SocioEnvironmental & Ecological Disparities Group: Identifying the Health Impacts of Dynamic Inequities

National Institute Of Environmental Health Sciences

Investigators

Linked publications, trials & patents

Abstract

The growing US immigrant population, while often categorized as resilient, has poor physical and mental health outcomes when compared to their US-born counterparts. The health disparity becomes apparent the longer immigrants reside in the US, even if their physical and mental health was initially better than the US-born population. The disparity can either be attenuated or magnified in a given environmental context. For instance, the process of acculturation or the adaptive/maladaptive strategy used to assimilate into a host culture has been associated with increased incidence, prevalence, morbidity and mortality from chronic diseases like cardiometabolic syndrome and cancer. To address the widening health disparity, contribute to the limited scientific literature, and fill current epidemiologic gaps, the SocioEnvironmental & Ecological Disparities (SeEDs) have two current and ongoing projects: (1) epidemiological assessment of cardiometabolic disease and environmentally associated health risks in the Bhutanese Community of Central Ohio Health Study; and (2) identifying novel biomarkers of acculturative stress and cardiometabolic disease. The Bhutanese Community of Central Ohio Health Study (BCCOHS) was developed to establish the foundation for a prospective cohort to characterize the role of socioenvironmental factors and dynamic acculturation pathways on cardiometabolic conditions, related etiologies, and comorbidities among the medically underserved, underrepresented, and hard-to-reach US Bhutanese refugees. Currently, the Bhutanese are the third largest refugee group in the US and are classified as racially/ethnically South Asian; the fastest growing immigrant group. And yet, health research concerning South Asians is limited, and even more so for US Bhutanese. The BCCOHS is among the first studies to address this major gap. Over 96,000 Bhutanese refugees have resettled in the US between 2008-23, making the US Bhutanese community the largest population outside of the Kingdom of Bhutan. Conservative estimates from 2015 place more than 23,000 Bhutanese residing in the central Ohio region of Columbus. The BCCOHS feasibility phase recruited 495 participants between March 2021 to March 2022 during the Covid-19 pandemic. The feasibility phase was funded through the William G. Coleman Jr., Ph.D., Minority Health and Health Disparities Research Innovation Award (1ZIJMD000009-05). We attribute the success of the feasibility phase to the mixed methods research design and community-based participatory approach, as well as our collaboration with The Ohio State University, Denison University, and the Bhutanese Community of Central Ohio non-governmental organization. The pre- and post-tested survey in English and Nepali collected data on medical and treatment self-reports of cardiovascular, metabolic, and mental health issues, as well as acculturation, socioeconomic, socioenvironmental, sociocultural and sociodemographic domains. Findings from the feasibility phase thus far: Villalobos et al. (in process) reports on the BCCOHS survey findings. Participants were male (51%), aged 25-44 years (37%), and ethnically Brahmin/Chhetri/Janajati/Dalit (93%). Self-reported insomnia symptoms were as follows: 56.4% said they did not or had little difficulty falling/staying asleep, 30.7% had quite a bit of difficulty, and 12.9% found it extremely difficult. From self-report of medical diagnosis and treatment, 64.1% were classified as overweight/obese (i.e., using body mass index criteria for Asian populations), 16.5% had dyslipidemia, 22.6% hypertension, and 14.7% type 2 diabetes. Overall, 28.2% of the sample reported no cardiometabolic conditions, 65.6% reported 1-3, and 6.2% reported all conditions. Singh et al. (in process) identified profiles of insomnia symptoms based on neighborhood cohesion, social support, and community challenges using latent class analysis, and were further differentiated by self-reported sociodemographic, socioeconomic, health, acculturative, and discrimination factors. The High Neighborhood Social Cohesion (Class 1) profile (30.1% of sample) had the highest likelihood of no insomnia symptoms at 93.5%, followed by Class 2 or High Community Social Support (23.6%) with an 84.7% likelihood. Class 3 or Lowest Neighborhood Social Cohesion and Support with Most Community Challenges profile (11.5%) had a moderate likelihood of insomnia symptoms at 51%. Class 4 or the Low Neighborhood Social Cohesion and Support profile (34.7%) had a 100% likelihood of reporting insomnia symptoms. Class 4 when compared to Class 1 was more likely to report cardiometabolic conditions, experience everyday discrimination, limited English linguistic proficiency, and not using telehealth. Cohen et al. (2022) reported on the digital divide, and the critical barrier it created to accessing health information and healthcare during the COVID-19 pandemic and negatively impacted the Bhutanese refugee community. Moving beyond a technological model of the digital divide that highlighted a lack of access to computers and internet, we identified the impact of sociocultural and socioenvironmental factors to not only address issues concerning health disparities but identify the critical elements needed to design salient interventions and prevention programs. Currently, the BCCOHS has moved to a cohort pilot study phase, which builds upon the feasibility study by expanding the breadth of the original survey and questionnaire. the cohort pilot will also collect minimally invasive biomarkers (i.e., anthropometrics; noninvasive biological samples) and establish the feasibility of collecting more invasive biological specimens like whole blood and urine.