Cardiovascular Health in Southeast Asian Immigrants: Acculturation’s Impact on Risk Factors

Abstract

Increased incidences of cardiovascular diseases in the US have been seen to disproportionately affect minority populations more than their whites. However, one population group that is not as often included in research studies is the Asian American population, particularly Southeastern Asian immigrants. Even though Asian American populations, especially the Southeast Asian ones, have relatively favorable socioeconomic indicators when compared to the overall US population, these populations have a major burden of traditional cardiovascular risk factors and are classified as a high-risk group for cardiovascular diseases. Most studies have pooled Asian populations into one major racial group instead of analyzing the various ethnicities and demographies that exist within the Asian categorization. Though some research studies suggest that the acculturation process does have a degree of impact on cardiovascular health, there hasn't been a widely used tool for measuring or ascertaining the totality of acculturation. Rather, multiple proxies have been used to measure acculturation; prior studies have argued for more culturally tailored acculturation proxies. The goal of this paper is to review the various acculturation measures that have been applied to cardiovascular health in Asian Americans, specifically Southeastern Asian immigrants. The four proxies described in this paper include English spoken at home, length of stay in the US, religiosity and spirituality, and mixed family structures. Earlier studies demonstrated that with the increased years staying in the US the burden of cardiovascular risk factors accrue. However, the effects of English spoken at home, religiosity, and admixed family structure remain inconclusive based on the magnitude of the existing body of work. Although most studies suggest that greater levels of acculturation increase the risk of cardiovascular disease, it is very much noteworthy to point out that acculturation is a complex process. Thus, further studies would be required to effectively assess the role of various styles of acculturation on cardiovascular risk factors in Asians, especially Southeastern Asian populations in the US.

Introduction

CVD has become a leading cause of morbidity and mortality in the United States. The prevalence and outcomes of CVD show varied levels across different demographics, and disparities very often go unchecked within minority populations. One such population is the Southeast Asian immigrant group, who face certain challenges related to cardiovascular health exacerbated by the intricacies of the acculturation process. It will try to explore the implications of various measures of acculturation on cardiovascular health among Southeast Asian immigrants in the United States.

The Epidemiology of Cardiovascular Disease in Asian Americans

Severe cardiovascular diseases burden Asian Americans: whilst Southeastern Asians have the highest burden of traditional risk factors, hypertension, diabetes, and obesity. There are studies available showing that relatively favorable socioeconomic indicators among Asian Americans appear to be compared with the general population. Such statistics are misleading because the different ethnic groups are aggregated into the Asian American category, which thus masks disparities within individual communities.

The systematic review of cardiovascular risk factors in Southeast Asian immigrants indicated that most are exposed to a higher risk for CVD regardless of social status compared to the majority of the population. Some of these risks include dietary habits, being inactive, and cultural beliefs on health and well-being. Although these risk factors have been molded because of acculturation, much research should be done to establish their connection.

Acculturation: A Multifaceted Process

Acculturation refers to the process of cultural change and psychological change that results following a meeting between cultures. For immigrants, the process can significantly influence health behaviors, access to healthcare, and overall health outcomes. The current literature highlights various proxies for measuring acculturation, including language proficiency, duration of residency in the US, religious practices, and family structure. This article focuses on how these specific proxies impact cardiovascular health among Southeastern Asian immigrants.

English Spoken at Home

Language plays a significant role in cultural identity and often is one of the first elements of acculturation. The fact that a patient can converse in English at home is influential for their access to health care, the ability to assist with the process of healthcare, and the exchange of information with healthcare providers. Patients with limited ability to speak English have been documented to have poorer health outcomes and increased cardiovascular risk.

However, in the case of the relationship between language spoken at home and health through cardiovascular outcomes, things do not seem straightforward. For instance, while fluency in English may grant better access to resources of health care, it is also associated with loss of traditional health practices and diets, which are very healthy. More studies are needed to tease out these effects and understand how the effects of language about languages spoken at home affect cardiovascular health.

Length of Stay in the US

The length of stay in the US is another important acculturation measure. Research indicates that as the duration of residency increases, so does the burden of cardiovascular risk factors. This increase may be attributed to lifestyle changes associated with adopting a Western lifestyle, including dietary changes and reduced physical activity levels.

Additionally, longer stays in the US can lead to increased stress due to the pressures of assimilation and economic challenges. Understanding the longitudinal impacts of residence duration on cardiovascular health can provide valuable insights for targeted interventions.

Religiosity and Spirituality

Religious beliefs and practices often play a significant role in health behaviors and coping mechanisms within immigrant communities. High levels of religiosity and spirituality have been associated with healthier lifestyle choices and stronger social support systems, which can positively influence cardiovascular health.

However, the interplay between acculturation and religiosity is nuanced. As individuals acculturate, their religious practices may change, impacting their health behaviors and community support. It is essential to investigate how these changes affect cardiovascular outcomes in Southeastern Asian immigrants.

Admixed Family Structures

Family structures within immigrant communities can significantly influence health behaviors and outcomes. The concept of admixed family structures—where traditional and modern family roles coexist—may impact health decisions and support systems.

In Southeastern Asian communities, family plays a crucial role in health decisions, including dietary choices and healthcare access. Understanding how these family dynamics change with acculturation can provide insights into the unique cardiovascular health challenges faced by this population.

Discussion

The disparities in cardiovascular health among Southeastern Asian immigrants highlight the urgent need for targeted research. Existing studies have primarily focused on broad Asian populations, often overlooking the distinct experiences of individual ethnic groups. As a result, our understanding of how acculturation processes affect cardiovascular risk factors in this population remains limited.

While some studies suggest that increased acculturation is associated with an elevated risk of cardiovascular disease, it is essential to recognize that acculturation is a multifaceted and dynamic process. Each proxy measure—whether it be language, length of stay, religiosity, or family structure—interacts with others, creating a complex web of influences on health outcomes.

Recommendations for Future Research

To better understand the implications of acculturation on cardiovascular health among Southeast Asian immigrants, future studies should focus on:

Culturally-Tailored Acculturation Measures: Develop and validate comprehensive tools that accurately capture the nuances of acculturation specific to Southeast Asian communities.

Longitudinal Studies: Conduct longitudinal research to assess how changes in acculturation over time impact cardiovascular health, allowing for a more dynamic understanding of these relationships.

Community-Based Interventions: Implement and evaluate culturally appropriate interventions targeting cardiovascular risk factors within Southeastern Asian immigrant communities.

Conclusion

The growing burden of cardiovascular disease among Southeastern Asian immigrants underscores the need for a deeper understanding of the role of acculturation in shaping health outcomes. By examining various measures of acculturation, this article aims to shed light on the complexities influencing cardiovascular health in this population. Further research is essential to inform tailored interventions that can mitigate the risks and improve the overall health of Southeastern Asian immigrants in the US.

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