Behavioral Risk Factors and Unintentional Injuries Among US Immigrant Adults

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Behavioral Risk Factors and Unintentional Injuries Among US Immigrant Adults Huiyun Xiang, MD, MPH, PhD Assistant Professor Columbus Children’s Hospital College of Medicine The Ohio State University Principal Investigator Director for International Program Center for Injury Research and Policy Columbus Children’s Research Institute

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Why this topic? In 2003, 33.5 million individuals in U.S. were immigrants, representing 11.7% of the total U.S. population 80.1% of the immigrants were 18-64 years old, 8.9% were under 18 years old Major gaps in our knowledge of risk behaviors and injuries among immigrants

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Importance Injuries are the leading cause of morbility and mortality among children and young adults Risk behaviors (e.g., alcohol drinking, drinking and driving) are closely associated with nonfatal and fatal injuries

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To briefly review previous findings about injury risk among immigrants To present national data on several major risk behaviors among immigrants To present our new research findings about the association between risk behaviors and injuries among immigrants Objectives

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Previous Research Findings

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Life Expectancy at Birth Males Females Us-born 71.5 78.6 Immigrants 74.9 81.1 Source: Singh GK, and Miller BA. Health, life expectancy, and mortality patterns among immigrant populations in the United States. Can J Public Health. 2004;95:I14-21.

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Adjusted Injury-related Death Risk for Immigrants Relative to US-born Males Females Unintentional Injuries (E800-E825) RR= 0.72* RR=0.89 Motor vehicle RR= 0.93 RR=1.22 All other RR=0.64** RR=0.75 Suicide (E950-E959) RR=0.48** RR=1.39 Homicide (E960-E978) RR=0.88 RR=0.93 Source: Singh GK, Siahpush M. All-cause and cause-specific mortality of immigrants and native born in the United States. Am J Public Health. 2001;91:392-9.

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Non-fatal Injuries Among Immigrants Medically Treated Injuries Us-born 1.00 (Reference) Immigrants OR= 0.54 (0.48-0.62) - Years in US <1 OR= 0.29 1-4 OR= 0.47 5-9 OR= 0.48 10-14 OR= 0.52 15+ OR= 0.63 Source: Sinclair SA, Smith GA, Xiang H. A comparison of nonfatal unintentional injuries in the United States among US-born and foreign-born persons. J Community Health. 2006;31:303-325.

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Nonfatal Injuries Among Immigrant Children Child injured in 12 months Us-born 27.3% Immigrant 13.0% Source: Schwebel DC, Brezausek CM, Ramey CT, Ramey SL. Injury risk among children of low-income US-born and immigrant mothers. Health Psychol. 2005;24:501-507.

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Immigrants seam to have lower injury risk than US-born in the U.S. Very little research on work-related injuries among immigrant workers Previous studies failed to investigate risk behaviors among immigrants Preliminary Conclusions

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Behavioral Risk Factors and Unintentional Injuries Among US Immigrant Adults Our Current Research Project

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National Epidemiologic Survey on Alcohol and Related Conditions 2001 - 2002 N= 43,093. Nationally-representative survey. Response rate: 81%. Oversampling of Blacks, Hispanics/ Latinos, young adults.

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Study Agencies

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13 Major Topics Covered in NESARC Background Information Alcohol Consumption Tobacco Use Low Mood High Mood Anxiety Social Situations 8. Specific Situations 9. General Anxiety 10. Usual Feeling and Actions 11. Behavior 12. Betting 13. Medical Conditions

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Study Subjects (43,093) Us-born Foreign-born Risk behaviors Risk Behaviors Injuries Our Research Model

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Study Subjects Us-born Foreign-born Injuries Previous Studies

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10 Injury-related Risk Behaviors Tobacco Use Drug abuses Alcohol drinking Heavy alcohol drinker Drinking & driving Heavy drinking (3+ drinks) & driving 7. Rode in vehicle of drinking driver 8. Reckless driving (ever) 9. Driver’s license suspended 10. Do things easily hurt him/herself or others

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In the past 12 months, how many injuries have you had that caused you to seek medical help or to cut down your usual activities for more than half a day? Injury Question:

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Results

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Comparison of Risk Behaviors Between Us-born and Immigrants US-Born Immigrants Current tobacco Use (%) 28.0% 15.3% Current drug abuses 6.3% 2.9% Current alcohol drinker 64.7% 52.9% Heavy alcohol drinker 40.6% 30.4% Drinking & driving 5.8% 2.5% Note: All P-value of difference statistical tests <0.01

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Comparison of Risk Behaviors Between Us-born and Immigrants US-born Immigrants Heavy drinking (3+ drinks) & driving 15.9% 8.9% 7. Rode in vehicle of drinking driver 8.6% 4.6% 8. 3+ tickets for reckless driving 8.2% 4.3% 9. Driver’s license suspended 8.0% 4.4% Do things easily hurt himself/other 13.7% 3.7% Note: All P-value of difference statistical tests <0.01

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Injury Prevalence (%) US-born Immigrants Prevalence Ratio Gender Males 20.9% 14.4% 1.45 (1.33-1.59)** Females 17.8% 12.4% 1.43 (1.32-1.57)**

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Injury Prevalence (%) US-born Immigrants Prevalence Ratio Age 18-29 23.1% 12.7% 1.81 (1.59-2.07)** 30-54 20.0% 13.0% 1.54 (1.41-1.68)** 55+ 15.5% 14.6% 1.06 (0.94-1.20)

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Plot of Behavioral Risk Factors & Injury % Injury% Total Number of Risk Behaviors (out of 10 Risk Behaviors)

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