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We examined whether acculturation and immigrant generation, a marker for assimilation, are associated with diabetes risk in an aging Mexican-origin population. Logistic regression modeled prevalent diabetes. Adjusting for age and gender, we observed significant but divergent associations between immigrant generation, acculturation, and diabetes risk. Relative to first-generation adults, second-generation adults had an odds ratio OR of 1. Greater US acculturation, however, was associated with a slightly decreased diabetes rate.
In the full model adjusting for socioeconomic and lifestyle factors, the association between generation but not acculturation and diabetes remained significant. Our study lends support to the previously contested notion that assimilation is associated with an increased diabetes risk in Mexican immigrants.
Researchers should examine the presence of a causal link between assimilation and health more closely. Diabetes is increasing in the United States 1 and in countries that contribute the largest number of immigrants to the United States. Immigrants are a large and dynamic segment of the US population. Between and , the foreign-born population in the United States increased Mexico is the largest contributor of immigrants to the United States 12 and has recently experienced rapid increases in both obesity and diabetes.
In the United States it is well known that relative to non-Latino Whites, Latinos—those of Mexican origin in particular—bear a much larger burden of diabetes. The evidence on whether the risk of type 2 diabetes in Latino immigrant populations increases with greater time in the United States or acculturation, however, is mixed. Although the Mexican national rate of diabetes is almost one and a half times higher than is the US rate, 2 , 40 it is not clear whether the US setting slows or accelerates the development of diabetes.
On the one hand, Mexican immigrants are moving from a country with high rates of diabetes to one with lower rates.
But diabetes growth worldwide has also been attributed to global secular shifts in lifestyles and diet that result from upward social mobility and rapid urbanization. Some studies have examined whether diabetes increases with longer US residence in middle-aged populations 24 , 26 ; however, we are the first, to our knowledge, to focus on an aging Mexican-origin population, aged 60 years and older.
We also examined whether there is significant heterogeneity in diabetes risk across different generations. Consistent with the unhealthy assimilation perspective, 37 we examined whether diabetes risk increases from the immigrant generation to US-born second and third generations, using data from the Sacramento Area Latino Study on Aging SALSA. The study population and the participant recruitment procedure have been described elsewhere.
An eligible person was aged 60 years or older in and self-designated as Latino. The sample was highly representative of older Latinos residing in the Sacramento area. In a 2-hour interview, each participant answered survey questions about lifestyle factors, acculturation, and medical diagnoses.
In-home visits were conducted every 12 to 15 months for a total of 7 follow-up visits. We used only data collected during the baseline interview for our analysis. Trained research staff obtained blood during the in-home interview and measured fasting glucose by standard venipuncture. Staff obtained information on medication by medicine chest inventory during the in-home interview.
Sociologists who study the assimilation process among US immigrants view immigrant generation as a central variable conceptualized broadly as a time dimension reflecting increasing exposure to US social and cultural norms. We classified a foreign-born respondent as a first-generation immigrant and a US-born respondent with at least 1 foreign-born parent as second generation; if the respondent and both parents were born in the United States, we classified him or her as third generation.
From a sociological perspective, assimilation entails both social mobility and the extent to which the immigrant population achieves social and economic parity with the native population i. The scoring procedures were similar to those Cuellar et al. We also assessed language of interview in the descriptive analysis. Demographic factors included age continuous and gender. We selected additional covariates according to their potential association with immigrant generation, because they were thought to be potential mediators on the causal pathway between assimilation, acculturation, and diabetes risk.
We derived income source from questions that assessed whether the respondent received any earned income salary, pension, social security, or veterans benefits or entitled income disability, supplemental social security, housing subsidy, or food stamps.
We grouped lifetime occupation into non-manual e. Lifestyle factors included smoking current, past, or never smoker , alcohol use, and physical activity, which are all known to vary by acculturation and to be associated with diabetes risk.
We determined physical activity on the basis of a question that asked the respondent to classify usual outdoor walking pace easy or casual; normal or average; brisk pace; very brisk or striding; and never walk outdoors. We measured waist circumference in inches at the level of maximum indentation over the abdomen when the participant bent to the side. We calculated body mass index BMI using the formula weight in kilograms divided by the square of height in meters. In the modeling stage, we examined 4 different logistic regression models predicting prevalent diabetes.
First, we examined the effect of generation and acculturation on diabetes risk, adjusting for age and gender. Second, we added all SES measures and lifestyle factors separately to examine whether their addition attenuated the relationship between generation and diabetes risk.
Finally, in the full model we adjusted for all covariates at once. We performed all analyses in SAS version 9. This was a sequential regression multivariate imputation approach that conditions on all observed variables as predictors. We reached similar conclusions, with unchanged statistical significance compared with the analysis using multiple imputations.
We used data from baseline in this analysis. The mean number of years of education was 7. Mean waist circumference was 38 inches. Participant Characteristics by Immigrant Generation: Sacramento Area Latino Study on Aging, — Every indicator in Table 1 varied by immigrant generation with the exceptions of gender and smoking status.
Similarly, the mean acculturation score ranged from 1. SES indicators also varied by immigrant generation. We also assessed other logistic regression models. Finally, we examined whether there was an association between number of years in the United States and diabetes risk among the immigrant sample. After adjusting for SES variables and lifestyle factors separately Table 2 , the significant association between generation and diabetes risk remained e.
In light of evidence that waist circumference is a more sensitive predictor of diabetes risk in the elderly and in ethnic minority groups including individuals of Mexican origin, 58 , 59 we have presented findings for waist circumference. Our study suggests that immigrant generation is significantly associated with diabetes risk among our population-based sample of aging adults of Mexican origin. Diabetes risk is higher in US-born second- and third-generation individuals compared with immigrants.
These associations are not influenced by acculturation, SES, or the lifestyle factors we measured. First, unlike immigrant generation, which was positively associated with diabetes risk, acculturation had an inverse association with diabetes risk in the unadjusted model.
Second, the association between immigrant generation and diabetes risk persisted even after accounting for all study covariates; this was not the case for acculturation. This latter relationship was somewhat attenuated after adjusting for SES factors. These findings are consistent with results of past studies. Although these findings can be interpreted as inconsistent, they may also suggest that different measures of acculturation are proxies for different mechanisms and point to the complexity of the adaptation process of immigrants to the United States.
From a broader perspective, increasing generations can be viewed as a marker of cumulative exposure to a new social, cultural, and physical environment. In this regard, our study provides evidence of an immigrant health advantage whereby being raised as a child in their home country of Mexico affords some protective effect on health, which then diminishes in subsequent generations.
This interpretation leaves open the question of whether culture, environment, selection, or some combination of these factors explains our findings.
Relating our findings to global changes in lifestyles and patterns in obesity and diabetes, however, may help elucidate some of the causal pathways implicated in this process of unhealthy assimilation. It is unknown, for example, whether the cumulative impact of exposure to repeated stressors or how the life course timing of exposure to stressors contributes to this heightened diabetes risk.
Furthermore, health behaviors of immigrants are transformed by prevailing US ideologies concerning diet and nutrition, 71 — 73 and how the food culture of immigrant populations evolves from the immigrant generation to the US-born generations is central to understanding diabetes development. Chronic exposure to the US built environment e.
Finally, there is evidence that points to an increased susceptibility to diabetes among Mexican-origin populations in the United States because of genetic predisposition. The Mexican-origin population and higher event rate populations present unique opportunities to disentangle and study the role of genetics and how it may interact with chronic stressors and change in environments and behaviors. Because we relied on cross-sectional data used from the SALSA baseline wave, it was beyond our scope to estimate temporal effects, which would help to establish causality.
It is possible, for example, that the observed inverse association between alcohol use and diabetes risk has a reverse causal relationship such that diabetes diagnosis would cause respondents who report alcohol use to drink less whereas the undiagnosed respondents continued to drink as usual.
The overall prevalence, however, of alcohol use in our sample was low, so this pattern may apply to only a small proportion of the respondents. We assessed only outdoor walking pace, which possibly underestimates physical activity levels; SALSA participants may also engage in other forms of leisure and nonleisure e. SALSA did not collect any dietary measures, and thus we were unable to examine the potential role that dietary change played in the relationship between assimilation and diabetes risk.
Cross-sectional studies of immigrants do not allow us to study key dynamic aspects of immigration at the individual level. Therefore, each generation may have come from a different migration cohort and thus have had a different migration experience.
This diversity may result in variations in diabetes risk. Finally, our measure of acculturation was a short adaptation of a previously validated scale. Relationships between migration, acculturation, and health are complex, 85 and both negative and positive associations between assimilation, acculturation, and diabetes and its risk factors have been observed.
It also highlights the need to employ more novel designs to evaluate whether there is a causal link between assimilation and poor health and, if so, to more closely examine potential mechanisms.
We also suggest that such examinations would be of benefit when placed in the context of the global epidemic of diabetes. The authors wish to thank Steven Gregorich and John M. Neuhaus for their statistical guidance on earlier stages of this project. Reprints can be ordered at http: The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. The institutional review boards of the University of Michigan, the University of California, Davis, and the University of California, San Francisco approved this study.
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