Post-Migration Health & Behavior Change in Midlife Women

本前瞻性研究的目的是检验可改变行为的纵向影响，这些行为介导了文化适应对移民后健康的影响。这项研究将确定护理干预对来自前苏联的中年移民妇女最有效的战略时间点。移民是在家庭制度背景下发生的一种非规范性的发展过渡。移民年龄较大和女性性别是脆弱性的重要预测因素。随着居住时间的延长，生理和心理健康状况显著恶化。然而，尚未采用纵向方法系统地研究文化适应和行为风险因素对健康状况的影响。该研究的具体目的是：1)追踪文化适应随时间的变化，使用英语使用、对美国生活方式的采用、文化认同和文化适应态度等指标；2)追踪压力管理资源、家庭适应、饮食和体育活动等可调节行为调节因子的变化；3)利用生理和心理健康指标跟踪健康状况随时间的变化；4)识别与健康状况变化相关的背景因素、文化适应特征和行为中介。参与者将包括225名妇女，年龄在40至70岁之间，她们在进入研究时移民后不到6年。数据收集将包括问卷调查、24小时饮食回顾和身体测量（如血压、血清胆固醇和体脂百分比），在3年内每9个月（5次）评估一次。样本将按年龄和居住时间进行分层。数据分析将采用层次线性模型的创新应用来记录个体内部随时间的变化，并估计迁移后前9年的群体变化。谨慎的干预目标对于促进卫生保健研究的有效分配，同时改善新移民的健康状况至关重要。本研究验证的资源方法可以应用于其他人群，以确定高风险时期，并设计针对年龄、性别和文化的多焦点方案。

The purpose of this prospective study is to examine the longitudinal influence of modifiable behaviors that mediate the effects of acculturation on post-migration health. The study will identify strategic points in time during which nursing interventions would be most effective for midlife immigrant women from the former Soviet Union. Immigration is a non-normative developmental transition that takes place in the context of the family system. Older age at immigration and female gender are important predictors of vulnerability. Significant deterioration in physical and psychological health has been documented cross- sectionally as duration of residence increases. Longitudinal methods have not been used, however, to systematically study the effects of acculturation and behavioral risk factors on health status. The specific aims of the study are to 1) track changes over time in acculturation, using indicators of English language usage, adoption of U.S. lifestyle, cultural identity, and acculturation attitudes; 2) track changes in modifiable behavioral mediators, including stress management resources, family adaptation, diet and physical activity; 3) track changes over time in health status, using indicators of physical and psychological health; and 4) identify background factors, acculturation characteristics, and behavioral mediators that are correlates of change in health status. Participants will include 225 women, 40 to 70 years old, who are less than 6 years post- migration at entry into the study. Data collection will include questionnaires, 24-hour dietary recalls, and physical measurements (e.g., blood pressure, serum cholesterol and percent body fat), assessed every 9 months (5 times) over 3 years. The sample will be stratified by age and duration of residence. Data analysis will employ an innovative application of hierarchical linear models to document within-individual change over time and estimate group change over the first 9 years post-migration. Prudent targeting of intervention is critical to facilitating effective allocation of health care research while improving health status for new immigrants. The resource methodology validated by this study can be applied to other populations to identify high risk periods and design multifocal programs that are age, gender and culture specific.