NIH – Addressing the Etiology of Health Disparities and Health Advantages Among Immigrant Populations (R01, R21)

November 7, 2016 by School of Medicine Webmaster

The following description is from the R01 version of this FOA:

The goal of the Immigrant Health Initiative is to support research to understand the risk/protective factors and challenges affecting the health of U.S. immigrant populations (particularly migrant workers, recent and 1st generation immigrants) and address issues that promote health equity. For the purposes of this funding announcement, the term “1st generation” refers to people who were born in their native country and relocated to the U.S.  The term “2nd generation” refers to the U.S. born children of 1st generation immigrants.

In 2015, the immigrant population in the U.S. was 44.9 million and the immigrant wave is expected to reach around 78 million people (18% of the population) by 2065.  Approximately 30% of immigrant families have incomes below the federal poverty level and 23% of today’s new immigrants tend to be less educated and have not completed high school.  Some immigrant populations suffer a significant burden of disease and healthcare systems face daunting challenges in addressing the health of these populations. Among immigrants, cardiovascular disease (CVD), stroke, hypertension diabetes and some types of cancers (particularly those associated with infectious agents) are often higher than their counterparts in the general U.S. born populations, although in some groups the rates of CVD and stroke are substantially lower. In addition, many immigrants come from areas of the world where exposures to toxic chemicals are common, such as pesticides long banned in the US at sensitive windows of development, that may pose risk for future health conditions/diseases. Importantly, risk factors and disease outcomes vary by subpopulations among immigrants based on the country of origin; however, many studies consider immigrants as one homogenous group. For example, U.S. immigrants from approximately 20 Latin American countries are treated as one group and not separated into nationality sub-groups, Asians (from more than 30 countries) or Africans are treated as one immigrant group when the health outcomes are often different among different sub-groups.

Factors associated with immigration processes can translate into higher risk for diseases.  Moreover, immigrant populations face multiple challenges, such as low health literacy, lack of health insurance, limited English proficiency, barriers to effective patient-provider communication, other limitations in accessing health care as well as maintenance of traditional health practices. Singularly or interactively, these factors that may contribute to health disparities observed in these populations. Factors like the concentration of immigrants in low-income and segregated neighborhoods (ethnic enclaves) and low-wage occupations with exposure to toxic chemicals, poor or other unsafe working conditions may also contribute to worse health outcomes among immigrant populations.

Despite the numerous stressors faced by immigrants, published literature documents that recent immigrants report better health status (e.g., healthy immigrant effect) than U.S. born populations, a status that is thought to deteriorate with length of U.S. residence and in subsequent generations. The role that ethnic enclaves, social networks, resilience and acculturation play in explaining some health advantages needs to be further explored. The effect might vary by gender and health outcome focus.  Alcohol use among Latina women may drop but among Latino males appears to increase in the first generation in the U.S.  How duration of stay in the U.S. coupled with acculturation pressures lead to changes in health behaviors and outcomes and how these factors interact with changes in socioeconomic status are some of the range of factors that need more research.

Therefore, to improve health outcomes and reduce observed disparities within these populations, more research to understand the risk and protective factors for U.S. immigrant sub-population is necessary.

Research Objectives

Given the scientific literature documenting health inequities among immigrant populations, this announcement calls for multidisciplinary research to address the specific underlying causes and mechanisms of health disparities and health advantages among immigrant populations, particularly among migrant workers, recent and 1st generation immigrants.

Many potential individual, contextual and structural factors influence the health of immigrants; therefore, this FOA invites applications that include multidisciplinary research to understand the interplay of multiple factors that cause health disparities among underserved immigrant populations and the mechanisms through which they operate. Research proposals are encouraged to utilize biological assessments (such as genomics, epigenomics, microbiome, telomere length, allostatic load, or other biomarkers) to show whether they may serve as measurable indicators for excess risk or health outcomes. Comparison of immigrant health factors between the U.S. and country of origin is encouraged; existing data available in the native country can be leveraged when possible for comparisons.

Cumulative processes over the life course across multiple life domains at the individual and community levels are critical for understanding health disparities among immigrants. Thus, focusing attention on critical time periods across the lifespan and associated risk and protective immigrant specific factors is needed for the development of interventions to improve immigrant health. This would also allow consideration of the reasons and the conditions under which the individuals migrated to the U.S.  Attention should be given to the positive aspects of lives of immigrants that may buffer the effects of adversity.

Projects should involve collaborations among relevant stakeholders in U.S. immigrant population groups, such as researchers, community organizations, healthcare providers, public health organizations, consumer advocacy groups, and faith-based organizations.  As appropriate for the research questions posed, inclusion of key immigrant community members in the conceptualization, planning and implementation of the research is encouraged (but not required) to generate better-informed hypotheses and enhance the translation of the research results into practice.

The focus of this FOA is specifically on immigrants who, once residing in the U.S., belong to one or more U.S. racial/ethnic minority populations (i.e. Blacks/African Americans, Hispanics/Latinos, Asians, or Pacific Islanders). Research is encouraged among distinct immigrant sub-populations based on the country of origin, rather than larger racial/minority populations when feasible (e.g., Koreans, Vietnamese, Cambodian, etc., rather than Asian Americans). For projects involving comparisons across populations, these comparisons should illuminate immigrant-specific phenomena rather than representing more global comparisons between immigrants with the non-Hispanic whites or the US general population. Examples of appropriate comparisons include:

  • immigrant subgroups within the same racial/ethnic minority group (e.g., Nicaraguan immigrants vs. Mexican immigrants)
  • immigrants across racial/ethnic minority groups that share similar experiences in the US (e.g. Asian immigrant garment workers vs. Latino immigrant garment workers)
  •  immigrants with their US-born counterparts (Chinese immigrants vs. US-born Chinese Americans)

For this FOA, residents of U.S. territories (Guam, Puerto Rico, American Samoa, Commonwealth of the Northern Mariana Islands, and US Virgin Islands) who migrate to the U.S. mainland are also considered as immigrants. Research on refugees is not supported under this FOA.

Specific Areas of Research Interest

Research topics of specific interest include but are not limited to:

  • Interplay of social, cultural, environmental, and biological factors that affect health disparities and health advantages in the U.S. (host country) among recent immigrant populations;
  • Acculturation stress in conjunction with other forms of psychological or physical stress that affect health outcomes among various immigrant sub-populations and migrant workers;
  • Biomarkers (e.g. allostatic load, telomere length) of cumulative immigration-specific stress that may relate to health disparities or health advantages among immigrants;
  • Changes in the genome, epigenome, metabolome or microbiome through the immigration and acculturation process due to diet and lifestyle factors in the native country and the U.S. and how that relates to health advantages and/or disparities in different immigrant populations;
  • How migrations shape the genomic diversity in African-Americans, Latinos, Asian and other U.S. health disparities immigrant populations and how that may impact health;
  • How exposure to stressful social environments throughout the life course specifically during transition time periods, increase risk of diseases later in life among different U.S. immigrant sub-populations;
  • How exposure to toxic chemicals and other environmental stressors prior to or subsequent to their immigration increase risk of diseases later in life among different U.S. immigrant subpopulations;
  • Mechanisms by which specific risk and protective factors associated with the acculturation process influence a particular health condition among recent immigrant sub-populations;
  • Influence of intergenerational family and household composition on where family members chose to seek health care and how adherence to treatment affect various health outcomes in immigrants;
  • Patterns and quality of health care for immigrants who travel back and forth from the US to the native country and receive care in both countries;
  • Health behaviors associated with resilience in immigrants at individual, family and/or community levels, including those related to the external environment, and neighborhood cohesion;
  • Health care practices and behaviors with the changing health care resources in the U.S., specifically as they interact with maintenance of traditional health care practices and the impact on health and health disparities;
  • Structural factors and discrimination that affect immigrant health disparities;
  • Tools that can be developed or utilized to build large datasets to better understand health changes in immigrant sub-populations for designing effective health promotion and disease prevention programs;
  • Studies that document the mechanisms by which risk and protective factors affect changes in drinking patterns, alcohol use disorders, other substance use and other common co-occurring mental health disorders (e.g., depression, PTSD, other anxiety disorders, etc.) among U.S. immigrant populations.

Deadlines:  standard dates apply


Filed Under: Funding Opportunities