title: Acculturation and perceived ethnic discrimination as potential etiological factors for Type 2 Diabetes among sub-Saharan African immigrants in Australia
Creators: name: Bilal, Paul Izaru
Publisher: name: Australian Catholic University
Year: 2019

description: Background: Acculturation and perceived ethnic discrimination (PED) are established risk factors for elevated blood glucose level or type 2 diabetes mellitus (EBGL or T2DM). These factors are known to affect health of immigrants in various ways, including dietary transition, psychological, sociocultural and economic status change. Although numerous studies on acculturation and PED have been conducted among immigrants worldwide, few studies have been reported for sub-Saharan African migrants across the world. Aim and objectives: This study aims to determine the potential mechanisms by which acculturation and PED influence EBGL or T2DM and psychological health risk factors such as depression, anxiety and stress among sub-Saharan Africans in north-eastern Australia (Darwin and Brisbane). Specific objectives include the assessment of EBGL or T2DM, PED, depression, anxiety, stress (DAS), overweight and obesity prevalence, the distribution of acculturation modes and sociodemographic characteristics in the sample population; determination of EBGL or T2DM, PED, depression, anxiety and stress prevalence by sociodemographic characteristics and finally, the assessment of the associations between independent variables (acculturation, PED, depression, anxiety, stress, dietary factors, high BMI) and the dependent variable (EBGL or T2DM). Methodology: A cross-sectional design and a purposive sampling method were used to recruit participants. A questionnaire was developed by the modification of validated acculturation scales, PED questionnaire, physical activity (PA) questionnaire, DAS scale and food frequency questionnaire (FFQ). Face-to-face interviews with 170 adults (≥ 18 years old) sub-Saharan African migrants from 18 African countries were conducted. Fasting blood glucose levels (FBGL) of the participants were measured during the interviews. Results: The results show that the prevalence of EBGL (High risk BGL) or T2DM (Diabetic BGL) was 17.6% (2.9% or 14.7%) in the sample population. This prevalence is higher than the recent Australian-wide prevalence (5.1%) and 41.8% of the sample population are in the integrated mode of acculturation, with 14.7% reporting a high level of PED. No previous data from Australia exists to compare these findings, since this study is the first of its kind in Australia. Of those who reported PED, 22.5% were in the integrated mode of acculturation. Similarly, 29.6% of those with EBGL or T2DM were in the integrated mode of acculturation. This is consistent with a previous finding that highly acculturated migrants are more likely to have EBGL or T2DM. Severe anxiety was higher (28.8%) than severe depression (18.8%) and stress (5.3%) in the sample population. The prevalence rates for anxiety and depression in the present study are higher than in the overall population of Australia, and they are higher in males than females. Overweight and obesity prevalence are 43.5% and 24.1%, respectively with more females (34.1%) than males (14.8%) in the obesity category, but more males (45.5%) than females (41.5%) in the overweight category. This is consistent with previous studies in sub-Saharan Africans, where females are more likely to be obese than males. According to literature, the condition was attributable to some African tradition that favours big body size for females as prestigious for the family. It is seen as a sign of fertility and success and wealth in a family. Forty-one-point two percent of the sample population had low income, and those with high income status were more likely to have EBGL or T2DM, compared to low or medium-income groups. Those who migrated to Australia on skilled migration visas were more likely to report PED and have severe depression (SD) and EBGL or T2DM than those who migrated on humanitarian, student and family/spouse visa type. They are also more likely to have higher income than those in other migration visa types. This result contradicts findings of previous studies where socioeconomic status correlated inversely with EBGL or T2DM. Nearly two thirds (62.2%) of the sample population was employed, 88.8% educated. The majority (74.8%) of those that were educated were employed, while 84.2% of the uneducated were unemployed. Relative risk analysis indicates that participants who were employed were 20 times more likely to report discrimination than those that were unemployed, and participants who were educated and employed were 18 times more likely to report discrimination than those that were uneducated and employed. This is consistent with previous findings where ethnic discrimination is reported to occur in workplaces and highly educated migrants indicate being discriminated against more than less-educated migrants. There was no statistically significant association between socioeconomic status and SA or severe stress (SS). Neither was there a statistically significant association between overweight, obesity, central adiposity and EBGL or T2DM. The lack of a significant correlation between BMI, central adiposity and EBGL or T2DM is contrary to previous findings. Most previous studies that examine the relationship between BMI and EBGL or T2DM find a positive association between them. Inverse and statistically significant associations between the consumption of sweets and snacks, fast food, processed meat and EBGL or T2DM were observed. Further analysis reveals that those who were aware of their EBGL or T2DM status had low consumption rates of sweets and snacks, fast food and processed meat. This gave the assumption that perhaps those who were aware of their EBGL or T2DM status had received some instructions on what to eat to manage their diabetic conditions. Australian vegetables were consumed more than the traditional African vegetables in the sample population. This implies that dietary acculturation is taking effect in the population. Correlation and multiple regression analysis show that an integrated and traditional mode of acculturation is significantly associated with EBGL or T2DM. The traditional mode was inversely associated while an integrated mode was positively associated. Strong associations were observed between PED, SD and EBGL or T2DM, reflecting a mediation effect between PED and SD in the association between acculturation and EBGL or T2DM, because when the relation was tested for mediation, the strength of the association between acculturation and EBGL or T2DM reduced, while that of PED remained strong, indicating that PED acts as mediator to acculturation in the association between acculturation and EBGL or T2DM. Conclusion: The prevalence of EBGL or T2DM in this study is higher than the current Australian prevalence and acculturation and PED are risk factors for EBGL or T2DM in the sub-Saharan African immigrant population in north-eastern Australia. Education and employment are risk factors for PED and EBGL or T2DM, and the association between acculturation and EBGL or T2DM is partially mediated by both PED and SD. Generally, the overall results of this study are unique in comparison to previous similar studies in other migrant groups in OECD countries. Therefore, more confirmatory studies are required to develop a targeted health promotion strategy for community and workplace settings, if sub-Saharan Africans are to positively acculturate in Australia.