Immigrant enclaves: Conferring health advantages or creating health disparities in Chinese immigrants?

项目总结 美国拥有世界上最多的移民人口。因为大多数人来自疟疾患病率较低的国家 肥胖和相关的慢性病，一个常见的轨迹是这些比率上升到与之趋同甚至是 超过了美国白人的税率。这一上升加剧了许多健康差距的发展。 移民/族裔群体。解释风险上升的主要理论是文化适应，但很少有纵向研究 已经在移民中进行了关于文化适应和健康的轨迹，而且轨迹也可能是 异质性：文化适应可能仅限于种族飞地(自给自足的社区 移民的居住密度)和种族飞地本身不同。尽管一个推定的、有益的民族 例如，传统的移民飞地可以作为经济剥削的环境，并被限制 社会关系和网络；城市中心外较新的新兴飞地可能会提供同样的社会联系 资源，而不是自给自足的传统飞地的缺点。中国人的体验 移民是美国增长最快的种族群体之一，在这方面具有独特的信息量，表现出 慢性病风险具有相当大的空间多样性和变异性。事实上，亚洲移民概括了 由于环境和个人层面的因素，从低到高的整个风险范围仍有待澄清。 移民飞地提供了一个框架，在其中检查疾病风险过渡并探索 文化适应途径和心理社会途径的作用。为此，我们建议研究健康轨迹在一个 使用纵向设计捕捉文化适应、心理社会变化的中国移民样本 心脏代谢风险(CMR)的因素和标记物。我们将在中国招募600名中国移民 费城地区，包括传统、新兴和非飞地社区的居民。具体目标 目的是：(1)比较三种社区类型(传统社区、新兴社区和非飞地)移民的社区认同程度； 以及(2)探索可能调节飞地对健康影响的途径--特别是，适应文化和 心理社会因素。数据收集将包括访谈(包括适应文化和衡量 心理社会压力和社会资源)；4天的饮食召回；人体测量；血压；和血液 用于评估风险标记物的样本，包括甘油三酯、高密度脂蛋白胆固醇(HDLC)和 空腹血糖。总体而言，我们试图确定在一个背景下的条件是否以及如何设置更好的轨迹 对于移民来说，或者是未来健康差距发展的基础。我们的模型挑战了两个主要和 普遍认为：美国华裔移民是低风险人群，飞地居民一致 提供健康福利，使移民保持在较低的CMR。拟议的工作将允许直接比较 跨越飞地(区分传统飞地和新兴飞地)和非飞地，并将 描述美国华人群体的CMR程度-不断增长、日益隔离和 美国人口中研究不足的一部分。

PROJECT SUMMARY The US has the world's largest immigrant population. As most arrive from countries with lower prevalence of obesity and related chronic conditions, a common trajectory is for these rates to rise to converge with or even exceed rates in US whites. This rise underlies the development of numerous health disparities among immigrant/ethnic groups. A primary theory to explain the rise in risk is acculturation, but few longitudinal studies on acculturative and health trajectories have been conducted among immigrants, and trajectories are also likely to be heterogeneous: Acculturation may be limited in ethnic enclaves (self-contained neighborhoods with high residential density of immigrants), and ethnic enclaves themselves differ. Despite a presumed, beneficial `ethnic density effect,' for example, traditional immigrant enclaves can be settings for economic exploitation and curtailed social ties and networks; newer, emerging enclaves outside of city centers might provide the same social resources without the disadvantages of a self-contained, traditional enclave. The experience of Chinese immigrants, among the fastest growing US ethnic groups, is uniquely informative in this regard, exhibiting considerable spatial diversity and variability in chronic disease risk. Indeed, Asian immigrants encapsulate the entire range of risk, from low to high, as a result of environmental and individual-level factors still to be clarified. Immigrant enclaves offer a framework in which to examine disease risk transitions and to explore the combined roles of acculturative and psychosocial pathways. Towards this end, we propose to study health trajectories in a sample of Chinese immigrants using a longitudinal design to capture changes in acculturation, psychosocial factors, and markers of cardiometabolic risk (CMR). We will recruit a cohort of 600 Chinese immigrants in the Philadelphia region, including residents of traditional, emerging, and non-enclave neighborhoods. Specific aims are to: (1) Compare CMR of immigrants in three neighborhood types (traditional, emerging, and non-enclaves); and (2) Explore pathways that may mediate enclave effects on health – in particular, acculturative and psychosocial factors. Data collection will include interviews (including acculturation and measures of psychosocial stress and social resources); 4 days of dietary recalls; anthropometry; blood pressure; and blood samples for assessing risk markers including triglycerides, high-density lipoprotein cholesterol (HDL-C), and fasting glucose. Overall, we seek to determine whether and how conditions in one context set a better trajectory for immigrants, or underlie the development of future health disparities. Our model challenges two primary and widely held beliefs: that US Chinese immigrants are a low risk population, and that enclave residence uniformly provides health benefits that keep immigrants at low CMR. The proposed work will allow for a direct comparison across enclaves (distinguishing between traditional and emerging enclaves) and non-enclaves, and will characterize the extent of CMR in the US Chinese population – a growing, increasingly segregated, and understudied segment of the US population.