Understanding health disparities in Pakistani, Bangladeshi and Asian Indian immigrants: the role of socio-cultural context, acculturation and resilience resources

项目摘要 南亚人，主要由亚洲印度人，巴基斯坦人和孟加拉国移民组成， 是美国人口增长第二快的族群我们的团队创建了第一个纵向研究， 南亚人称之为生活在美国的南亚人中的调解人（MASALA）， 南亚人群的心血管健康状况明显较差， 美国其他主要种族/民族。然而，MASALA关于心血管疾病的信息非常有限， 自MASALA以来，巴基斯坦和孟加拉国人的健康状况包括83%的亚洲印度人，但只有6%的人 巴基斯坦和0.5%的孟加拉移民。来自南亚次大陆、英国、 孟加拉国和加拿大的心血管疾病负担明显较高， 巴基斯坦人与印度人相比。社会文化背景，包括社会经济地位，移民历史， 文化背景和邻里因素在这三个南亚亚群中各不相同， 移民经历并适应新的环境，以及他们如何激活弹性资源来科普 影响心血管健康差异的压力因素。我们的目标是扩大MASALA研究队列， 包括更多巴基斯坦和孟加拉国移民利用新的和现有的措施， 了解移民人群中心血管健康的差异。我们计划招募600名孟加拉人 和550名年龄在40-84岁之间的巴基斯坦成年人，他们来自大纽约市和芝加哥地区， 加入正在进行的MASALA队列，并将其与参加MASALA的亚洲印度人进行比较。我们的具体 目的是：1）确定巴基斯坦和孟加拉国移民是否以及在多大程度上更糟 心血管健康（饮食、体力活动、烟草使用、糖尿病、高血压、血脂异常、肥胖） 与已经在MASALA注册的印度移民相比。2)识别多层次风险和保护因素 与南亚亚组内和南亚亚组之间的心血管健康相关。测试文化适应是否 战略和复原力资源介导或调节社会文化背景和 心血管健康和解释三个亚组之间的差异。3)为了进一步解释我们的 定量结果，进行深入访谈，以阐明如何移民，文化适应，歧视， 韧性资源影响南亚人的心血管健康。研究不同的移民人口 通过了解生物心理社会和生态 这些特征可能与原籍国相关并相互作用，从而影响心血管健康。我们的混合- 研究影响心血管健康差异的复杂、多层次相互作用的方法 南亚移民为发展更有效的公共卫生和临床 预防战略，以减少心血管疾病的差距。

PROJECT SUMMARY South Asians, comprised predominantly of Asian Indians, Pakistanis and Bangladeshi immigrants, are the second fastest growing ethnic group in the United States. Our team has created the first longitudinal study of South Asians called the Mediators of Atherosclerosis in South Asians Living in America (MASALA), which has demonstrated significantly poorer cardiovascular health in the aggregated South Asian population compared to other major U.S. race/ethnic groups. However, MASALA has very limited information about the cardiovascular health profiles for Pakistanis and Bangladeshis since MASALA included 83% Asian Indian but only 6% Pakistani and 0.5% Bangladeshi immigrants. Studies from the South Asian subcontinent, the United Kingdom, and Canada have shown significantly higher burden of cardiovascular disease among Bangladeshis and Pakistanis compared to Indians. Socio-cultural context, including socioeconomic position, immigration history, cultural background, and neighborhood factors vary across these three South Asian subgroups and affect how immigrants experience and adjust to a new context, and how they activate resilience resources to cope with stressors that impact cardiovascular health disparities. Our goal is to expand the MASALA study cohort to include more Pakistani and Bangladeshi immigrants leveraging new and existing measures to characterize and understand cardiovascular health disparities in immigrant populations. We propose to recruit 600 Bangladeshi and 550 Pakistani adults between the age of 40-84 years from greater New York City and Chicago areas to add to the ongoing MASALA cohort and compare them to Asian Indians enrolled in MASALA. Our specific aims are to: 1) Determine whether and the extent to which Pakistani and Bangladeshi immigrants have worse cardiovascular health (diet, physical activity, tobacco use, diabetes, hypertension, dyslipidemia, obesity) compared to Indian immigrants already enrolled in MASALA. 2) Identify multilevel risk and protective factors associated with cardiovascular health within and across South Asian subgroups. Test whether acculturation strategies and resilience resources mediate or moderate the association between socio-cultural context and cardiovascular health and explain disparities across the three subgroups. 3) To further interpret our quantitative results, conduct in-depth interviews to elucidate how immigration, acculturation, discrimination, and resilience resources influence South Asians’ cardiovascular health. Studying diverse immigrant populations advances the science of health disparities by understanding how biopsychosocial and ecological characteristics may associate and interact with country of origin to influence cardiovascular health. Our mixed- methods approach for studying the complex, multilevel interactions influencing cardiovascular health disparities in South Asian immigrants offers promise for the development of more effective public health and clinical prevention strategies to reduce CVD disparities.