Post-Migration Health & Behavior Change in Midlife Women

这项前瞻性研究的目的是考察调节文化适应对移民后健康影响的可改变行为的纵向影响。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发展转变。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，人们的身心健康有了明显恶化的横向记录。然而，还没有使用纵向方法来系统地研究文化适应和行为危险因素对健康状况的影响。这项研究的具体目的是：1)使用英语语言使用、美国生活方式的采用、文化认同和文化适应态度的指标，跟踪文化适应随时间的变化；2)跟踪可改变的行为中介的变化，包括压力管理资源、家庭适应、饮食和体育活动；3)使用身心健康指标跟踪健康状况随时间的变化；以及4)确定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。参与者包括225名年龄在40岁到70岁之间的女性，她们在进入这项研究时移民后不到6年。数据收集将包括问卷调查、24小时饮食回忆和身体测量(例如，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期限进行分层。数据分析将采用分层线性模型的创新应用，以记录随着时间的推移个人内部的变化，并估计移民后头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。这项研究验证的资源方法论可以应用于其他人群，以确定高危时期，并设计针对年龄、性别和文化的多重点方案。

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.