born Hispanics

-Jose Cuchilla, Healthy City Data Analyst-

Jose Cuchilla1

Micere Keels, PhD2

1 California State Polytechnic University of Pomona

2 The University of Chicago, Department of Comparative Human Development

http://www.baltimorehia.org/social-determinants-of-health.html

Social Determinants of Health“The economic and social conditions that influence individuals and group differences in health status.” – The World Health Organization

The Immigrant Health Paradox

Lower mortality (Jasso et al., 2002; Muennig and Fahs, 2002) Lower rates of obesity (Gordon-Larsen, 2003) Better mental health (Dey and Lucas, 2006) Lower rates of heart and circulatory disease (Singh and Siahpush,

2001)

Despite lower levels of education and income, immigrants are generally healthier than the US-born population

However, as their length of residence increases, so does the prevalence of poor health behaviors and chronic conditions (Kaplan, 2004)

The Acculturation Hypothesis

Acculturation The acquisition and integration of dominant cultural norms by

members of a non-dominant group (Gordon-Larsen, 2003). Over time, immigrants integrate American behavioral norms and

lifestyles (Gordon-Larsen, 2003).

Immigrant dietary patterns More fruits and vegetables (Satia-Abouta, 2002) Less processed foods (Akresh, 2007)

Americanization Eat less fruits & vegetable (Neuhouser, 2004) Eat more red meat & processed foods (Ayala, 2008) Less exercise (Lanza, 2005) Increase smoking & drinking (Detjen et al., 2007)

Research on acculturation and Type-2 diabetes

Limited research exists on the association of length of residence and type 2 diabetes outcomes

Research that does exist has two limitations…1) Regional sample2) Self-reported data to measure diabetes

A quantitative analysis of diabetes prevalence in Hispanics

2001- 2010 NHANES (CDC) Nationally representative sample US/foreign-born Mexican Americans ages 20-65 Tested for diabetes (n= 2417)

Fasting blood glucose test Nativity (US-born/foreign-born) Acculturation (Length of time [years] in the US)

STATA T-test Logistic Regression

Model 1: Basic DifferencesModel 2: Control

Research Question and Hypothesis

RQ: Does nativity and acculturation affect diabetes health outcomes among Hispanics?

H1: Hispanics born in the US will be more likely to suffer from diabetes than foreign born Hispanics.

H2: The longer foreign born Hispanics are in the US, the more likely they are to have diabetes.

Native-born Mexican Americans had a higher rate of diabetesTable 1: Descriptive Characteristics

VariableFull Sample

(n= 5416)Native

(n= 2035)Foreign(n=3381)

Diabetes (%) 10.63 12.57 9.49Undiagnosed Diabetes (%) 33.20 30.09 35.66Female (%) 52.25 56.16 49.83Length in US (%) <5 years 18.66 5 - <15 years 32.54 15 - <30 years 33.15 30+ years 15.66Citizenship (%) 22.61Education (%) <9th grade 33.90 9.30 48.70 9th grade - H.S. 41.26 47.72 37.41 Some College 18.26 31.55 10.27 College Degree 6.57 11.42 3.61Married (%) 60.75 53.79 64.82No Insurance (%) 47.62 27.25 59.85

Significant values (t-test: p<0.05) indicated in red.

Foreign-born Mexican Americans were less likely to have diabetes

Table 2: Logistic regression results for nativity

Diabetes Model 1* Model 2**

Variable Odds Ratio (Std. Err.)

P-value Odds Ratio (Std. Err.)

P-value

All Mexican Americans

Native born reference category

Foreign born 0.73 0.018 0.50 <0.001

(0.10) (0.09)

*Model 1: Includes only nativity or length in US. **Model 2: Adds controls for education, poverty, marital status, smoker, insurance, age, and gender.

Foreign-born Mexican Americans who have been in the US longer were more likely to have diabetesTable 2: Logistic regression results for length of time among foreign-born Hispanics

Diabetes Model 1* Model 2**

VariableOdds Ratio (Std. Err.) P-value

Odds Ratio (Std. Err.) P-value

Foreign Born Mexican Americans

< 5 years in US reference category

5 - <15 years in US 1.78 0.109 1.87 0.113

(0.63) (0.74)

15-<30 years in US 2.64 0.005 3.11 0.003

(0.90) (1.21)

30+ years in US 5.06 <0.001 6.67 <0.001

(1.78) (2.82)*Model 1: Includes only nativity or length in US. **Model 2: Adds controls for education, poverty, marital status, smoker, insurance, age, and gender.

Nativity and acculturation highlight important risk factors for diabetes

Nativity & length of time in the US • Study supports the immigrant health paradox• Supports the acculturation hypothesis

• Identifying length of residence as a risk factor is useful for targeting populations for diabetes prevention

“Obesogenic” environments (Powell, 2010)• Low income communities (Walker, 2010)• Less supermarkets (Weinberg, 1995)• Longer distance (Rose and Richards, 2004)

Questions?

v5.healthycity.org

Services Listings

Interactive Mapping

Data Ranking

View Community Data/Stories

What is available on HealthyCity.org…

Map Your Data/Media

With HealthyCity.org’s Data and Mapping Tools, you can …

Create more effective community engagement

Assess need and strength at the community level for outreach and planning

Identify new target areas

Network with other organizations and identify community partners

1

2

Enter a word in “Keyword Search”

to pinpoint data for your map

Click on a category

to find servicesScroll down

Make maps and charts for ZIP Codes, Congressional

Districts, neighborhoods, Counties, and more...

1 2 3

Select your

geography!

Search results and categories

Filter and sort your

results

Name

your list!

Print, save

& share your list

View contact details with a direct link for

directions!

Browse through listings to look

at service details

1 Select your

geography!

2

Make maps and charts for ZIP Codes, Congressional

Districts, neighborhoods, Counties, and more...

1 2 3

Select your

geography!

Upload your own data using an

Excel file!

To upload data from a

spreadsheet: Make sure you are logged into your account!

On to the website!

Questions?

www.Healthycity.orgFacebook.com/HealthyCityCA@HealthyCityCAinfo@healthycity.org

www.AdvancementProjectCA.orgFacebook.com/AdvancementProjectCAinfo@advanceproj.org

Thank You!

Your feedback is very important to us!

We will be following up with you in 24 hours with an email and a

survey!