Cardiovascular risk factors (CR) are the leading cause of morbidity and mortality in developed countries. By adolescence, CR of diet, exercise, blood pressure, body mass index, and smoking already are predictive of adulthood morbidity. Although genetics play a part in CR, health behaviors are the major contributors. Health status and service use differ between ethnic/racial groups (including immigrants) and the dominant population, but is this true of the influences on health behaviors? Europe and Israel are common destinations for international migrants from the least developed African nations. Capitalizing on a mixed-methods design and Community Based Participatory Research approach, this study will address ethnic/racial disparities in health care access by examining the influences of all four Bioecological Model's domains on cardiovascular risk factors in youth, comparing native-born youth of African immigrants (Ethiopians) to veteran Israelis. Qualitative interviews from 45 stakeholders and youth will be used to identify unique influences not found in existing literature. Informed by the interviews, quantitative surveys with new and established instruments will measure the impact of the four domain influences of the Model on CR. The surveys will be administered in three areas of Israel to a sample (n=600) comprised of two groups of 15-18 year old native-born youth, one born to African immigrants and the other to veteran Israeli parents. Using a variety of statistical techniques, the impact of each domain will be measured for all youth and each group. This study represents the first attempt to integrate the full range of domains on health behaviors affecting CR in youth, and disaggregate them for dominant society and second generation immigrant youth. Not only will this information inform the development of effective health care interventions for all youth, but it also will reduce ethnic/racial disparities for Europe's future generations of immigrants.
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