SocioEnvironmental & Ecological Disparities Group: Identifying the Dynamic Health Impacts of Social and Environmental Factors on Chronic Disease Outcomes

National Institute Of Environmental Health Sciences

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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 2021 Bhutanese Community of Central Ohio Health Study (BCCOHS) was developed as a cross-sectional study to serve as 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. The BCCOHS is among the first studies to address this major gap and was funded through the William G. Coleman Jr., Ph.D., Minority Health and Health Disparities Research Innovation Award (1ZIJMD000009-05). Over 96,000 Bhutanese refugees have resettled in the US between 2008-23 with more than 23,000 estimated to be 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. Currently, through NIH OD funding, the Bhutanese Community Health Study I (BCHS I) will build upon the initial 2021 BCCOHS cross-sectional study by expanding data collected and collection methods. The BCHS I will recruit Bhutanese participants from the 2021 BCCOHS and from the central Ohio area, and include expanded and robust measures of acculturation and acculturative stress to account for synergizing socioenvironmental and biobehavioral risk factors. Expanded data collection methods will include rapid qualitative data collection methods, collection of minimally invasive biospecimens, as well as establishing the feasibility of more invasive biological sample collection among US Bhutanese participants in the central Ohio community. The BCHS I will create a stronger epidemiologic foundation to understand cardiometabolic disease etiologies among underserved, underrepresented, and hard-to-reach immigrant and refugee groups as they relate to the process of acculturation in a socioecological context to understand synergizing socioenvironmental and biobehavioral risk factors. The long-term goal of which will be to design efficient interventions that will ultimately develop sustainable evidence-based strategies that further strengthen epidemiological research through the inclusion of diverse community organizations, study participants, and trainees to create meaningful change in chronic disease outcomes. To this end, we are publishing findings from the 2021 BCCOHS (N = 495; 51.5% male, 69.8% aged 18-44 years). Singh et al. (2024), using latent class analysis (LCA), identified distinct profiles of neighborhood social cohesion, social support, and community challenges (e.g., limited access to healthcare services and transportation, crime and safety issues, substance use, intimate partner violence) and their associations with insomnia symptoms. Our LCA revealed four distinct classes/profiles. Identified classes/profiles were further differentiated by self-reported sociodemographic, socioeconomic, health, acculturative, and discrimination factors. Results: Latent class analysis revealed four distinct classes/profiles. The High Cohesion (class 1) profile (30.1% of sample) had the lowest likelihood of insomnia symptoms at 6.5%, followed by class 2 or High Support (23.6%) with a 15.3% likelihood. Class 3 or High Challenges profile (11.5%) had a moderate likelihood of insomnia symptoms at 49%. Class 4 or the Low Cohesion/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, experiences of everyday discrimination, limited English linguistic proficiency, and not using telehealth. Our study findings revealed that community social cohesion and support may play an important role in mitigating insomnia symptoms among Bhutanese refugees, but further investigations are warranted. Similarly, in Montiel Ishino et al. (2024), we used mixture modeling that incorporated multiple acculturation and acculturative stress proxies. We identified South Asian (SA) cardiometabolic risk profiles using acculturative process indicators. As such, we conducted latent class analysis of adults from the Mediators of Atherosclerosis in South Asians Living in America study (N=771). Cardiometabolic disease distal risk outcome was constructed using prevalent hypertension, type 2 diabetes, and body mass index. Acculturation indicators included years living in the US, language use, dietary behaviors, passing down cultural traditions, social and neighborhood supports, friends kept, and discrimination, as well proxies of acculturative stress (i.e., depressive symptomology, trait anxiety and anger). Social and environmental determinants of health, health behaviors, religiosity and spirituality were used as covariates of latent class membership. Four cardiometabolic risk profiles were identified: (1) lowest risk [73.8% of sample] were the most integrated with both SA and US culture; (2) modest risk [13.4% of sample] had high mental health distress and discrimination, and marginalized themselves from SA and US culture; (3) moderate risk [8.9% of sample]; and (4) highest risk [3.9% of sample] profiles were more assimilated with US culture. Compared to the lowest risk profile: the modest risk profile was low-income with conflicting religiosity/spirituality attitudes; the moderate profile had lower income and educational attainment with positive religiosity/spirituality behaviors and attitudes. Findings expand our understanding of immigrant cardiometabolic risk as a syndemic issue wherein multiple co-occurring and interacting processes are synergizing negative outcomes in already at-risk subpopulations. Furthermore, acculturation may provide a missing key facet in understanding health disparities among US foreign-born.