This webinar will be examining diabetes hospitalization rates among US and Foreign-Born Hispanics/Latin@s in California. Using the Social Determinants of Health framework, we will be exploring potential contributing factors to these hospitalization rates. Lastly, we will demonstrate (live) how to access and map related health data of other communities of interest on HealthyCity.org.

1. Investigating the Immigrant Health
Paradox in California
Wednesday, September 10th
www.Healthycity.org
Facebook.com/HealthyCityCA
@HealthyCityCA
info@healthycity.org
www.AdvancementProjectCA.org
Facebook.com/AdvancementProjectCA
info@advanceproj.org
11:00am – 12:00pm
Taisha Bonilla
Training & Communications Coordinator
tbonilla@advanceproj.org
Jose Cuchilla
Healthy City Data Analyst
jcuchilla@advanceproj.org

2. Healthy City is a program of
Championing the struggle for greater equity and opportunity for all,
Advancement Project California fosters upward mobility in communities
most impacted by economic and racial injustice.
We build alliances and trust, use data-driven policy solutions, create
innovative tools and work alongside communities.
We ignite social transformation!
Integrity * Innovation * Capacity-Building * Collaboration * Audacity * Equity *

3. What We Do
DIRECT TECHNICAL
ASSISTANCE:
Work ON-THE-GROUND
to develop targeted
research/policy
strategies and web
tools.
COMMUNITY
RESEARCH LAB
Engages, trains, and
provides tools for
community groups to lead
and sustain action-oriented
research
ONLINE MAPPING
TECHNOLOGY
www.HealthyCity.org

4. HealthyCity.org?
Case
Manager
Who Uses
Funder
HealthyCity.org
Website
Service
Provider
Policy
Advocate
Community
Organizer
Researcher
Grant
Writer
Fuel social change and empower communities!

5. CHAT:
Where in CA do you work (city
or county), and what
populations do you serve?
Please use the interactive ‘CHAT’ feature throughout the webinar.
We will read out your comments and answer any questions.

6. Webinar Agenda:
• Learn about the Immigrant Health Paradox
• Examine diabetes hospitalization rates among US and
Foreign-Born Hispanics/Latin@s
• Using the Social Determinants of Health framework, we
will explore potential contributing factors
• Live demonstration of how to access and map related
data on other communities of interest on
HealthyCity.org

7. Exploring the Association between
Acculturation and Diabetes among
US/foreign-born Hispanics
-Jose Cuchilla, Healthy City Data Analyst-
 Jose Cuchilla1
 Micere Keels, PhD2
 1 California State Polytechnic University
of Pomona
 2 The University of Chicago, Department
of Comparative Human Development

8. Social Determinants of Health
“The economic and social conditions that influence individuals and group differences in health status.”
– The World Health Organization
http://www.baltimorehia.org/social-determinants-of-health.html

9. The Immigrant Health Paradox
Despite lower levels of education and income,
immigrants are generally healthier than the US-born
population
Lower mortality (Jasso et al., 2002; Muennig and Fahs, 2002)
Lower rates of obesity (Gordon-Larsen, 2003)
Better mental health (Dey and Lucas, 2006)
Lower rates of heart and circulatory disease (Singh and Siahpush, 2001)
However, as their length of residence increases, so does the prevalence
of poor health behaviors and chronic conditions (Kaplan, 2004)

10. The Acculturation Hypothesis
Acculturation
The acquisition and integration of dominant cultural norms by
members of a non-dominant group (Gordon-Larsen, 2003).
Over time, immigrants integrate American behavioral norms and
lifestyles (Gordon-Larsen, 2003).
Immigrant dietary patterns
More fruits and vegetables (Satia-Abouta, 2002)
Less processed foods (Akresh, 2007)
Americanization
Eat less fruits & vegetable (Neuhouser, 2004)
Eat more red meat & processed foods (Ayala, 2008)
Less exercise (Lanza, 2005)
Increase smoking & drinking (Detjen et al., 2007)

11. Research on acculturation and Type-2 diabetes
Limited research exists on the association of length of
residence and type 2 diabetes outcomes
Research that does exist has two limitations…
1) Regional sample
2) Self-reported data to measure diabetes

12. A quantitative analysis of diabetes prevalence in
Hispanics
2001- 2010 NHANES (CDC)
Nationally representative sample
US/foreign-born Mexican Americans ages 20-65
Tested for diabetes (n= 2417)
Fasting blood glucose test
Nativity (US-born/foreign-born)
Acculturation (Length of time [years] in the US)
STATA
T-test
Logistic Regression
Model 1: Basic Differences
Model 2: Control

13. Research Question and Hypothesis
RQ: Does nativity and acculturation affect diabetes health outcomes
among Hispanics?
H1: Hispanics born in the US will be more likely to suffer from diabetes than
foreign born Hispanics.
H2: The longer foreign born Hispanics are in the US, the more likely they
are to have diabetes.

14. Native-born Mexican Americans had a higher rate
of diabetes
Table 1: Descriptive Characteristics
Variable
Full Sample
(n= 5416)
Native
(n= 2035)
Foreign
(n=3381)
Diabetes (%) 10.63 12.57 9.49
Undiagnosed Diabetes (%) 33.20 30.09 35.66
Female (%) 52.25 56.16 49.83
Length in US (%)
<5 years 18.66
5 - <15 years 32.54
15 - <30 years 33.15
30+ years 15.66
Citizenship (%) 22.61
Education (%)
<9th grade 33.90 9.30 48.70
9th grade - H.S. 41.26 47.72 37.41
Some College 18.26 31.55 10.27
College Degree 6.57 11.42 3.61
Married (%) 60.75 53.79 64.82
No Insurance (%) 47.62 27.25 59.85
Significant values (t-test: p<0.05) indicated in red.

15. Foreign-born Mexican Americans were less likely
to have diabetes
Table 2: Logistic regression results for nativity
Diabetes Model 1* Model 2**
Variable
Odds Ratio
(Std. Err.)
P-value
Odds Ratio
(Std. Err.)
P-value
All Mexican Americans
Native born reference category
Foreign born 0.73 0.018 0.50 <0.001
(0.10) (0.09)
*Model 1: Includes only nativity or length in US.
**Model 2: Adds controls for education, poverty, marital status, smoker, insurance, age, and gender.

16. Foreign-born Mexican Americans who have been
in the US longer were more likely to have diabetes
Table 2: Logistic regression results for length of time among foreign-born
Hispanics
Diabetes Model 1* Model 2**
Variable
Odds Ratio
(Std. Err.)
P-value
Odds Ratio
(Std. Err.)
P-value
Foreign Born Mexican Americans
< 5 years in US reference category
5 - <15 years in US 1.78 0.109 1.87 0.113
(0.63) (0.74)
15-<30 years in US 2.64 0.005 3.11 0.003
(0.90) (1.21)
30+ years in US 5.06 <0.001 6.67 <0.001
(1.78) (2.82)
*Model 1: Includes only nativity or length in US. **Model 2: Adds controls for education, poverty, marital status, smoker, insurance, age, and gender.

17. Nativity and acculturation highlight important risk
factors for diabetes
Nativity & length of time in the US
• Study supports the immigrant health paradox
• Supports the acculturation hypothesis
• Identifying length of residence as a risk factor is useful
for targeting populations for diabetes prevention
“Obesogenic” environments (Powell, 2010)
• Low income communities (Walker, 2010)
• Less supermarkets (Weinberg, 1995)
• Longer distance (Rose and Richards, 2004)

18. Questions?

20. v5.healthycity.org

22. What is available on HealthyCity.org…
Services Listings Interactive Mapping Data Ranking
View Community
Data/Stories
Map Your Data/Media

23. With HealthyCity.org’s Data and
Mapping Tools, you can …
Create more effective community engagement
Assess need and strength at the community level
for outreach and planning
Identify new target areas
Network with other organizations and identify
community partners

24. 1
2
Enter a word in
“Keyword Search”
to pinpoint data for
your map
Click on a
category
to find services Scroll down

25. 1 2 3
Make maps and charts for ZIP
Codes, Congressional Districts,
neighborhoods, Counties, and
more...
Select your
geography!

26. Search results and
categories
Filter
and
sort
your
results

27. Name
your
list!
Print,
save &
share
your
list

28. View contact
details with a
direct link for
directions!

29. Browse through
listings to look at
service details

30. 1
Select your
2 geography!

31. 1 2 3
Make maps and charts for ZIP
Codes, Congressional Districts,
neighborhoods, Counties, and
more...
Select your
geography!

33. Upload your own
data using an Excel
file!
To upload data from
a spreadsheet:
Make sure you are
logged into your
account!

36. On to the
website!

37. Questions?

39. Thank You!
www.Healthycity.org
Facebook.com/HealthyCityCA
@HealthyCityCA
info@healthycity.org
www.AdvancementProjectCA.org
Facebook.com/AdvancementProjectCA
info@advanceproj.org
Your feedback is very
important to us!
We will be following up with
you in 24 hours with an
email and a survey!