The Dynamics of Ethnicity, Acculturation, and Nativity among Foreign-born and US-born Blacks in the United States

Written by Sureshi Jayawardene

In a recent study published in the American Journal of Public Health, researchers investigated variation within the ethnic/racial group “Non-Hispanic Blacks” to account for difference in allostatic load based on nativity. The category, “Non-Hispanic Blacks” is a growing demographic owing to increased migration from a number of countries and ethnic backgrounds. According to the Tabulations of 2010 American Community Survey, the foreign-born segment of the Black population has nearly tripled in the past 30 years representing approximately 8% of the overall US Black population. Despite this increase, little is known about health-related concerns and issues within the foreign-born Black population. Nevertheless, previous research reveals differences in physical and mental health indicators between US-born Blacks and those from the African continent and the Caribbean (Williams, 1997; Pallotto et al, 2000; Singh and Siahpush, 2002; Read et al, 2005; Williams et al, 2007). 

Immigrant Health Advantage
Read and Emerson (2005) and David and Collins (1997) suggest that compared with US-born Blacks, foreign-born Blacks tend to have better health outcomes due to the healthy immigrant effect. The healthy immigrant effect refers to the phenomenon whereupon arrival to the United States, immigrants are generally healthier than their native counterparts (Antecol and Bedard, 2006). It suggests that immigrants follow positive lifestyles in their home countries, are the most open to enduring the stressors of immigration, and are the healthiest population in their home countries (Doamekpor and Dinwiddie, 2015). However, research also indicates that over time this advantage declines due to the adoption of American lifestyle habits and adaptation to the American sociocultural landscape (Kennedy et al, 2006; Doamekpor and Dinwiddie, 2015). These include increased engagement in unhealthy behaviors such as unhealthy diets and tobacco and alcohol use. In addition, the exposure to racism as well as the psychological stress of immigration and adjustment to new environments are also said to contribute to the decline in the healthy immigrant advantage over time (Williams et al, 2007). 

The Meaning of Allostasis and Allostatic Load
In their study, Doamekpor and Dinwiddie (2015) investigated the applicability of the immigrant health advantage to non-Hispanic Black immigrants and examined whether nativity-based differences in allostatic load was present among this population. The use of allostatic load in investigations about health-related racial disparities is a burgeoning area of research. The particular advantage of this consideration in terms of racial disparities in health outcomes is that it requires researchers look beyond the individual toward broader social-ecological and economic determinants in explaining these outcomes. Peek et al (2010) assert that since Blacks and Hispanics experience institutionalized racism, discrimination, and the anxieties of lower socioeconomic situations more often than do their White counterparts, these adversities can increase their allostatic load and result in more serious mid-to late-life health outcomes. 

Allostasis means to literally maintain stability (or a sense of homeostasis) through changes in social and ecological conditions (Sterling and Eyer, 1988). Put differently, the capacity for individuals’ physiological systems to adapt to stressors and challenges is a fundamental aspect of healthy human functioning. These systems possess a capacity to adapt to changing ecological conditions. Thus, the term allostasis aims to describe how these systems adjust to resting and active states of the body. Allostatic load refers to the “wear and tear” experienced by the body in response to cumulative and chronic stress. Peek et al (2010) explain that repeated and frequent adaptation to stressors throughout the life course produces cumulative consequences often resulting in the “dysregulation of these same physiological systems” (940).  As identified by Seeman et al (1997), allostatic load has been assessed as comprising ten biological markers which function in the following areas: sympathetic nervous system, immune system, cardiovascular system, metabolic system, and the hypothalamic-pituitary-adrenal axis. Therefore, measurements of high allostatic load correlates with increased mortality, disability, cognitive decline, and other ailments (cf. Peek et al, 2010). 

Differences in Allostatic Load Predictors between US-born and Foreign-born Blacks
Doamekpor and Dinwiddie (2015) used pooled data from the 2001-2010 National Health and Nutrition Examination Survey and compared allostatic load scores for US-born and foreign-born Black adults. The sample included 2745 US-born and 152 foreign-born Blacks, advantaging women in both categories. The mean age for US-born Blacks was 41 and 40 for foreign-born Blacks. The data revealed that time spent in the United States, age, and education were significant predictors of allostatic load scores among foreign-born Blacks. Within this group, 25% had lived in the US for less than 5 years and 37% had lived in the US between 5 and 19 years. Those who had lived in the US for less than 5 years had a 73% lower odds of a high allostatic load score, compared with individuals who had been in the US for 20 years or longer. This effect persisted even as age, gender, and marital status were controlled for in the model. 

Age and marital status were significant predictors of allostatic load for US-born Blacks. In their analysis, Doamekpor and Dinwiddie (2015) found that those divorced, widowed, or separated had higher allostatic load scores than those who were married. Older US-born Blacks were also more likely to have higher allostatic load scores. However, both groups experienced higher allostatic load as age increased. This finding is consistent with previous research that found associations between increased allostatic load and increased age resulting from the cumulative effects of adversity over the life span and subsequent multisystem dysregulation of the body (Antecol and Bedard, 2006). Doamekpor and Dinwiddie (2015) contend that both groups experience similar allostatic load scores at early ages, but this begins to widen at middle age. Furthermore, with US-born Blacks this increase is said to be steeper. Other socioeconomic factors between the two groups were fairly divergent as well.  For instance, a larger proportion of foreign-born Blacks were below the 299% poverty line than US-born Blacks.

For foreign-born Blacks, the effect of time spent in the United States on the odds of high allostatic load score disappeared when poverty-income ratio and education were considered. More than twice as many foreign-born Blacks had a college degree compared to US-born Blacks. Ironically, the researchers found that lower educational attainment protected against the odds of a high allostatic load score among foreign-born Blacks. What this means is that for those with a high school diploma, the odds of high allostatic load score was 83% lower and 54% lower for those with less than high school education in comparison to immigrants with a college degree or more. Although educational achievement is shown to produce positive results and protective effects among US populations, this finding contradicts the general belief that lower education is associated with greater risk for disease and poor health outcomes. This finding also contradicts research suggesting that African immigrants’ superior health is related to the fact that they are more highly educated than are US-born Blacks and Whites (Doodoo, 1997). Doamekpor and Dinwiddie (2015) argue that despite their high educational achievements, for foreign-born Blacks this discrepancy is explained as a health paradox, or healthy immigrant advantage, similar to the Hispanic health paradox. Although such an advantage exists for Black immigrants, its effect diminishes as they adapt to the cultural and social context of the United States. This health deterioration is likely explained by overexposure to race-related stress and racism which are more significant predictors of poor health outcomes and declines than are diet and unhealthy behaviors (Williams, 2000; Yip et al, 2008). 

Moving Forward: Finding Solutions
Undoubtedly, Doamekpor and Dinwiddie’s (2015) study offers valuable evidence about the variation in allostatic load within Black populations in the United States based on nativity. As suggested by these researchers further examination of the degree to which other factors such as country of origin and internalization of stress is necessary in order to discern nuances in health advantages and disadvantages. While the identification of allostatic load based on ethnic background within the Black population is important, research must also engender solutions. Thus, the question remains, how do the coping strategies employed by different groups of Blacks impact health outcomes and the odds of high allostatic load scores?  Some studies have already identified culturally specific coping strategies. Lewis-Coles and Constantine (2006) explain that culturally specific coping refers to the ways in which members of a particular cultural heritage draw on a wealth of cultural knowledge to not only assign meaning to a specific stressor but also to identify resources in dealing with that stressful event. One such example, as conceptualized by Utsey et al (2000), is Africultural coping. The four primary components of Africultural coping include: 1) cognitive/emotional debriefing (composed of adaptive reactions by Blacks to manage their perceived environmental stressors); 2) spiritual-centered coping (coping behaviors based on Black peoples’ sense of connection to spiritual forces such as God, ancestors, the universe, etc.); 3) collective coping (behaviors contingent upon group-related activities); and 4) ritual-centered coping (involving the practice of rituals such as lighting candles, burning incense, etc. to address the stressful event) (Lewis-Coles and Constantine, 2006). 

Another direction in advancing Doamekpor and Dinwiddie’s (2015) research is in the development of therapeutic and healing models that address racism-related stress and high allostatic load. To this end, a model that could be potentially beneficial is NTU psychotherapy. Phillips (1990) developed this as a spiritually-based and African-centered model of psychotherapy. In essence, NTU aims to help people of African descent in finding balance and authenticity within a shared energy that is in alignment with the natural order. Grounded in the Nguzo Saba as foundational to harmonious and balanced living, this form of psychotherapy comprises five progressive phases: harmony, awareness, alignment, actualization, and synthesis. Moreover, NTU therapy has previously been used with success in addressing the concerns of substance abuse among Black youth (Cherry et al, 1998). 

Works Cited
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Cherry, V.R., Belgrave, F.Z., Jones, W., Kennon, D.K., Gray, F.S., and Phillips, F. (1998). NTU: An Africentric approach to substance abuse prevention among African American youth. Journal of Primary Prevention 18 (3), 319-339. 

David, R.J. and Collins, J. (1997). Differing birth weight among infants born of US-born Blacks, African-born Blacks, and US-born Whites. New England Journal of Medicine 337(17): 1209-1214. 

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