Africans Who Arrive in the United States before 20 Years of Age Maintain Both Cardiometabolic Health and Cultural Identity: Insight from the Africans in America Study

Abstract

The overall consensus is that foreign-born adults who come to America age < 20 y achieve economic success but develop adverse behaviors (smoking and drinking) that lead to worse cardiometabolic health than immigrants who arrive age ≥ 20 y. Whether age of immigration affects the health of African-born Blacks living in America is unknown. Our goals were to examine cultural identity, behavior, and socioeconomic factors and determine if differences exist in the cardiometabolic health of Africans who immigrated to America before and after age 20 y. Of the 482 enrollees (age: 38 ± 1 (mean ± SE), range: 20–65 y) in the Africans in America cohort, 23% (111/482) arrived age < 20 y, and 77% (371/482) arrived age ≥ 20 y. Independent of francophone status or African region of origin, Africans who immigrated age < 20 y had similar or better cardiometabolic health than Africans who immigrated age ≥ 20 y. The majority of Africans who immigrated age < 20 y identified as African, had African-born spouses, exercised, did not adopt adverse health behaviors, and actualized early life migration advantages, such as an American university education. Due to maintenance of cultural identity and actualization of opportunities in America, cardiometabolic health may be protected in Africans who immigrate before age 20. In short, immigrant health research must be cognizant of the diversity within the foreign-born community and age of immigration.

Self-Care of African Immigrant Adults with Chronic Illness

“…In addition to acculturation, the following variables were explored as possible determinants of self-care: self-care self-efficacy, age in years, length of chronic conditions in months, sex (male/female), marital status (single never married, divorced/separated/widowed, or married), insurance status (with/without health insurance), employment status (employed [full-time or part-time] or unemployed/retired), perceived income adequacy (have enough or more than enough to meet needs, ordo not have enough to meet needs), living situation (lives alone or lives with family/others), immigration status (US citizen/ permanent resident, Refugee status, and Non-immigrant temporary visa holder), and educational level (high school graduate or below and some college or above). We chose these variables as potential determinants of self-care because they are linked to health outcomes in African immigrant populations in the US (Commodore-Mensah, et al, 2016; Commodore-Mensah, Matthie, et al, 2018; Mukaz et al, 2020; Shoup et al, 2020). Additionally, self-care self-efficacy was included because it has been shown previously to explain self-care behavior (Riegel et al, 2012).…”

Sleep and Economic Status Are Linked to Daily Life Stress in African-Born Blacks Living in America

“…The Africans in America cohort was established to assess both the well-being and cardiometabolic health of African-born Blacks living in the United States [ 23 , 25 , 26 , 27 , 28 ]. The recruitment methods included announcements on the NIH website, flyers, presentations at community events (in-person and virtual) and previous participant referrals.…”

“…Thirty-two participants were excluded because they were childhood immigrants, meaning their age at United States entry was <18 years. Childhood arrivals face different educational financial and acculturation pressures than adult arrivals [ 23 ]. Therefore, they were not included in the current analyses.…”

“…To our knowledge PSS and PSQI have not been administered simultaneously in other African immigrant cohorts such as the Afro-Cardiac Study [ 18 ], the African Immigrant Health Study [ 19 ], Research on Obesity and Diabetes in African Migrants (RODAM) [ 13 , 14 , 20 , 21 ], and the Africans in America study [ 2 , 22 , 23 , 24 ]. The Afro-Cardiac Study [ 18 ] revealed that cardiovascular disease (CVD) risk in West Africans living in the Baltimore-Washington area depends on degree of acculturation and duration of United States residence.…”

“…The RODAM [ 13 , 14 , 20 , 21 ] study has provided key insights into obesity, exercise, CVD, and diabetes physiology in Ghanaians who have migrated to Amsterdam, Berlin, and London. The Africans in America [ 2 , 22 , 23 , 24 ] cohort [ 2 , 22 , 23 , 24 ] enrolls African-born Blacks living in metropolitan Washington, DC and previously focused on issues related to both metabolism and chronic stress such as reason and age of immigration. With this report we provide our newest insights from the Africans in America cohort regarding contributors to daily life stress.…”