Adrian Matias Bacong

All Publications

• Obesity Disparities Among Adult Single-Race and Multiracial Asian and Pacific Islander Populations. JAMA network open Bacong, A. M., Gibbs, S. L., Rosales, A. G., Frankland, T. B., Li, J., Daida, Y. G., Fortmann, S. P., Palaniappan, L. 2024; 7 (3): e240734

  Abstract

  Despite increasing numbers of multiracial individuals, they are often excluded in studies or aggregated within larger race and ethnicity groups due to small sample sizes.To examine disparities in the prevalence of obesity among single-race and multiracial Asian and Pacific Islander individuals compared with non-Hispanic White (hereafter, White) individuals.This cross-sectional study used electronic health record (EHR) data linked to social determinants of health and health behavior data for adult (age ≥18 years) members of 2 large health care systems in California and Hawai'i who had at least 1 ambulatory visit to a primary care practitioner between January 1, 2006, and December 31, 2018. Data were analyzed from October 31, 2022, to July 31, 2023.Self-identified race and ethnicity provided in the EHR as a single-race category (Asian Indian, Chinese, Filipino, Japanese, Native Hawaiian only, Other Pacific Islander, or White) or a multiracial category (Asian and Pacific Islander; Asian, Pacific Islander, and White; Asian and White; or Pacific Islander and White).The main outcome was obesity (body mass index [BMI] ≥30.0), based on last measured height and weight from the EHR. Logistic regression was used to examine the association between race and ethnicity and odds of obesity.A total of 5229 individuals (3055 [58.4%] male; mean [SD] age, 70.73 [11.51] years) were examined, of whom 444 (8.5%) were Asian Indian; 1091 (20.9%), Chinese; 483 (9.2%), Filipino; 666 (12.7%), Japanese; 91 (1.7%), Native Hawaiian; 95 (1.8%), Other Pacific Islander; and 888 (17.0%), White. The percentages of individuals who identified as multiracial were as follows: 417 (8.0%) were Asian and Pacific Islander; 392 (7.5%), Asian, Pacific Islander, and White; 248 (4.7%), Asian and White; and 414 (7.9%), Pacific Islander and White. A total of 1333 participants (25.5%) were classified as having obesity based on standard BMI criteria. Obesity was highest among people who identified as Asian, Pacific Islander, and White (204 of 392 [52.0%]) followed by those who identified as Other Pacific Islander (47 of 95 [49.5%]), Native Hawaiian (44 of 91 [48.4%]), and Pacific Islander and White (186 of 414 [44.9%]). After accounting for demographic, socioeconomic, and health behavior factors, people who identified as Asian, Pacific Islander, and White (odds ratio [OR], 1.80; 95% CI, 1.37-2.38) or Pacific Islander and White (OR, 1.55; 95% CI, 1.18-2.04) had increased odds of obesity compared with White individuals. All single-race Asian groups had lower odds of obesity compared with White individuals: Asian Indian (OR, 0.29; 95% CI, 0.20-0.40), Chinese (OR, 0.22; 95% CI, 0.17-0.29), Filipino (OR, 0.46; 95% CI, 0.35-0.62), and Japanese (OR, 0.38, 95% CI, 0.29-0.50).In this study, multiracial Asian and Pacific Islander individuals had an increased prevalence of obesity compared with many of their single-race counterparts. As the number of multiracial individuals increases, it will be important for clinical and public health systems to track disparities in these populations.

  View details for DOI 10.1001/jamanetworkopen.2024.0734

  View details for PubMedID 38502128

• Social Determinants of Health and Allergic Disease Prevalence Among Asian American Children. Journal of racial and ethnic health disparities Le, A., Bui, V., Chu, R., Arroyo, A. C., Chen, M., Bacong, A. M. 2024

  Abstract

  Although racial and ethnic disparities in allergic diseases have previously been observed, the relationship between social determinants of health (SDoH) and allergic disease prevalence among disaggregated Asian American (AsA) subgroups is poorly understood.To examine the association of SDoH with allergic disease prevalence among disaggregated AsA subgroups.Using the 2011-2018 National Health Interview Survey, we examined caregiver-reported race and ethnicity, SDoH, and allergic diseases. We compared survey-weighted allergic disease prevalence by AsA subgroup. Subgroup-stratified multivariable logistic regression accounting for age, sex, child/parent nativity, and survey year modeled the association between SDoH and allergic disease prevalence. We provide predicted probabilities of having each allergic disease based on exposure to each SDoH.We examined data from 5042 non-Hispanic AsA children representing 3,264,768 AsA children. Approximately 25% of all AsA children reported at least one allergic disease, ranging from 20% of Asian Indian children to 30% of Filipino/a children. The number of unfavorable SDoH was lowest among Asian Indian and Chinese children (mean 0.7) and highest among "other Asian" children (mean 1.2). In stratified analyses, financial instability and inaccessible healthcare were associated with greater probability of allergic diseases among some, but not all AsA subgroups. Lower parent education level, food insecurity, and rent/other housing arrangement were associated with lower probability of allergic disease among some AsA children.There was heterogeneity in the association of SDoH and allergic disease prevalence among AsA children. Further study of SDoH may inform modifiable environmental factors for allergic disease among AsA children.

  View details for DOI 10.1007/s40615-024-01918-0

  View details for PubMedID 38315290

  View details for PubMedCentralID 9901425

• Asthma heterogeneity amongst Asian American children: the California Health Interview Survey. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology Chen, M., Bacong, A. M., Feng, C., Kikuta, N. T., Datir, R. R., Chen, S., Srinivasan, M., Camargo, C. A., Palaniappan, L., Arroyo, A. C. 2023

  Abstract

  The Asian American (AsA) population is heterogenous and rapidly growing; however, little is known regarding childhood asthma burden amongst AsA ethnic groups. The relation of obesity and asthma among AsA ethnic groups also remains unclear.To evaluate asthma prevalence and the relation of obesity to asthma risk amongst children in seven AsA ethnic groups.We analyzed data from the California Health Interview Survey from 2011-2020. AsA ethnicities were self-reported. Body mass index (BMI) z-scores, calculated from self-reported height/weight, were used to categorize children by obesity status, based on BMI-for-age growth charts. Prevalence of self-reported lifetime doctor-diagnosed asthma and asthma attack in the last 12 months were calculated. We performed multivariable logistic regressions adjusting for age and sex.Of 34,146 survey respondents, 12.2% Non-Hispanic White (NHW) and 12.5% AsA children reported lifetime asthma. Among AsA ethnic groups, however, lifetime asthma ranged from 5.1% (Korean American) to 21.5% (Filipino American). Compared to NHW children, AsA children had a similar lifetime asthma prevalence (aOR=1.05; 95%CI: 0.71-1.55; p=0.81), but lower prevalence in Korean American children (aOR 0.37; 95%CI, 0.19-0.73; p=0.004) and higher prevalence in Filipino American children (aOR 1.97; 95%CI, 1.22-3.17; p=0.006). The lifetime asthma prevalence of different AsA ethnic groups persisted even when stratified by obesity status.Childhood lifetime asthma prevalence varied among AsA ethnic groups, with lowest prevalence among Korean American children and highest prevalence among Filipino American. Further characterization of asthma burden amongst AsA ethnic groups may help guide asthma screening and prevention measures and offer new insights into asthma pathogenesis.

  View details for DOI 10.1016/j.anai.2023.10.030

  View details for PubMedID 37949352

• Modes of COVID-19 Information and Vaccine Hesitancy Among Asian Americans: The Moderating Role of Exposure to Cyberbullying. AJPM focus Bacong, A. M., Horse, A. J., Lee, E., Doan, L. N., Saw, A. 2023: 100130

  Abstract

  Introduction: : COVID-19 vaccination is an important public health intervention to curb the pandemic's magnitude and spread, and racial discrimination is a key predictor of COVID-19 preventive behavior, vaccine hesitancy, and uptake. This study evaluated the association of vaccine hesitancy with various modes of information on COVID-19 (i.e., online, social media) and the moderating role of cyberbullying among Asian Americans.Methods: : We used population-weighted data from the nationwide Asian American & Native Hawaiian/Pacific Islander COVID-19 Needs Assessment Survey, which was conducted from January to April 2021 (unweighted n=3,127). We examined the association of various modes of COVID-19 information and vaccine hesitancy, moderated by exposure to cyberbullying.Results: : In general, 16% of Asian Americans reported vaccine hesitancy; 26% reported experiencing cyberbullying. Asian Americans reported receiving the majority of COVID-19 information from online sources (75%) and social media (52%). In unadjusted models, receiving information online (OR=0.46, 95%CI=0.33, 0.62, p<.001), via social media (OR=0.80, 95%CI=0.52, 0.93, p<.05), and via broadcast (OR=0.60, 95%CI=0.44, 0.81, p<.001) were significantly associated with a lower vaccine hesitancy. However, reporting any cyberbullying was associated with increased vaccine hesitancy (OR=1.39, 95%CI=1.02, 1.90, p<.05). The protective effects for COVID-19 information modes remained when accounting for health and sociodemographic factors, while the effect of cyberbullying was no longer statistically significant. Cyberbullying moderated the protective effect of broadcast information only, so those who received information via broadcast and reported experiencing cyberbullying had similar odds of vaccine hesitancy compared to those who did not receive information via broadcast.Conclusions: : Online, social media, and broadcast remain important sources of information about COVID-19 for Asian Americans; however, experiencing cyberbullying can reduce the effectiveness of these sources in the uptake of the vaccine. COVID-19 information promotion strategies for Asian Americans must account for the role of cyberbullying in social media campaigns.

  View details for DOI 10.1016/j.focus.2023.100130

  View details for PubMedID 37362393

• Diabetes-Related Cardiovascular and All-Cause Mortality in Asian American Subgroups. JACC. Asia Shah, N. S., Khan, S. S., Carnethon, M. R., Bacong, A. M., Palaniappan, L. P. 2023; 3 (3): 365-372

  Abstract

  Asian Americans experience heterogeneity in cardiovascular risk factors and cardiovascular disease, with a particularly high burden of diabetes in several Asian subgroups.The objectives of this study were to quantify diabetes-related mortality in Asian American subgroups and compare this with Hispanic, non-Hispanic Black, and non-Hispanic White individuals.Using national-level vital statistics data and concurrent population estimates, age-standardized mortality rates and proportional mortality from diabetes-related mortality were calculated for non-Hispanic Asian (and subgroups: Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese), Hispanic, non-Hispanic Black, and non-Hispanic White populations in the United States, 2018-2021.Diabetes-related deaths numbered 45,249 in non-Hispanic Asian, 159,279 in Hispanic, 209,281 in non-Hispanic Black, and 904,067 in non-Hispanic White individuals. Among Asian Americans, age-standardized mortality rates of diabetes-related mortality with cardiovascular disease as underlying cause ranged from 10.8 (95% CI: 9.9-11.6) per 100,000 in Japanese females to 19.9 (95% CI: 18.9-20.9) per 100,000 in Filipina females, and from 15.3 (95% CI: 13.9-16.8) per 100,000 in Korean males to 37.8 (95% CI: 36.1-39.5) per 100,000 in Filipino males. The proportion of all deaths related to diabetes was higher in all Asian subgroups (9.7%-16.4% for females; 11.8%-19.2% for males) compared with non-Hispanic Whites (8.5% for females; 10.7% for males). The highest proportion of diabetes-related deaths occurred in Filipino adults.There was an approximately 2-fold variation in diabetes-related mortality among Asian American subgroups, with Filipino adults experiencing the greatest burden. All Asian subgroups experienced higher proportional mortality for diabetes-related mortality compared with non-Hispanic White individuals.

  View details for DOI 10.1016/j.jacasi.2022.12.010

  View details for PubMedID 37323867

  View details for PubMedCentralID PMC10261884

• Loneliness and Psychological Distress among Older Californians: The Moderating Roles of Citizenship Status and English Proficiency. The journals of gerontology. Series B, Psychological sciences and social sciences Tsuchiya, K., Taylor, H. O., Bacong, A. M., Nino, M. D. 2023

  Abstract

  OBJECTIVES: Guided by the theory of stress proliferation, our study examined whether loneliness, citizenship status, and English proficiency were associated with psychological distress among older adults, and if citizenship status and English proficiency moderated these relationships.METHODS: Using the older adult subsample (65+ years) of the 2019-2020 California Health Interview Survey (N=15,210), we assessed cross-sectional associations between loneliness, citizenship status, and English proficiency on psychological distress by conducting multivariable linear regression models. Interaction terms were included in subsequent models to determine if citizenship status and English proficiency moderated the relationship between loneliness and psychological distress.RESULTS: In unadjusted models, greater loneliness was associated with higher distress. Both naturalized citizens and non-citizens, and those with limited English proficiency (LEP) exhibited greater distress than native-born citizens and those who speak English only (EO). After adjusting for socio-demographic and health covariables, loneliness remained significant for distress while the relationships for citizenship status and English proficiency became attenuated. With the inclusion of interactions, the magnitude of the relationship between loneliness and distress was stronger for naturalized citizens and those with LEP than native-born citizens and those who speak EO, respectively.DISCUSSION: Loneliness was the most consistent stressor impacting multiple life domains. However, our findings demonstrate that stress proliferation is occurring among older immigrant adults and the interplay between loneliness, citizenship status, and English proficiency is contributing to heightened distress. Further attention is needed in understanding the role of multiple stressors influencing mental health among immigrant older adults.

  View details for DOI 10.1093/geronb/gbad074

  View details for PubMedID 37195426

• Prevalence of cardiovascular disease among Asian, Pacific Islander and multi-race populations in Hawai'i and California. BMC public health Waitzfelder, B., Palaniappan, L., Varga, A., Frankland, T. B., Li, J., Daida, Y. G., Kaholokula, J. K., Bacong, A. M., Rawlings, A. M., Chung, S., Howick, C., Fortmann, S. P. 2023; 23 (1): 885

  Abstract

  Cardiovascular disease (CVD) remains the leading cause of death in the US. CVD incidence is influenced by many demographic, clinical, cultural, and psychosocial factors, including race and ethnicity. Despite recent research, there remain limitations on understanding CVD health among Asians and Pacific Islanders (APIs), particularly some subgroups and multi-racial populations. Combining diverse API populations into one study group and difficulties in defining API subpopulations and multi-race individuals have hampered efforts to identify and address health disparities in these growing populations.The study cohort was comprised of all adult patients at Kaiser Permanente Hawai'i and Palo Alto Medical Foundation in California during 2014-2018 (n = 684,363). EHR-recorded ICD-9 and ICD-10 diagnosis codes were used to indicate coronary heart disease (CHD), stroke, peripheral vascular disease (PVD), and overall CVD. Self-reported race and ethnicity data were used to construct 12 mutually exclusive single and multi-race groups, and a Non-Hispanic White (NHW) comparison group. Logistic regression models were used to derive prevalence estimates, odds ratios, and confidence intervals for the 12 race/ethnicity groups.The prevalence of CHD and PVD varied 4-fold and stroke and overall CVD prevalence varied 3-fold across API subpopulations. Among Asians, the Filipino subgroup had the highest prevalence of all three CVD conditions and overall CVD. Chinese people had the lowest prevalence of CHD, PVD and overall CVD. In comparison to Native Hawaiians, Other Pacific Islanders had significantly higher prevalence of CHD. For the multi-race groups that included Native Hawaiians and Other Pacific Islanders, the prevalence of overall CVD was significantly higher than that for either single-race Native Hawaiians or Other Pacific Islanders. The multi-race Asian + White group had significantly higher overall CVD prevalence than both the NHW group and the highest Asian subgroup (Filipinos).Study findings revealed significant differences in overall CVD, CHD, stroke, and PVD among API subgroups. In addition to elevated risk among Filipino, Native Hawaiian, and Other Pacific Islander groups, the study identified particularly elevated risk among multi-race API groups. Differences in disease prevalence are likely mirrored in other cardiometabolic conditions, supporting the need to disaggregate API subgroups in health research.

  View details for DOI 10.1186/s12889-023-15795-5

  View details for PubMedID 37189145

  View details for PubMedCentralID PMC10184427

• Assessing and Addressing Social Determinants of Cardiovascular Health: JACC State-of-the-Art Review. Journal of the American College of Cardiology Brandt, E. J., Tobb, K., Cambron, J. C., Ferdinand, K., Douglass, P., Nguyen, P. K., Vijayaraghavan, K., Islam, S., Thamman, R., Rahman, S., Pendyal, A., Sareen, N., Yong, C., Palaniappan, L., Ibebuogu, U., Tran, A., Bacong, A. M., Lundberg, G., Watson, K. 2023; 81 (14): 1368-1385

  Abstract

  Social determinants of health (SDOH) are the social conditions in which people are born, live, and work. SDOH offers a more inclusive view of how environment, geographic location, neighborhoods, access to health care, nutrition, socioeconomics, and so on are critical in cardiovascular morbidity and mortality. SDOH will continue to increase in relevance and integration of patient management, thus, applying the information herein to clinical and health systems will become increasingly commonplace. This state-of-the-art review covers the 5 domains of SDOH, including economic stability, education, health care access and quality, social and community context, and neighborhood and built environment. Recognizing and addressing SDOH is an important step toward achieving equity in cardiovascular care. We discuss each SDOH within the context of cardiovascular disease, how they can be assessed by clinicians and within health care systems, and key strategies for clinicians and health care systems to address these SDOH. Summaries of these tools and key strategies are provided.

  View details for DOI 10.1016/j.jacc.2023.01.042

  View details for PubMedID 37019584

• Associations between Socioeconomic Status and Psychological Distress: An Analysis of Disaggregated Latinx Subgroups Using Data from the National Health Interview Survey. International journal of environmental research and public health McSorley, A. M., Bacong, A. M. 2023; 20 (6)

  Abstract

  Differences in socioeconomic status (SES), including income, education, and employment, continue to be significant contributors to health disparities in the United States (US), including disparities in mental health outcomes. Despite the size and diversity of the Latinx population, there is a lack of literature describing differences in mental health outcomes, including psychological distress, for Latinx subgroups (e.g., Dominican, Puerto Rican, Cuban). Therefore, we used pooled data from the 2014-2018 National Health Interview Survey to examine variations in psychological distress among Latinx subgroups as compared to other Latinx subgroups and non-Latinx whites. Additionally, we conducted regression analyses and tested whether race/ethnicity modified the relationship between SES indicators and psychological distress. Findings indicate that individuals categorized as Dominican and Puerto Rican were among the Latinx subgroups with the highest levels of psychological distress when compared to other Latinx subgroups and non-Latinx whites. Additionally, results demonstrate that SES indicators, such as higher levels of income and education, were not necessarily significantly associated with lower levels of psychological distress for all Latinx subgroups when compared to non-Latinx whites. Our findings discourage the practice of making broad generalizations about psychological distress or its associations with SES indicators to all Latinx subgroups using results garnered from the aggregate Latinx category.

  View details for DOI 10.3390/ijerph20064751

  View details for PubMedID 36981660

• Asthma heterogeneity amongst Asian American children: the California Health Interview Survey Chen, M., Bacong, A., Kikuta, N., Datir, R., Chen, S., Camargo, C., Srinivasan, M., Palaniappan, L., Arroyo, A. MOSBY-ELSEVIER. 2023: AB75

  View details for Web of Science ID 000991651900228

• Racial Discrimination, Social Disadvantage, and Racial-Ethnic Disparities in COVID-19 Vaccine Uptake. AJPM focus Haro-Ramos, A. Y., Bacong, A. M., Rodriguez, H. P. 2023: 100072

  Abstract

  Introduction: Racial-ethnic disparities in COVID-19 vaccination are well documented. The extent to which racism, manifested at the individual and zip code levels, explains disparities in early vaccination uptake remains unclear.Methods: Data from a statewide poll of California registered voters (n=10,256), conducted between April 29 to May 5, 2021, linked to area-level resource data, were analyzed. Weighted multivariable logistic regression models examined racial disparities in COVID-19 vaccination. Decomposition analyses quantified how much of the observed racial disparities in vaccination were explained by racial discrimination and social disadvantage (i.e., educational attainment, 2019 household income, and zip code social vulnerability).Results: Compared to White adults (74.7%), Latinx (64.6%) and Black (66.7%) adults were less likely to have at least one COVID-19 vaccine dose by April or May 2021. In adjusted analyses, Latinx (aOR=0.69, 95% Confidence Interval (CI)=0.57-0.84) and Black (aOR=0.51, 95% CI=0.37-0.70) adults had a lower likelihood of being vaccinated than Whites. Social disadvantage accounted for 77.4% (p<0.05) and 35.8% (p<0.05) of the explainable variation in Latinx-White and Black-White disparities, respectively. Self-reported racial discrimination was not associated with COVID-19 vaccination in adjusted analyses.Conclusions: Social disadvantage, but not self-reported racial discrimination, explained racial-ethnic disparities in COVID-19 vaccination in California. Removing resource-related barriers may help increase the relatively low COVID-19 vaccination rates among Black and Latinx populations.

  View details for DOI 10.1016/j.focus.2023.100072

  View details for PubMedID 36744154

• Visa type and financial strain on depressive symptoms among Filipino migrants to the United States. Journal of migration and health Tsuchiya, K., Bacong, A. M., de Castro, A. B., Gee, G. C. 2023; 7: 100155

  Abstract

  Migrants have been theorized to be healthier than their non-migrant counterparts; however, there is limited examination of health selection using binational data and how selection occurs, particularly for mental health outcomes. This study examines the role of visa status and financial strain as critical factors for mental health selection among Filipino migrants to the U.S. and non-migrants who remain in the Philippines. We used the baseline data from the Health of Philippine Emigrants Study (HoPES; n=1631) to compare depressive symptoms between non-migrants and migrants who were both surveyed prior to their departure to the U.S. We assessed depressive symptoms using linear regression by migration status, financial strain, and by visa categories including fiancee/marriage, unlimited family reunification, limited family reunification, and employment. Overall, all migrants reported lower depressive symptoms than non-migrants; however, depressive symptoms varied by visa type. Fiancee/marriage migrants had lower depressive symptoms than compared to limited family reunification migrants. Additionally, those who reported financial strain had higher depressive symptoms than those without any financial strain. We find that migrants were positively selected for mental health using a unique sample of Filipino migrants before they left for the U.S.

  View details for DOI 10.1016/j.jmh.2023.100155

  View details for PubMedID 36755688

• Willingness to Receive the COVID-19 Vaccine in California: Disparities by Race and Citizenship Status. Journal of racial and ethnic health disparities Bacong, A. M., Haro-Ramos, A. Y. 2022

  Abstract

  Although it is widely acknowledged that racialized minorities may report lower COVID-19 vaccine willingness compared to non-Hispanic white individuals, what is less known, however, is whether the willingness to receive the COVID-19 vaccine also differs by citizenship. Understanding disparities in vaccine willingness by citizenship is particularly important given the misleading rhetoric of some political leaders regarding vaccine eligibility by citizenship status. This study used the 2020 California Health Interview Survey (n=21,949) to examine disparities in vaccine willingness by race/ethnicity and citizenship among Asian, Latinx, and non-Hispanic white individuals. Overall, 77.7% of Californians indicated that they were willing to receive the COVID-19 vaccine if it was made available. However, there were distinct differences by race/ethnicity and citizenship. Asian people, regardless of citizenship, had the highest predicted probability of vaccine willingness, accounting for demographic, socioeconomic, and health factors. Non-citizen Latinx and non-citizen non-Hispanic white people had higher predicted probabilities of vaccine willingness compared to their US-born counterparts, accounting for demographic, socioeconomic, and health factors. Our results reveal that although vaccine willingness may be high among non-citizen individuals, it may not necessarily translate into actual vaccine uptake. Furthermore, while individual-level factors may account for some of the differences in vaccine willingness by race/ethnicity and citizenship, other institutional and structural barriers prevent vaccine uptake.

  View details for DOI 10.1007/s40615-022-01468-3

  View details for PubMedID 36449129

• Prevalence and risk factors of food insecurity among Californians during the COVID-19 pandemic: Disparities by immigration status and ethnicity. Preventive medicine Haro-Ramos, A. Y., Bacong, A. M. 2022: 107268

  Abstract

  The COVID-19 pandemic exacerbated socioeconomic disparities in food insecurity. Non-citizens, who do not qualify for most publicly-funded food assistance programs, may be most vulnerable to food insecurity during the pandemic. However, no study has examined heterogeneity in food insecurity by immigration status and ethnicity in the context of the pandemic. We analyzed the 2020 non-restricted California Health Interview Survey to examine disparities in food insecurity by ethnicity and immigration status (i.e., US-born, naturalized, non-citizen) among Asians and Latinxs (N = 19,514) compared to US-born Whites. Weighted multivariable logistic regression analyses assessed the association of immigration status and ethnicity with food insecurity. Decomposition analyses assessed the extent to which pandemic-related economic stressors, including experiencing reduced work hours or losing a job versus pre-pandemic socioeconomic position (SEP), accounted for disparities in food insecurity by ethnicity and immigration status. Regardless of immigration status, Latinxs were more likely to experience food insecurity than Whites. Based on the adjusted analyses, non-citizen, naturalized, and US-born Latinxs had a predicted probability of 12%, 11.4%, and 11.9% of experiencing food insecurity, respectively. In contrast, non-citizen Asians, but not US-born or naturalized Asians, reported greater food insecurity than Whites (12.5% vs. 8.2%). SEP accounted for 43% to 66% of the relationship between immigration status-ethnicity and food insecurity. The pandemic exacerbated economic hardship, but food insecurity was largely explained by long-standing SEP-related factors among Latinxs, regardless of immigration status, and non-citizen Asians. To address disparities in food insecurity, social assistance programs and COVID-19 economic relief should be extended to non-citizens.

  View details for DOI 10.1016/j.ypmed.2022.107268

  View details for PubMedID 36150445

• Immigration and the Life Course: Contextualizing and Understanding Healthcare Access and Health of Older Adult Immigrants JOURNAL OF AGING AND HEALTH Bacong, A. M., Doan, L. N. 2022: 8982643221104931

  Abstract

  Immigrant health discussions often focus on acculturation and omit discussions on historical events that may underlie health differences among immigrant older adults. This paper provides a historical overview of immigration policy and flows to the U.S. and examines insurance access and health difficulties by sending country.We analyzed the "Immigrants Admitted to the United States, Fiscal Years 1972-2000" and 2015-2019 American Community Survey datasets to examine the number of admitted immigrants, sociodemographic profiles for current immigrant older adults, and the predicted probabilities of health insurance access and health difficulties.Our results highlight alignment of immigration flows with immigration legislation and vast heterogeneity in migration, health, and healthcare access of immigrants by sending country.Public health practitioners must consider how historical events and social factors contribute to the healthcare access and health of immigrant populations, as demographic shifts will require interventions that promote equitable healthy aging.

  View details for DOI 10.1177/08982643221104931

  View details for Web of Science ID 000806882700001

  View details for PubMedID 35641140

• Health selection on self-rated health and the healthy migrant effect: Baseline and 1-year results from the health of Philippine Emigrants Study. PLOS global public health Bacong, A. M., Hing, A. K., Morey, B., Crespi, C. M., Kabamalan, M. M., Lee, N. R., Wang, M. C., de Castro, A. B., Gee, G. C. 2022; 2 (7)

  Abstract

  Studies of migration and health focus on a "healthy migrant effect" whereby migrants are healthier than individuals not migrating. Health selection remains the popular explanation of this phenomenon. However, studies are mixed on whether selection occurs and typically examine migrants post-departure. This study used a novel pre-migration dataset to identify which health and social domains differ between migrants and their non-migrant counterparts and their contribution to explaining variance in self-rated health by migrant status at pre-migration and 1-year later. Data were used from the baseline and 1-year follow-up of the Health of Philippine Emigrants Study (HoPES). We used multivariable ordinary least squares regression to examine differences in self-rated health between migrants to the U.S. and a comparable group of non-migrants at baseline (premigration) and one year later, accounting for seven domains: physical health, mental health, health behavior, demographics, socioeconomic factors and healthcare utilization, psychosocial factors, and social desirability. A migrant advantage was present for self-rated health at baseline and 1-year. Accounting for all domains, migrants reported better self-rated health compared to non-migrants both at baseline (beta = 0.32; 95% CI = 0.22, 0.43) and at 1-year (beta = 0.28; 95% CI = 0.10, 0.46). Migrant status, health behavior, and mental health accounted for most of the variance in self-rated health both at baseline and 1-year follow-up. This analysis provides evidence of migrant health selection and nuanced understanding to what is being captured by self-rated health in studies of migrant health that should be considered in future research.

  View details for DOI 10.1371/journal.pgph.0000324

  View details for PubMedID 36082314

• Learning to love ourselves again: Organizing Filipinx/a/o scholar-activists as antiracist public health praxis. Frontiers in public health Manalo-Pedro, E., Mackey, A., Banawa, R. A., Apostol, N. J., Aguiling, W., Aguilar, A., Oronce, C. I., Sabado-Liwag, M. D., Yee, M. D., Taggueg, R., Bacong, A. M., Ponce, N. A. 2022; 10: 958654

  Abstract

  A critical component for health equity lies in the inclusion of structurally excluded voices, such as Filipina/x/o Americans (FilAms). Because filam invisibility is normalized, denaturalizing these conditions requires reimagining power relations regarding whose experiences are documented, whose perspectives are legitimized, and whose strategies are supported. in this community case study, we describe our efforts to organize a multidisciplinary, multigenerational, community-driven collaboration for FilAm community wellness. Catalyzed by the disproportionate burden of deaths among FilAm healthcare workers at the onset of the COVID-19 pandemic and the accompanying silence from mainstream public health leaders, we formed the Filipinx/a/o Community Health Association (FilCHA). FilCHA is a counterspace where students, faculty, clinicians, and community leaders across the nation could collectively organize to resist our erasure. By building a virtual, intellectual community that centers our voices, FilCHA shifts power through partnerships in which people who directly experience the conditions that cause inequities have leadership roles and avenues to share their perspectives. We used Pinayism to guide our study of FilCHA, not just for the current crisis State-side, but through a multigenerational, transnational understanding of what knowledges have been taken from us and our ancestors. By naming our collective pain, building a counterspace for love of the community, and generating reflections for our communities, we work toward shared liberation. Harnessing the collective power of researchers as truth seekers and organizers as community builders in affirming spaces for holistic community wellbeing is love in action. This moment demands that we explicitly name love as essential to antiracist public health praxis.

  View details for DOI 10.3389/fpubh.2022.958654

  View details for PubMedID 36062092

• Addressing The Interlocking Impact Of Colonialism And Racism On Filipinx/a/o American Health Inequities. Health affairs (Project Hope) Sabado-Liwag, M. D., Manalo-Pedro, E., Taggueg, R. J., Bacong, A. M., Adia, A., Demanarig, D., Sumibcay, J. R., Valderama-Wallace, C., Oronce, C. I., Bonus, R., Ponce, N. A. 2022; 41 (2): 289-295

  Abstract

  Within the monolithic racial category of "Asian American," health determinants are often hidden within each subgroup's complex histories of indigeneity, colonialism, migration, culture, and socio-political systems. Although racism is typically framed to underscore the ways in which various institutions (for example, employment and education) disproportionately disadvantage Black/Latinx communities over White people, what does structural racism look like among Filipinx/a/o Americans (FilAms), the third-largest Asian American group in the US? We argue that racism defines who is visible. We discuss pathways through which colonialism and racism preserve inequities for FilAms, a large and overlooked Asian American subgroup. We bring to light historical and modern practices inhibiting progress toward dismantling systemic racial barriers that impinge on FilAm health. We encourage multilevel strategies that focus on and invest in FilAms, such as robust accounting of demographic data in heterogeneous populations, explicitly naming neocolonial forces that devalue and neglect FilAms, and structurally supporting community approaches to promote better self- and community care.

  View details for DOI 10.1377/hlthaff.2021.01418

  View details for PubMedID 35130069

• The Impact of Structural Inequities on Older Asian Americans During COVID-19 FRONTIERS IN PUBLIC HEALTH Ma, K., Bacong, A., Kwon, S. C., Yi, S. S., Doan, L. N. 2021; 9: 690014

  Abstract

  Structural racism manifests as an historical and continued invisibility of Asian Americans, whose experiences of disparities and diverse needs are omitted in research, data, and policy. During the pandemic, this invisibility intersects with rising anti-Asian violence and other persistent structural inequities that contribute to higher COVID-19 mortality in older Asian Americans compared to non-Hispanic whites. This perspective describes how structural inequities in social determinants of health-namely immigration, language and telehealth access, and economic conditions-lead to increased COVID-19 mortality and barriers to care among older Asian Americans. Specifically, we discuss how the historically racialized immigration system has patterned older Asian immigrant subpopulations into working in frontline essential occupations with high COVID-19 exposure. The threat of "public charge" rule has also prevented Asian immigrants from receiving eligible public assistance including COVID-19 testing and vaccination programs. We highlight the language diversity among older Asian Americans and how language access remains unaddressed in clinical and non-clinical services and creates barriers to routine and COVID-19 related care, particularly in geographic regions with small Asian American populations. We discuss the economic insecurity of older Asian immigrants and how co-residence in multigenerational homes has exposed them to greater risk of coronavirus transmission. Using an intersectionality-informed approach to address structural inequities, we recommend the disaggregation of racial/ethnic data, meaningful inclusion of older Asian Americans in research and policy, and equitable investment in community and multi-sectoral partnerships to improve health and wellbeing of older Asian Americans.

  View details for DOI 10.3389/fpubh.2021.690014

  View details for Web of Science ID 000693443200001

  View details for PubMedID 34490181

  View details for PubMedCentralID PMC8417937

• Selection, experience, and disadvantage: Examining sources of health inequalities among naturalized US citizens SSM-POPULATION HEALTH Sohn, H., Bacong, A. 2021; 15: 100895

  Abstract

  We integrated major theories in immigrant health and assimilation into a single analytical framework to quantify the degrees to which demographic composition, pathways to citizenship, and socioeconomic assimilation account for physical and mental health disparities between naturalized immigrants by region of origin.Using the restricted data from the 2015-2016 California Health Interview Survey, we decomposed differences in physical and mental health into demographic factors, path to citizenship, and socioeconomic characteristics by region of origin using the Karlson, Holm, and Breen (KHB) method.Differences in socioeconomic status mediated most of the disparity in physical health between naturalized immigrants from different regions. Factors associated with major immigrant health theories-demographic composition, pathways to citizenship, and socioeconomic assimilation-did not mediate disparities in mental health.This article argues that the study of health disparities among immigrants must simultaneously account for differences in demographic composition, immigration experience, and socioeconomic disadvantage. The findings also underscore the need for theory development that can better explain mental health disparities among immigrants.

  View details for DOI 10.1016/j.ssmph.2021.100895

  View details for Web of Science ID 000697998100077

  View details for PubMedID 34430702

  View details for PubMedCentralID PMC8368999

• Heterogeneity in the Association of Citizenship Status on Self-Rated Health Among Asians in California. Journal of immigrant and minority health Bacong, A. M. 2021; 23 (1): 121-136

  Abstract

  Citizenship is considered an egalitarian legal identity but may function differently among minorities because of racial/ethnic stratification and historical context. Using Asians, I examine whether the association between citizenship and self-rated health differs by ethnicity. I examine the moderating effect of Asian ethnic group (Chinese, Filipino, Korean, Vietnamese, and Other Asian) on citizenship and self-rated health using the 2012-2016 California Health Interview Survey (n = 11,084). Models account for demographics, socioeconomic status, healthcare, and English proficiency. Adjusting for demographics, naturalized citizens and non-citizens were statistically significantly more likely to report fair/poor health compared to U.S.-born citizens. Naturalized and non-citizen Vietnamese reported statistically significantly poorer health to all U.S.-born groups. These trends largely disappear when controlling for all covariates. Citizenship status can be useful in considering structural barriers for immigrants. Future work should interrogate the non-citizen category and why trends are seen among Vietnamese, but not others.

  View details for DOI 10.1007/s10903-020-01039-w

  View details for PubMedID 32578010

  View details for PubMedCentralID 6546429

• Disentangling contributions of demographic, family, and socioeconomic factors on associations of immigration status and health in the United States. Journal of epidemiology and community health Bacong, A., Sohn, H. 2020

  Abstract

  In the United States, immigration policy is entwined with health policy, and immigrants' legal statuses determine their access to care. Yet, policy debates rarely take into account the health needs of immigrants and potential health consequences of linking legal status to healthcare. Confounding from social and demographic differences and lack of individual-level data with sensitive immigration variables present challenges in this area of research.This article used the restricted California Health Interview Survey (CHIS) to assess differences in self-rated health, obesity, and severe psychological distress. Between US-born citizens, naturalised citizens, lawful permanent residents (LPR), undocumented immigrants, and temporary visa holders living in California.Results show that while immigrant groups appear to have poorer health on the surface, these differences were explained predominantly by older age among naturalised citizens and by lower-income and education among LPRs and undocumented immigrants. Favourable family characteristics acted as protective factors for immigrants' health, especially among disadvantaged immigrants.Immigration policy that limits access to healthcare and family support may further widen the health disadvantage among immigrants with less legal protection.

  View details for DOI 10.1136/jech-2020-214245

  View details for PubMedID 33239346

  View details for PubMedCentralID PMC8144240

• Epidemiologists Count: The Role of Diversity and Inclusion in the Field of Epidemiology. American journal of epidemiology Ðoàn, L. N., Bacong, A. M., Ma, K. P., Morey, B. N. 2020; 189 (10): 1033-1036

  Abstract

  We present interpretations of the idea that "epidemiologists count" in response to the current status of membership and diversity and inclusion efforts within the Society for Epidemiological Research (SER). We review whom epidemiologists count to describe the (mis)representation of SER membership and how categorizations of people reflect social constructions of identity and biases that exist in broader society. We argue that what epidemiologists count-how diversity and inclusion are operationalized-has real-world implications on institutional norms and how inclusive/non-inclusive environments are. Finally, we examine which epidemiologists count within the field and argue that inclusion can only be achieved when we address how resources and opportunities are distributed among epidemiologists. To improve diversity and inclusion within SER and beyond, we recommend that SER strengthen its commitment to diversity, inclusion, and equity by: 1) integrating this priority on all agendas; 2) enhancing efforts to improve self-awareness among members and accountability within the organization; 3) supporting the growth of a diversifying workforce in epidemiology; and 4) increasing the visibility of health disparities research and researchers in epidemiology.

  View details for DOI 10.1093/aje/kwaa108

  View details for PubMedID 32602522

  View details for PubMedCentralID PMC7666407

• Heterogeneity in Migrant Health Selection: The Role of Immigrant Visas. Journal of health and social behavior Morey, B. N., Bacong, A. M., Hing, A. K., de Castro, A. B., Gee, G. C. 2020; 61 (3): 359-376

  Abstract

  This study proposes that visa status is an important construct that is central to understanding how health selection occurs among immigrants. We used the 2017 baseline survey data of the Health of Philippine Emigrants Study (n = 1,632) to compare the health of nonmigrants remaining in the Philippines and migrants surveyed prior to migration to the United States. Furthermore, we compared migrant health by visa type: limited family reunification, unlimited family reunification, fiancé(e)/marriage, and employment. Migrants reported fewer health conditions than nonmigrants overall. However, health varied among migrants by visa type. Migrants with fiancé(e)/marriage visas were the healthiest, reporting significantly fewer health conditions than the other groups. Limited family reunification migrants reported more health conditions than nonmigrants and unlimited family reunification migrants. We discuss how the immigration visa process reflects broader forms of social and political stratification that cause heterogeneity in immigrant health selection.

  View details for DOI 10.1177/0022146520942896

  View details for PubMedID 32723093

  View details for PubMedCentralID PMC8105085