Acculturation and Religiosity as Moderators of Cardiovascular Disease Risk Factors Among South Asians in the United States

Acculturation and Religiosity as Moderators of Cardiovascular Disease Risk Factors Among South Asians in the United States
Author: Nazleen Hatim Bharmal
Publisher:
Total Pages: 192
Release: 2012
Genre:
ISBN:

South Asians are people with origins in India, Pakistan, Bangladesh, Sri Lanka, Nepal, Bhutan, and the Maldives. In the United States (US), South Asians are among the fastest growing ethnic/immigrant groups with a growth rate of 70% from the 2000 to the 2010 Census, now consisting of 1-2% of the total population. California is the state with the largest population of South Asians in the US. South Asians have a genetic tendency towards insulin resistance and central adiposity, increasing their risk for cardiovascular disease (CVD), coronary heart disease, and diabetes mellitus. Immigrants to Western countries may have an amplified risk of CVD due to the adoption of a Western diet and physical inactivity. Two potential social factors that may moderate CVD risk factors among South Asians in the US are acculturation and religiosity. Chapter 1 provides a literature review of acculturation and health, CVD risk factors among South Asians and how they may vary by duration of residence in the US, and religion and health. Conceptual models for the relationships between acculturation and CVD risk factors and between religiosity and obesity are also presented in Chapter 1. Acculturation to American cultural practices has generally been associated with unfavorable changes in CVD risk factors among foreign-born populations. There are few validated measures of acculturation for Asian Americans or South Asians, and acculturation is often operationalized as duration of residence in the US despite problems with this proxy measure. Chapter 2, the first manuscript, examines the validity of acculturation proxy measures, such as duration of residence in the US, with self-reported acculturation measures in validated acculturation scales using the California Asian Indian Tobacco Survey. We found that greater duration of residence in the US, greater percentage of lifetime in the US, and younger age at immigration were associated with more American acculturated responses to the items for South Asian immigrants. We also developed an 11-item acculturation scale for South Asians using existing survey items with an internal consistency reliability of 0.73 and examined the psychometric properties of the scale. Chapter 3, the second manuscript, uses national and state-level cross-sectional data to examine the association of duration of residence in the US with self-reported CVD risk factors among South Asian adults using regression analysis. We found that South Asians immigrants who have resided in the US for greater than 15 years were more likely to be overweight or obese, drink alcohol, eat five or more servings of fruits and vegetables per day, and engage in physical activity compared with more recent immigrants in models adjusting for confounding socio-demographic characteristics, health status, health access, and health behaviors. Age at immigration modified the relationship between duration of residence in the US and body mass index, binge drinking, and alcohol use. Duration of residence was not associated with increased risk for hypertension, high cholesterol, diabetes mellitus, cigarette smoking, fast food intake, or soda intake in adjusted models. Religious involvement has been associated with improved health practices and outcomes. Longitudinal and cross-sectional studies have found lower morality rates, lower prevalence of smoking, and better self-reported health status among individuals who report high levels of religiosity or attend religious services frequently. However, religiosity has also been associated with greater risk of obesity. For South Asians, religiosity and religious participation may be an especially important concept to understand in health promotion because of the dietary restrictions associated with traditional Indian religions and community fellowship for immigrant populations. Chapter 4, the third manuscript, examines the association of religiosity with obesity among a multi-religious group of South Asians in California using regression analysis. We found that high self-identified religiosity was significantly associated with higher BMI after adjusting for socio-demographic and acculturation measures, including the acculturation scale developed in Chapter 2. Highly religious South Asians had 1.53 greater odds (95% CI: 1.18, 2.00) of being overweight or obese than low religiosity immigrants, though this varied by religious affiliation. Religiosity was associated with greater odds of being overweight/obese for Hindus (OR 1.54; 95% CI: 1.08, 2.22) and Sikhs (OR 1.88; 95% CI: 1.07, 3.30), but not for Muslims (OR 0.69; 95% CI: 0.28, 1.70). The findings from this dissertation may provide information on relevant social and cultural norms that may be incorporated in the conceptual model and design of a cardiovascular disease prevention lifestyle change intervention culturally tailored for South Asians in the US.

Health of South Asians in the United States

Health of South Asians in the United States
Author: Memoona Hasnain
Publisher: CRC Press
Total Pages: 275
Release: 2017-03-16
Genre: Medical
ISBN: 1315342588

Leading scholars and practitioners come together in this contributed volume to present the most current evidence on cutting edge health issues for South Asian Americans, the fastest growing Asian American population. The book spans a variety of health topics while examining disparities and special health needs for this population. Subjects discussed include: cancer, obesity, HIV/AIDS, women's health, LGBTQ health and mental health. Health of South Asians in the United States presents research-based recommendations to help determine priorities for prevention, diagnosis, treatment, education, and policies which will optimize the health and well-being of South Asian American communities in the United States. Although aimed at both students, healthcare professionals and policy makers, this book will prove to be useful to anyone interested in the health and well-being of the South Asian communities in the United States.

Biopsychosocial Approaches to Understanding Health in South Asian Americans

Biopsychosocial Approaches to Understanding Health in South Asian Americans
Author: Marisa J. Perera
Publisher: Springer
Total Pages: 252
Release: 2018-08-07
Genre: Psychology
ISBN: 3319911201

This volume is the first comprehensive and interdisciplinary text to holistically improve understanding of the health of South Asians residing in the United States by considering biological, psychological, and sociocultural factors of health. The vast literatures of diverse fields – psychology, medicine, public health, social work, and health policy – are integrated by leading scholars, scientists, and practitioners in these areas to explore the impact of South Asian cultural factors on health, health risk, and illness. Chapters incorporate available theoretical and empirical information on the status of chronic health conditions in South Asians in the United States, with consideration of future directions to improve understanding of the health of this group. Cultural and ethnic insights imperative for clinical/community/medical practitioners to provide effective and culturally-appropriate care and treatment from an interdisciplinary lens are provided.

Attitudes and Beliefs Towards Cardiovascular Disease Risk Factors Among South Asians

Attitudes and Beliefs Towards Cardiovascular Disease Risk Factors Among South Asians
Author: Mihir Patel
Publisher:
Total Pages: 114
Release: 2011
Genre:
ISBN: 9781267307637

INTRODUCTION: South Asians are a rapidly growing segment of the U.S. population. Despite improvements in the care of coronary artery disease over the last half century, the prevalence remains disproportionately high in this population. Much of this is felt to due to the early acquisition and high prevalence of lifestyle related risk factors. To appropriately address these risk factors, we must understand the culture barriers that make it difficult for South Asians to modify these behaviors. Individuals from Bangladesh comprise a South Asian sub-ethnic group that has the highest prevalence of CVD risk factors and the highest rates of mortality from CVD. To address lifestyle behavior modification in this population, we must first understand their perceptions regarding illness and cardiovascular disease. MANUSCRIPT I - Barriers to Lifestyle Behavioral Change in Migrant South Asian Populations. OBJECTIVE: The purpose of this literature review is to describe and assess the cultural barriers to behavior change in migrant South Asians, given the high morbidity and mortality associated with cardiovascular disease in this population. DESIGN: We reviewed studies that explored the relationship between South Asian culture in the Diaspora and lifestyle behaviors. RESULTS: Our review produced 91 studies, of which 25 discussed the relationship between various aspects of South Asians' belief system and their approach to modifying lifestyle habits. We identify 6 specific categories of beliefs which play the largest role in the difficulties South Asians describe with behavior change: gender roles, body image, physical activity misconceptions, cultural priorities, cultural identity, and explanatory model of disease. DISCUSSION: Cultural beliefs and practices play a substantial role in South Asians' approach to diet and exercise modification. Future research and interventions should account for these cultural factors to successfully improve dietary habits and physical activity levels in migrant South Asian populations. MANUSCRIPT 2 - Attitudes and Beliefs regarding Cardiovascular Risk Factors among Bangladeshi Immigrants in the U.S. OBJECTIVE: To apply Kleinman's Explanatory Model of Disease as a framework to elicit perspectives on cardiovascular disease in order to address behavior change among a cohort of Bangladeshi immigrants. DESIGN: This was a qualitative study using individual in-depth interviews to explore attitudes towards and difficulties with modifying CVD related behaviors. Interviews were audio-taped, transcribed verbatim, and analyzed by using grounded theory. RESULTS: We interviewed 55 patients before reaching data saturation. Patients' responses to the meaning of heart disease were grouped into 3 categories: 1) fear of consequences of heart disease; 2) symptoms of heart disease; 3) causes of heart disease. When specifically asked d about what they felt caused heart disease, responses fell into 2 categories: 1) behavioral causes; 2) psychological causes. When asked to discuss the difficulties in addressing the causes of heart disease, responses fell into 2 categories: 1) internal forces such as self motivation; 2) external forces such as lack of time due to work and family responsibilities and stress. Patients were able to discuss the behavioral causes of CVD, but felt that either they themselves or others in their community lacked the time needed, due to socioeconomic reasons, to address these causes. DISCUSSION: Bangladeshi patients in our study are aware and scared of CVD, but feel unable to address behavioral risk factors. They cite a combination of internal and external factors as barriers to lifestyle modification in their community. Interventions to address these barriers must account for these factors, simultaneously addressing self-efficacy and work-life balance. OVERALL CONCLUSION: Cultural beliefs influence South Asian's approach to behavior modification and their attitudes regarding illness. Interventions need to address a community's attitudes and cultural beliefs towards illness to be successful.

Epidemic of Cardiovascular Disease and Diabetes

Epidemic of Cardiovascular Disease and Diabetes
Author: Raj S. Bhopal
Publisher: Oxford University Press
Total Pages: 384
Release: 2019-02-07
Genre: Medical
ISBN: 0192569945

In people with South Asian ancestry, the cardiovascular diseases of stroke and coronary heart disease (CVD) are epidemic, and type 2 diabetes mellitus (DM2) is pandemic. As South Asians comprise about 25% of the world's population their high susceptibility is of global public health and clinical importance. Eluding researchers across the globe, this phenomenon continues to be a subject of intensive enquiry. As Ban Ki-moon, the United Nations Secretary-General, points out, the epidemics of chronic diseases, which he describes as a public health emergency in slow motion, can be restrained but not stopped. With a focus on the global South Asian population, Epidemic of Cardiovascular Disease and Diabetes: Explaining the Phenomenon in South Asians Worldwide is a critical review of current literature investigating the increase in cases of CVD and DM2, and the data underpinning them. The book argues that the high risk of CVD and DM2 in urbanised South Asians is not inevitable, genetic, or programmed in a fixed way. Rather, exposure to risk factors in childhood, adolescence, and most particularly in adulthood, is the key to unravelling its cause. Drawing on current scientific literature and discussions with 22 international scholars, the book presents a unique synthesis of theory, research, and public health practice under one cover - from tissue research to human intervention trials. It also addresses the challenge many health professionals face in developing countries: to produce focused, low cost and effective actions for combating CVD and DM2. The lessons contained within will have ramifications in healthcare across the globe Epidemic of Cardiovascular Disease and Diabetes: Explaining the Phenomenon in South Asians Worldwide is ideal for scholars, researchers and health practitioners working towards understanding and preventing the epidemics of these modern chronic diseases across the world.

Cardiovascular Diseases and Risk Factors Among North American Indians

Cardiovascular Diseases and Risk Factors Among North American Indians
Author: T. Kue Young
Publisher: Winnipeg, Man. : Northern Health Research Unit, Department of Community Health Sciences, Faculty of Medicine, University of Manitoba
Total Pages: 133
Release: 1990-01-01
Genre: Cardiovascular system
ISBN: 9781895034004

Reviews literature on the incidence, prevalence and mortality of cardiovascular or circulatory diseases among North American Indians, primarily studies conducted in the United States. Presents design, methods and results of phase I of the Northern Indians Chronic Diseases Study, conducted in northern Manitoba and Ontario during 1986-87.

Critical Perspectives on Racial and Ethnic Differences in Health in Late Life

Critical Perspectives on Racial and Ethnic Differences in Health in Late Life
Author: National Research Council
Publisher: National Academies Press
Total Pages: 753
Release: 2004-10-16
Genre: Social Science
ISBN: 0309092116

In their later years, Americans of different racial and ethnic backgrounds are not in equally good-or equally poor-health. There is wide variation, but on average older Whites are healthier than older Blacks and tend to outlive them. But Whites tend to be in poorer health than Hispanics and Asian Americans. This volume documents the differentials and considers possible explanations. Selection processes play a role: selective migration, for instance, or selective survival to advanced ages. Health differentials originate early in life, possibly even before birth, and are affected by events and experiences throughout the life course. Differences in socioeconomic status, risk behavior, social relations, and health care all play a role. Separate chapters consider the contribution of such factors and the biopsychosocial mechanisms that link them to health. This volume provides the empirical evidence for the research agenda provided in the separate report of the Panel on Race, Ethnicity, and Health in Later Life.