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

项目总结 南亚人，主要由亚裔印度人、巴基斯坦人和孟加拉国移民组成，是 美国增长第二快的种族群体。我们的团队已经创建了第一个纵向研究 南亚人称居住在美国的南亚人为动脉粥样硬化的调解人(Masala)，该组织 在聚集的南亚人口中表现出明显较差的心血管健康 美国其他主要种族/民族。然而，Masala对心血管疾病的信息非常有限。 自Masala以来，巴基斯坦人和孟加拉国人的健康状况包括83%的亚裔印度人，但只有6% 巴基斯坦移民和0.5%的孟加拉国移民。来自南亚次大陆英国的研究， 在孟加拉国和加拿大，心血管疾病的负担要高得多。 巴基斯坦人和印度人相比。社会文化背景，包括社会经济地位、移民历史、 在这三个南亚亚群中，文化背景和邻里因素各不相同，并如何影响 移民经历和适应新的环境，以及他们如何激活弹性资源来应对 影响心血管健康差距的压力源。我们的目标是将Masala研究队列扩大到 包括更多的巴基斯坦和孟加拉国移民，利用新的和现有的措施来描述和 了解移民人群的心血管健康差异。我们建议招募600名孟加拉人 以及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 添加到正在进行的Masala队列中，并将他们与在Masala注册的亚裔印度人进行比较。我们的特定 目的是：1)确定巴基斯坦和孟加拉移民是否以及在多大程度上 心血管健康(饮食、体力活动、吸烟、糖尿病、高血压、血脂异常、肥胖) 与已经在马萨拉注册的印度移民相比。2)识别多级风险和保护因素 与南亚亚组内部和跨亚组的心血管健康有关。测试文化适应是否 策略和复原力资源调节或调节社会文化背景与 并解释三个亚组之间的差异。3)进一步诠释我们的 量化结果，进行深入访谈，阐明移民、文化适应、歧视和 韧性资源影响南亚人的心血管健康。研究不同的移民群体 通过了解生物、心理、社会和生态 特征可能与来源国相关并相互作用，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、多水平相互作用的方法 在南亚，移民为发展更有效的公共卫生和临床提供了希望 减少心血管疾病差距的预防战略。

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.