Background Racial/ethnic minorities, especially non‐Hispanic blacks, in the United States are at higher risk of developing cardiovascular disease. However, less is known about the prevalence of cardiovascular disease risk factors among ethnic sub‐populations of blacks such as African immigrants residing in the United States. This study's objective was to compare the prevalence of cardiovascular disease risk factors among African immigrants and African Americans in the United States. Methods and Results We performed a cross‐sectional analysis of the 2010 to 2016 National Health Interview Surveys and included adults who were black and African‐born (African immigrants) and black and US ‐born (African Americans). We compared the age‐standardized prevalence of hypertension, diabetes mellitus, overweight/obesity, hypercholesterolemia, physical inactivity, and current smoking by sex between African immigrants and African Americans using the 2010 census data as the standard. We included 29 094 participants (1345 African immigrants and 27 749 African Americans). In comparison with African Americans, African immigrants were more likely to be younger, educated, and employed but were less likely to be insured ( P <0.05). African immigrants, regardless of sex, had lower age‐standardized hypertension (22% versus 32%), diabetes mellitus (7% versus 10%), overweight/obesity (61% versus 70%), high cholesterol (4% versus 5%), and current smoking (4% versus 19%) prevalence than African Americans. Conclusions The age‐standardized prevalence of cardiovascular disease risk factors was generally lower in African immigrants than African Americans, although both populations are highly heterogeneous. Data on blacks in the United States. should be disaggregated by ethnicity and country of origin to inform public health strategies to reduce health disparities.

Summary Non‐Hispanic Black women have the highest rates of overweight/obesity of any group in the United States. To date, few interventions have worked to reduce overweight/obesity in this population. This study investigated the views of Black women with overweight and obesity treated in a primary care setting regarding desired and undesired verbal and non‐verbal behaviours by providers in provider‐patient clinical encounters focused on losing weight, maintaining weight loss, and/or obesity. Two focus groups and an individual interview (n = 15) were conducted. Qualitative data analysis yielded five distinct themes, with 11 codes (listed in parenthesis): (a) desired weight‐focused discussions (codes: Discussing weight loss with patients and discussing weight‐loss maintenance with patients), (b) desired weight‐focused support (codes: Supporting patients experiencing weight loss and supporting patients experiencing weight gain), (c) undesired weight‐focused discussions (codes: Things to avoid during weight loss discussions and things to avoid during weight gain discussions), (d) desired attitudes and behaviours during weight‐focused discussions (codes: Show caring and understanding and encourage behaviour change for weight loss), and (e) building physician‐patient rapport (codes: Enable patients to feel respected by doctors, enable patients to feel comfortable with doctors and enable patients to trust their doctors). The qualitative approach employed in this study generates a deep understanding not only of the experiences of Black women patients but also of potential strategies that physicians could employ to succeed in their discussions with patients regarding healthy weight achievement and maintenance.

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Global migration from Africa to more economically developed regions such as the United States, Europe, the Middle East, and Australia has reached unprecedented rates in the past five decades. The size of the African immigrant population in the United States has roughly doubled every decade since 1970. However, research has not kept up with the growing size of this vulnerable population. Data from African immigrants have not traditionally been reported sepa­rately from Blacks/African Americans. There is growing interest in increasing the partici­pation of African immigrants in research to understand their unique health needs and the full spectrum of factors impacting their health, ranging from racial, social, environ­mental, and behavioral factors, to individual biological and genetic factors which may also inform health challenges. This line of inquiry may also inform our understanding of health disparities among their African American counterparts. However, little is known about effective community engage­ment and recruitment strategies that may increase the participation of this popula­tion in research studies. The purpose of this commentary is to: 1) describe lessons learned from our experiences engaging Afri­can immigrants in research in the Baltimore, Washington, DC, and Atlanta metropolitan areas; 2) discuss strategies for successful re­cruitment; and 3) consider future directions of research and opportunities to translate research findings into health policy for this population. Ethn Dis. 2019;29(4):617-622; doi:10.18865/ed.29.4.617

Since the release of Healthy People 2020, there has been extensive research understanding factors associated with health-related quality of life (HRQoL) among specific populations. Despite this growing body of research, little has been conducted to understand the factors associated with HRQoL among uninsured/underinsured Americans. The purposes of the present study were to assess clinic staff to determine: (1) whether there is a need to examine HRQoL among uninsured/underinsured individuals, (2) whether there is a need for tailored HRQoL-promoting interventions among uninsured/underinsured individuals, and (3) the factors associated with HRQoL among uninsured/underinsured individuals. A survey was sent to an association of 41 clinics that provides free medical services to uninsured/underinsured individuals. The majority of participants indicated that uninsured/underinsured individuals experience unique factors associated with HRQoL and that there was a need to implement tailored HRQoL-improving interventions among uninsured/underinsured individuals. The results also present the personal/contextual factors associated with HRQoL of uninsured/underinsured individuals.

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Background: Racial/ethnic disparities in cardiovascular disease (CVD) deaths continue to persist, despite advances in preventive strategies. Few studies have examined disparities in CVD deaths by nativity status (US- vs. foreign-born). Objective: To assess differences in CVD deaths by nativity status across racial/ethnic groups in the US. Methods: Using a cross-sectional design, we pooled data from 1999-2018 National Health Interview Survey, with linked death records through 2019. Outcome, cardiovascular related deaths (CVD & CVA) was modelled, in years, as time from interview till year of death, or last date of follow-up (December 31, 2019). Nativity status was defined as US- or foreign-born. We used Cox proportional hazards regression to estimate differences in CVD deaths across racial/ethnic groups (White, Black, Asian, Indigenous American, and Hispanic adults) stratifying by nativity status. Models were sequentially adjusted for sociodemographic and CVD risk factors. Results: We included 172,896,665 adults (16% US-born, 84% foreign-born). During median 10 follow-up years, 3.41 CVD deaths /1,000person-years occurred. Among US-born adults, age-and sex-adjusted CVD death rates were 34% higher among Non-Hispanic Black adults (Hazard Ratio: 1.34; 95% CI, 1.29–1.39), 23% higher among Indigenous Americans (HR: 1.23; 95% CI, 1.00–1.52) compared to Non-Hispanic White adults [Table] . In the fully adjusted models, CVD death rates were 6% and 23% lower among Black (HR: 0.94 [95% CI, 0.89–0.99]) and Hispanic (HR: 0.77 [95% CI, 0.70–0.84]) adults. Compared to US-born White adults, CVD death was lower in foreign-born White (HR: 0.74; 95% CI, 0.66–0.82), Black (HR: 0.57; 95% CI, 0.45-0.73), Hispanic (HR: 0.55; 95% CI, 0.50–0.61), and Asian (HR: 0.61; 95% CI, 0.53–0.71) adults, respectively. Conclusions: Overall, CVD deaths were lower among foreign- than US-born adults. Although, there were some racial/ethnic differences in CVD deaths, we found evidence of persistent survival advantage among foreign-born adults.

Introduction: Stress alters the cardiometabolic and inflammatory systems. Allostatic load, a measure of chronic and cumulative stress is associated with cardiovascular events and mortality. Immigration is known to be a stressful experience; however, it is unclear how length of stay, a proxy for acculturation, is associated with allostatic load in US immigrants. Hypothesis: We hypothesized that greater length of stay will be associated with higher allostatic load among US immigrants. Methods: We used a cross-sectional design to examine the 2011-2016 National Health and Nutrition Examination Surveys. Allostatic load was defined by a count of the number of high-risk classifications for 10 cardiovascular, metabolic, and immune system biomarkers: systolic blood pressure, diastolic blood pressure, total cholesterol, triglycerides, glycated hemoglobin, albumin, creatinine clearance, body mass index, waist circumference, and white blood cells. Logistic regression was used to examine the odds of a high allostatic load score (≥ 4) as in previous literature, adjusting for survey weights. Results: We included 7318 immigrants with mean age (±se) 44(±0.52); 49% were male. Half of the sample was of Mexican/Hispanic origin, 26% were Asian and 7% were Black. The median allostatic load score was 2.2. The odds of high allostatic load decreased with longer stay in the US. After adjusting for age, race, education, income, insurance status, and routine place for healthcare, those who had resided in the US for 10 to 20 years were 45% (95% CI: 1.1-1.9) more likely to have a high allostatic load than those who had been in the US <10 years. The unadjusted and adjusted results are presented in the Table. Conclusion: Length of stay in immigrants is associated with having a high allostatic load. The odds of increased allostatic load declines with longer length of US residence. Additional research is needed to further understand the process and impact of cumulative stress among immigrants to reduce racial/ethnic health disparities.