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Native-Born Youth of African Immigrants and Cardiovascular Risk: A Mixed Methods Study

Final Report Summary - BYAIMS (Native-Born Youth of African Immigrants and Cardiovascular Risk: A Mixed Methods Study)


Guided by a community-based participatory research approach (CBPR), the BYAIMS research team used a mixed method design to examine the influence of Uri Bronfenbrenner’s Bioecological theory domains on cardiovascular risk factors (CR) in adolescents, comparing those of Ethiopian descent to other immigrants and non-immigrants. Adolescent immigrants are comprised of two groups: 1st generation – both adolescent and parents were born in another country; and 2nd generation adolescent was native-born but parents were born in another country. Both generations of adolescent immigrants are growing in Europe and Israel. While European countries have approximately 600,000 Ethiopian immigrants, the State of Israel has approximately 120,000.

During adolescence, CR (i.e. diet, exercise, smoking, chronic stress, health status, experiences with health services) become established and often continue throughout the life course. While past studies on adult immigrants have shown lower age-adjusted CR than the native population, studies on adolescent immigrants conflict. This study represents the first attempt to examine the impact of the full range of Bronfenbrenner’s bioecological domains on CR in adolescent immigrants and non-immigrants, with a particular focus on adolescent Ethiopian immigrants.

The BYAIMS study showed that while all adolescent immigrants reported lower socioeconomic status and higher levels of psychological symptoms (the microsystem) and more frequent school difficulties (the mesosystem), only 2nd generation Ethiopian adolescent male immigrants demonstrated the poorest health status (CR) compared to other immigrants and non-immigrant groups. Ethiopian immigrants used the internet primarily to obtain health information, while other adolescent immigrants and non-immigrants primarily sought parent input. Ethiopian immigrants also reported poorer health treatment and less positive doctor-patient communication (exosystem) than other adolescent immigrants and non-immigrants. Like other immigrants, Ethiopian adolescent immigrants are sandwiched by stress. On one side, they have the stressors of helping their parents with culture and language interpretation; and on the other side, they have the stressors of peers and school where they must actively study and compete alongside peers who have a better command of the language and culture. Ethiopian adolescent immigrants have the additional stress of witnessing and experiencing pervasive racist societal attitudes (macrosystem), which in some situations has resulted in incidents such as donated Ethiopian blood being disrespectfully discarded. Interventions, such as youth villages, designed to acculturate Ethiopian and other immigrant adolescents from families struggling with poverty have been successful with some CR (diet and exercise) but not others (smoking). These interventions facilitated acclimation to Israeli culture, but also resulted in the loss of Ethiopian immigrant culture.

Influences on CR emanate from all Bioecological domains – family, school, the health system, and society attitudes and governmental policies, but often highest for Ethiopian adolescent immigrants. Since adolescence is the stage of development when many attitudes and behaviors become established, it may be that these disadvantages will impact the life course. Interventions have been piecemeal, and often uninformed by the community itself. Little attention has been given to events that reflect discrimination and disrespect to the Ethiopian Community. Yet, their aftermath is recorded in historical memory and absorbed as a stressor in Ethiopian immigrant adolescents.