Association of Acculturation and Health Literacy with Prevalent Dysglycemia and Diabetes Control Among Latinos in the Boston Area Community Health (BACH) Survey

Abstract

This study assessed the effect of acculturation on type 2 diabetes and whether health literacy may mediate this association. The Boston Area Community Health cohort is a multi-stage stratified random sample of adults from Boston including 744 Latinos. We defined dysglycemia as a HbA1c ≥5.7 %. Multivariable analyses examined the associations between acculturation and health literacy adjusting for demographic and clinical variables. Similar analyses were performed among participants with HbA1c ≥7.0 % to assess the association between acculturation and diabetes control. Among an insured primarily foreign born Spanish speaking Latino population, with a long residence period in the US and good healthcare utilization, higher levels of acculturation were not associated with dysglycemia. Lower levels of acculturation were associated with worse diabetes control. Health literacy level did not modify these associations. Elucidating the components of heterogeneity among Latinos will be essential for understanding the influence of acculturation on diabetes.

Associations of Acculturation with English- and Spanish-Language Health Literacy Among Bilingual Latino Adults

“…Other work has found that acculturation, or its proxies, is associated with a number of health service/use behaviors that may in turn influence HL. Persons with greater acculturation toward their heritage culture (typically as measured by unidirectional measures/proxies) report more barriers to care and are less likely to seek out patient services for physical or mental health, use preventive services, attend postpartum appointments, or have a regular service provider (Ciampa et al, 2013; Lara et al, 2005; López et al, 2016; Sentell, Shumway, & Snowden, 2007). Thus, higher Latino cultural identity may be associated with lower HL by way of its association with health service use behaviors that provide opportunities for exposure to important health information and opportunities to make health-related decisions.…”

“…For instance, Latinos are more likely than non-Latino Whites to have low SES (Barnett & Vornovitsky, 2016; Proctor, Semega, & Kollar, 2016). Although HL among Latinos has been associated with access to health care, social networks, capital, health-related skills (e.g., medication dosing), sociolinguistic environment, and comfort with speaking English (Ciampa et al, 2013; Jacobson, Hund, & Soto Mas, 2016; Leyva, Sharif, & Ozuah, 2005; López et al, 2016), very little is known about which sociodemographic variables may be associated with HL other than SES (Becerra, Arias, & Becerra, 2017; Ross & Wu, 1995; Sentell & Halpin, 2006).…”

“…In the first study, Ciampa et al (2013) found that higher U. S. acculturation scores (assessed with the Short Acculturation Scale for Hispanics [SASH]; Marin, Sabogal, Marin, Otero-Sabogal, & Perez-Stable, 1987), were positively associated with Spanish-language HL. In the second study, López et al (2016) used the Bidimensional Acculturation Scale (BAS) (Marin & Gamba, 1996) to categorize people into high and low U. S. acculturation levels and found that persons in the high-acculturation group were significantly more likely to have adequate Spanish or English HL compared to persons in the low-acculturation group. Although findings suggest that greater acculturation toward American culture is associated with higher HL in either English or Spanish, both studies are limited in their unidimensional operationalization of acculturation.…”

“…These measures are considered unidimensional in that they evaluate acculturation following the premise that increased involvement in American culture is indicative of decreased involvement in Latino culture (Rodriguez, Mira, Paez, & Myers, 2007). Use of the BAS (López et al, 2016) further limits examination of acculturation to the language domain, and although the SASH consists of three domain factors (language use, media, social relations), Ciampa et al (2013) used the mean of all items and thus did not allow for explicit examination of acculturation in distinct social or inter-/intrapersonal domains. As such, it is unknown if acculturation in different domains or acculturation toward one's heritage culture are associated with HL among Latinos.…”

Health Engagement Living Lab Project: A Pilot Mixed-Methods Study To Advance Self-Care Agency Among Migrant Workers In South Korea

“…Acculturation is a multidimensional cultural and psychological change process that results from a contact between two or more different cultures and groups [7]. A high level of acculturation is associated with positive aspects such as improved language ability, higher socioeconomic status, easy access to health care and preventive health services, lower depressive symptoms, and better quality of life and health outcomes for migrants in general [8,9]. Social support is another key factor that reduces acculturative stress, depression, and anxiety levels, and positively affects psychological well-being among migrants [10].…”