Disparities in Preventive Health Behaviors Among Non-Hispanic White Men

Abstract

The objectives of this study were to estimate and compare the age-adjusted prevalence of not receiving a flu vaccine, pneumonia vaccine, or prostate cancer screening among U.S.- and foreign-born White men by region of birth (Europe/Russia and the Arab Nations) and examine these associations while controlling for potential confounders. Twelve years of restricted data from the National Health Interview Survey (NHIS) including 91,636 U.S.- and foreign-born men were used. Chi-squares were used to compare descriptive statistics, and odds ratios (ORs; 95% confidence intervals [CIs]) were used for inferential statistics. In crude and adjusted analyses, foreign-born Arab American men were less likely to report receiving a flu (OR = 0.38; 95% CI = 0.21, 0.67) and pneumonia (OR = 0.33; 95% CI = 0.16, 0.70) vaccine compared with U.S.-born White men. There were no statistically significant differences for PSA testing between Arab American and White men. This national study examining uptake of flu and pneumonia vaccines suggests estimates are lower for foreign-born Arab American men compared with U.S.-born White men. Future studies should collect qualitative data that assesses the cultural context surrounding prevention and screening behaviors among Arab Americans.

Keywords

immunization screening men nativity immigrant National Health Interview Survey Arab American

Preventive health screenings and vaccinations may be effective in preventing or delaying the risk of or complications from disease (American Diabetes Association, 2014; National Center for Immunization and Respiratory Diseases, 2011; Smith, Brooks, Cokkinides, Saslow, & Brawley, 2013). The United States Preventive Services Task Force (USPSTF) and Centers for Disease Control and Prevention (CDC) recommend routine vaccinations (CDC, 2011) and preventive cancer screenings (Moyer, 2012; USPSTF, 2008) for early detection and disease prevention among adults. For example, the CDC recommends a flu vaccine every year for all adults aged 19 years and older and one dose of the pneumonia vaccine for adults aged 65 years and older who lack evidence of immunity (CDC, 2011). Among healthy men aged 50 years and older, the American Cancer Society recommends they make an informed decision with their health care provider about the potential benefits and uncertainties of screening with a prostate-specific antigen (PSA) test to detect prostate cancer (Smith et al., 2013).

While these aforementioned recommendations apply to all adults, disparities in screening and vaccination still exist by race, ethnicity, and nativity status. For example, in 2010, 47% of men aged 50 years and older self-reported receiving a flu vaccine in the past year and 58% of men aged 65 years and older reported receiving a pneumonia vaccine (National Center for Health Statistics, 2012b). However, foreign-born adults were less likely to report having an annual flu vaccine (Vlahov, Bond, Jones, & Ompad, 2012) when compared with U.S.-born adults. Foreign-born men were less likely to report PSA testing when compared with U.S.-born men (Consedine, Morgenstern, Kudadjie-Gyamfi, Magai, & Neugut, 2006; Singh & Hiatt, 2006). These disparities exist when comparing foreign-born and U.S.-born men collectively and disaggregated by race and ethnicity (Argeseanu Cunningham, Ruben, & Narayan, 2008). Studies have compared foreign-born Hispanic (Jandorf et al., 2010), Asian (Misra, Menon, Vadaparampil, & BeLue, 2011), and non-Hispanic Black (Odedina et al., 2011) men with their U.S.-born counterparts (Argeseanu Cunningham et al., 2008). However, the research is limited when comparing U.S.- and foreign-born non-Hispanic Whites.

Among White immigrants, limited research exists on screening behaviors for men from different geographic regions, including immigrants from Europe and the Middle East. Consedine et al. (2006) examined digital rectal exam and PSA testing estimates among men from seven ethnic groups and compared U.S.-born European Americans with foreign-born Eastern European men. They identified that Eastern European immigrants reported fewer tests than their U.S.-born counterparts (Consedine et al., 2006). These results differ from Singh and Hiatt (2006), who identified that when disaggregated by race and ethnicity, there were no differences between self-reports of PSA testing between U.S.- and foreign-born non-Hispanic White men. Non-Hispanic White men, according to the U.S. federal government include individuals from Europe, North Africa, and the Middle East (Office of Management and Budget, 1997). This classification may mask important disparities in health status and preventive health behaviors within each geographic region, in particular, Arab Americans.

Minimal research exists on preventive health behaviors among Arab American men. The majority of knowledge about preventive health behaviors of Arab Americans is gleaned from community-based surveys in Michigan. Screening behaviors of Arab American adults (≥40 years of age) are measured by telephone and compared with other groups using the Special Cancer Behavioral Risk Factor Survey (SCBRFS; Yassine, Wing, Wojcik, & Tan-Schriner, 2010). In 2008, Arab American men had higher use of PSA testing when compared with Hispanics and American Indians yet had lower estimates than African Americans and the general population (Yassine et al., 2010). Focus groups with Arab Americans in New York reported that a majority of men had never been screened for cancer (Shah, Ayash, Pharaon, & Gany, 2008). Although these screening estimates were higher for Arab American men than some racial and ethnic groups, these studies were conducted regionally and results may be limited in generalizability to the rest of the United States. Furthermore, to our knowledge, no current literature exists that examines flu and pneumonia vaccine uptake among Arab American men.

To begin the work of better understanding the health of Arab Americans nationally, a few researchers have analyzed data from the National Health Interview Survey (NHIS) to obtain representative estimates of diabetes and hypertension (Dallo & Borrell, 2006), serious psychological distress (Dallo, Kindratt, & Snell, 2013), functional limitations (Dallo, Booza, & Nguyen, 2013), and self-rated health (Read, Amick, & Donato, 2005). Researchers have not analyzed national data to estimate preventive health behaviors among Arab Americans. The NHIS studies that have focused on Arab Americans have not limited the sample to only those from the Arab League of Nations (i.e., considered Arab Nations). Rather, these studies included the general region of the “Middle East,” where not all individuals from that region identify as Arab American.

To address this gap, the objectives of this study are to (a) estimate and compare the age-adjusted prevalence of not receiving a flu vaccine, pneumonia vaccine, or prostate cancer screening among U.S.- and foreign-born White men by region of birth (Europe/Russia and the Arab Nations) and (b) examine these associations while controlling for potential confounders.

Method

Data Collection

Twelve years of National Health Interview Survey (NHIS) data were combined. The NHIS uses a multistage sample design to collect demographic and health information using face-to-face interviews among a representative sample of the U.S. population. Details of the NHIS sampling design, oversampling of minority groups, weighting, and our data collection methods have been reported previously (Dallo, Kindratt, et al., 2013; National Center for Health Statistics, 2012a).

Participants

The total unweighted sample (2000 to 2011) comprised 1,086,035 people from 428,568 families and 419,599 households. Of the 984,160 persons, 320,827 individuals completed the Sample Adult section. The sample for this study was limited to Whites aged 18 years or older who answered questions about place of birth and preventive health behaviors. The final sample size was 215,985 adults (U.S.-born = 205,763 and foreign-born = 10,222).

The NHIS collects annual estimates of selected health conditions, vaccines uptake, and preventive health behaviors. Designated years of the NHIS include additional survey modules that focus on specific health conditions. The NHIS included an additional cancer control module in 2000, 2005, and 2010. The final unweighted sample sizes for the cancer control modules used to evaluate PSA testing estimates in this study included 20,737 men (U.S.-born = 19,853; foreign-born = 884) for five years of data combined (2000, 2003, 2005, 2008, and 2010).

Table 1.

Selected Characteristics of Sample for U.S.- and Foreign-Born White Males From Europe and the Arab Nations, NHIS 2000-2011 (N = 91,636).

	Non-Hispanic White males
		Foreign-born
	US-born (n = 88,413), % (SE)	Europe (n = 2,567), % (SE)	Arab Nations (n = 238), % (SE)	p Value
Mean age	46.6 (0.10)	49.1 (0.42)	38.6 (1.07)	.0000
Marital status				.0000
Never married	20.6 (0.23)	15.6 (0.93)	28.8 (3.31)
Married/live with partner	67.2 (0.25)	72.4 (0.96)	63.9 (3.41)
Divorced/widowed/separated	12.2 (0.12)	12.1 (0.55)	7.4 (1.79)
Education				.0000
Less than high school	11.6 (0.18)	12.1 (0.72)	11.5 (2.84)
High school/GED	29.6 (0.24)	23.4 (1.10)	22.2 (3.18)
Some college/associate’s	29.4 (0.20)	24.9 (1.05)	20.9 (3.04)
Bachelor’s or higher	29.5 (0.29)	39.6 (1.19)	45.4 (5.12)
Imputed poverty level (>200%)	78.5 (0.27)	76.3 (1.14)	48.9 (4.26)	.0000
Employed (% no)	30.5 (0.23)	33.0 (1.01)	34.4 (3.70)	.0301
Health insurance (% no)	13.1 (0.15)	15.8 (0.97)	27.5 (3.60)	.0000
Place most often receive care				.0023
Clinic/health center	16.4 (0.29)	13.3 (1.07)	12.9 (2.99)
Doctor’s office/HMO	79.1 (0.30)	83.1 (1.12)	75.7 (4.67)
No usual source of care	4.4 (0.10)	3.6 (0.46)	11.5 (3.66)
Current smoker (% no)	47.5 (0.24)	45.8 (1.09)	52.5 (3.68)	.0005
BMI				.0000
Normal	30.8 (0.20)	34.8 (1.08)	28.1 (3.28)
Overweight	42.1 (0.20)	43.8 (1.12)	50.3 (3.90)
Obese	27.1 (0.20)	21.4 (0.92)	21.6 (2.94)
Length of time in the United States				.0003
U.S.-born	100.0 (0.00	—	—
Less than 15 years	—	32.4 (1.20)	55.9 (4.55)
15 years or more	—	67.6 (1.20)	44.1 (4.55)

Note. NHIS = National Health Interview Survey; BMI = body mass index.

Measures

Independent Variables

The independent variables examined in this study were nativity (U.S.- or foreign-born), region of birth (the United States, Europe, the Arab Nations), race (White), and ethnicity (non-Hispanic). The NHIS determines nativity by asking respondents if they were born in one of the 50 states, Washington DC, a U.S. territory, or on a U.S. military base overseas. Any person not born in the U.S. was asked if they were a U.S. citizen. Non-U.S. citizens were asked what country they were born in and the NHIS categorizes each country into 10 world regions (the United States, Mexico, Central America and Caribbean Islands, South America, Europe, Middle East, Russia, Indian subcontinent, Asia, and Southeast Asia). To better approximate an “Arab American” ethnicity, the authors identified 15 “Arab” countries that overlap with the 25 countries from the NHIS and the 22 countries that comprise the Arab Nations. These 15 countries are: Arab Palestine; Bahrain; Gaza Strip; Iraq; Jordan; Kuwait; Lebanon; Oman; Palestine; Qatar; Saudi Arabia; Syria; United Arab Emirates; West Bank; and Yemen.

Because country of birth is a restricted variable in the NHIS, data from individuals from these 15 countries were requested from the NCHS Research Data Center (National Center for Health Statistics, 2012c). The race and ethnicity of interest in this study were non-Hispanic Whites. The NHIS collects race and ethnicity data in accordance with the 1997 Office of Management and Budget federal guidelines (National Center for Health Statistics, 2012a; Office of Management and Budget, 1997). Respondents were asked whether they were Hispanic (Hispanic or Latino and not Hispanic or Latino) and shown flashcards to indicate their race (National Center for Health Statistics, 2011). Our sample was limited to foreign-born men from the United States, Europe (including Russia and the former Soviet Union), and the Arab Nations who responded that they were not Hispanic or Latino and White race.

Dependent Variables

The dependent variables examined in this study were flu vaccine, pneumonia vaccine, and a PSA test. To determine annual flu and pneumonia vaccine uptake, respondents were asked whether they had a flu shot during the last 12 months (yes or no) and if they ever had a pneumonia vaccine (yes or no). During selected years (2000, 2003, 2005, 2008, 2010) men were asked whether they had ever had a PSA test (yes or no) (National Center for Health Statistics, 2012a).

Covariates

Covariates examined comprised demographic (age and marital status), socioeconomic status (education, employment and poverty ratio), health care access and health insurance, and behavioral risk factors (smoking and BMI) based on previous studies (Dallo, Kindratt, et al., 2013). Acculturation characteristics also were included in the analysis given the sample includes foreign-born individuals and the consistent findings that foreign-born have better health than their U.S.-born counterparts (Argeseanu Cunningham et al., 2008; Dey & Lucas, 2006). However, this advantage disappears with acculturation (Borrell & Lancet, 2012; John, de Castro, Martin, Duran, & Takeuchi, 2012; Lara, Gamboa, Kahramanian, Morales, & Bautista, 2005). Our analyses included length of time in the United States (U.S.-born, lived in United States <15 years, and lived in United States ≥15 years) as a proxy for acculturation.

Analysis

The age-adjusted prevalence of not reporting preventive health behaviors for U.S.- and foreign-born White men from Europe and the Arab Nations was estimated. First, descriptive statistics were obtained to report demographic, socioeconomic status, health care, risk factor, and acculturation characteristics for U.S.- and foreign-born White men from Europe and the Arab Nations. Chi square was used to determine statistically significant differences for each covariate. Second, the authors estimated the age-adjusted prevalence of not receiving preventive health behaviors for White men from the United States, Europe, and the Arab Nations. Lastly, logistic regression was used to examine the association between region of birth (the United States, Europe, the Arab Nations, and other) among White men (independent variable) and each preventive health behavior (outcome variables) while controlling for potential confounders. All analyses were weighted to produce representative estimates of the U.S. population.

The authors used SAS 9.3 and SUDAAN version 10 for data analysis methods to account for the sophisticated weighting in the NHIS sample design, multiple imputations of personal earnings/family income, and adjustment for age. More details about the NHIS complex sample design were reported previously (National Center for Health Statistics, 2012a). Data collection for the NHIS was approved by the NCHS Research Ethics Review Board. Analysis of de-identified data from the survey is exempt from the federal regulations for the protection of human research participants. Analysis of restricted data through the NCHS Research Data Center is also approved by the NCHS ERB (National Center for Health Statistics, 2012c).

Results

Descriptive Findings

The mean age was significantly lower among foreign-born White men from the Arab Nations (38.6 years) when compared with U.S.-born (46.6 years) and foreign-born White men from Europe (49.1 years). Foreign-born White men from the Arab Nations were less likely to be married/living with their partner, live above the poverty level, or be employed compared with U.S.- and foreign-born White men from Europe (all ps < .05). However, foreign-born White men from the Arab Nations were more likely to report having a bachelor’s degree or higher (48.9%) when compared with U.S.-born (29.5%) and foreign-born White men from Europe (39.6%). Foreign-born White men from the Arab Nations were more likely to report that they did not have health insurance and no usual source of care when compared to U.S.- and foreign-born White men from Europe (all ps ≤ .00). Foreign-born White men from the Arab Nations were less likely to smoke yet were more likely to be overweight when compared with U.S.- and European-born counterparts (all ps ≤ .00). A majority (67.6%) of foreign-born White men from Europe lived in the United States for 15 years or longer compared with 44% of foreign-born White men from the Arab Nations.

Preventive Health Behaviors

Table 2 reports the age-adjusted prevalence of not receiving vaccines and a prostate cancer screening among U.S.- and foreign-born White men from Europe and the Arab Nations. Foreign-born White men from the Arab Nations were more likely to report not receiving a flu vaccine (78%) when compared with U.S.-born (70%) and foreign-born Whites from Europe (75%). Similarly, foreign-born White men from the Arab Nations were more likely to report not receiving a pneumonia vaccine (85%) when compared with U.S.-born (81%) men, yet had similar estimates of not receiving a pneumonia vaccine when compared with foreign-born White men from Europe (86%). Foreign-born White men from the Arab Nations had similar estimates of not receiving a PSA test (41%) when compared with U.S.-born (40%) men, yet were less likely to report not receiving a PSA test when compared with foreign-born White men from Europe (49%).

Table 2.

Age-Adjusted Prevalence of Not Receiving Preventive Health Behaviors of U.S.- and Foreign-Born White Males From Europe and the Arab Nations, NHIS 2000-2011 (N = 91,636).

	Non-Hispanic Whites
		Foreign-born
	U.S.-born (n = 88,413), % (SE)	Europe (n = 2,567), % (SE)	Arab Nations (n = 238), % (SE)	p Value
Flu vaccine	70.0 (0.00)	75.0 (0.01)	78.0 (0.03)	.0000
Pneumonia vaccine	81.0 (0.00)	86.0 (0.01)	85.0 (0.03)	.0000
PSA test^a	40.0 (0.00)	49.0 (0.02)	41.0 (0.10)	.0000

Note. NHIS = National Health Interview Survey; PSA = prostate-specific antigen.

Five years of data analyzed, 2000, 2003, 2005, and 2010.

Multivariable Results

In unadjusted analyses (Table 3, Model 1), foreign-born White men from the Arab Nations were less likely to report receiving a flu vaccine (OR = 0.42; 95% CI = 0.27, 0.64) when compared with U.S.-born White men. Results remained statistically significant after controlling for demographic, socioeconomic, health insurance and health care access, behavioral risk factors, and acculturation covariates (OR = 0.38; 95% CI = 0.21, 0.67). Similar results were reported when examining pneumonia vaccine uptake. In unadjusted analyses (Table 3, Model 1), foreign-born men from the Arab Nations were 61% less likely to report having a pneumonia vaccine when compared with U.S.-born White men. Results remained significant after controlling for demographic, socioeconomic, health insurance and health care access, behavioral risk factors, and acculturation characteristics (OR = 0.33; 95% CI = 0.16, 0.70). There were no significant differences in PSA testing estimates in crude (OR = 0.57; 95% CI = 0.26, 1.27) or adjusted (OR = 0.91; CI = 0.17, 4.74) models.

Table 3.

Crude and Adjusted Odds Ratios (95% Confidence Intervals) for Preventive Health Behaviors Among the Male Foreign-Born White Population, 2000-2011 NHIS (N = 91,636).

	Model 1 (Crude)^a	Model 2 (Demographic Effects)^b	Model 3 (Socioeconomic Effects)^c	Model 4 (Health Access Effects)^d	Model 5 (Risk factor Effects)^e	Model 6 (Acculturation Effects)^f
U.S.-born	1.00	1.00	1.00	1.00	1.00	—
Flu vaccine
Foreign-born
Europe	0.86 (0.78, 0.95)	0.81 (0.73, 0.90)	0.76 (0.68, 0.85)	0.77 (0.68, 0.88)	0.77 (0.68, 0.88)	0.47 (0.36, 0.62)
Arab Nations	0.42 (0.27, 0.64)	0.56 (0.35, 0.89)	0.52 (0.32, 0.85)	0.58 (0.35, 0.99)	0.56 (0.34, 0.94)	0.38 (0.21, 0.67)
Pneumonia vaccine
Foreign-born
Europe	0.83 (0.75, 0.93)	0.79 (0.71, 0.88)	0.73 (0.65, 0.82)	0.68 (0.59, 0.78)	0.68 (0.59, 0.78)	0.42 (0.29, 0.60)
Arab Nations	0.39 (0.24, 0.63)	0.58 (0.33, 1.02)	0.53 (0.29, 0.97)	0.43 (0.21, 0.88)	0.43 (0.21, 0.87)	0.33 (0.16, 0.70)
PSA test
Foreign-born
Europe	0.76 (0.63, 0.93)	0.76 (0.61, 0.93)	0.68 (0.55, 0.85)	0.71 (0.57, 0.88)	0.71 (0.57, 0.88)	0.47 (0.27, 0.85)
Arab Nations	0.57 (0.26, 1.27)	0.81 (0.31, 2.13)	0.83 (0.28, 2.45)	1.34 (0.30, 6.04)	1.18 (0.27, 5.14)	0.91 (0.17, 4.74)

Note. NHIS = National Health Interview Survey; PSA = prostate-specific antigen; BMI = body mass index.

Unadjusted, crude estimates.

Adjusts for age (<45 years as referent) and marital status (married as referent).

Adjusts for variables in Model 2 plus education (Bachelor’s degree or higher as referent), employment (employed as referent), and poverty ratio (≥200% as referent).

Adjusts for variables in Model 3 plus health insurance coverage (yes as referent) and place most often received care (doctor’s office/HMO as referent).

Adjusts for variables in model 4 plus smoking history (no as referent) and BMI (normal as referent).

Adjusts for variables in model 5 plus years in the United States (U.S.-born as referent).

Discussion

The objectives of this study were to estimate and compare the age-adjusted prevalence of not receiving recommended vaccines and prostate cancer screening among U.S.- and foreign-born White men from Europe and the Arab Nations. In addition, this study examined the association between region of birth and preventive health behaviors before and after controlling for potential confounders. The three main findings were that foreign-born White men from the Arab Nations reported: (a) lower flu vaccine uptake; (b) lower pneumonia vaccine uptake; and (c) no differences in PSA testing when compared to U.S.- and foreign-born White men.

To our knowledge, this is the first population-based study to evaluate flu and pneumonia vaccine uptake between U.S.- and foreign-born men, in particular foreign-born men from the Arab Nations. Lebrun (2012) evaluated foreign-born adults in Canada and the U.S. to determine whether acculturation characteristics were associated with health care experiences, including flu vaccine uptake. Results indicated that there were no differences in receipt of a flu vaccine between foreign-born adults living in the United States <10 years or 10 years or longer. Vlahov et al. (2012) evaluated access, attitudes, and beliefs about flu vaccines in Harlem and South Bronx communities. Regardless of whether they had access to a health care provider, foreign-born adults were four times more likely to express lack of interest in getting the seasonal flu vaccine (Vlahov et al., 2012). Neither of these studies compared U.S.- and foreign-born men. While it does appear that foreign-born individuals are less likely to receive preventive vaccines, it is not possible to compare our results directly to other studies.

No differences were identified in PSA testing estimates between U.S.- and foreign-born men from the Arab Nations. Research has produced mixed results when examining PSA testing among foreign-born men. Consedine et al. (2006) examined digital rectal exam and PSA testing estimates among men from seven ethnic groups and compared U.S.-born European Americans with foreign-born Eastern European men. They identified that Eastern European immigrants reported fewer tests than their U.S.-born counterparts (Consedine et al., 2006). Singh and Hiatt (2006) identified that foreign-born men were 23% less likely to report having a PSA test in the past year before and after controlling for demographic, socioeconomic, and geographic confounders. However, when disaggregated by race and ethnicity, there were no significant differences between U.S.- and foreign-born non-Hispanic White men (Singh & Hiatt, 2006).

In Michigan, studies have been conducted evaluating PSA testing estimates among Arab American men. Arab American men reported higher estimates of PSA testing when compared with Hispanics and American Indians yet had lower estimates than African Americans and the general population (Yassine et al., 2010).

In New York, focus groups with Arab Americans reported that a majority of men had never been screened for cancer (Shah et al., 2008). Although these screening estimates were higher than some racial and ethnic groups, these studies were conducted regionally and results may be limited in generalizability to the rest of the United States.

Cultural context may influence screening estimates. One study about Arab Americans’ perspectives on health care suggested that preventive care is generally not practiced among Arab Americans (Aboul-Enein & Aboul-Enein, 2010). In addition, several qualitative studies have been conducted among Arab Americans to understand the barriers associated with screening. Three focused on women only (Kawar, 2013; Salman, 2012; Schwartz, Fakhouri, Bartoces, Monsur, & Younis, 2008) and one included men (Shah et al., 2008). One study investigated barriers to breast cancer screening for Jordanian and Palestinian women in the United States (Kawar, 2013). The authors reported that factors such as embarrassment, fatalism, the use of traditional healers, citizenship and language issues, stigmatization of cancer, and ignorance about cancer screening were major barriers to breast cancer screening. Another qualitative study explored participation in breast and cervical cancer screening among immigrant Arab American Muslim women (Salman, 2012). The findings were similar to Kawar’s study with additional barriers of transportation, lower income, older age, and not having a referral from their physician (Salman, 2012). The study by Schwartz et al. (2008) indicated that women who did not receive a mammogram were more likely to have no education, be unmarried, have no health insurance, have been in United States for 0 to 10 years, and originate from Iraq (Schwartz et al., 2008). The study that included Arab American men and women (Shah et al., 2008) displayed many of the barriers identified above in addition to factors such as societal discrimination and difficulty in navigating the complexity of the health care system (Shah et al., 2008).

Researchers have garnered important information from the studies above, which may help explain the findings of the current study. Health forums in Michigan have been reported to be effective at increasing cancer screening estimates. For example, among Arab American men who attended a cancer forum, 28.9% obtained a PSA test (Vicini et al., 2012). Therefore, such educational forums may be useful in increasing screening estimates for other preventive behaviors, such as flu and pneumonia vaccines.

This study is not without strengths and limitations. Among the strengths of this study are the use of multiple years of a national representative sample and the large sample size, which allows the ability to control for numerous potential confounders. Furthermore, our study builds on existing research evaluating Arab Americans using restricted data from the NHIS by unmasking differences that may not be revealed when evaluating foreign-born adults from the Middle East as a proxy for Arab Americans. Previous research evaluating the health of foreign-born Arab Americans is limited by including respondents who reported that they were not born in the United States and were born in one of the 25 countries included in the Middle East region variable. Not all of the 25 countries included in the Middle East region variable comprise the Arab Nations. This study also had limitations that may have affected the findings. The use of self-report data can be problematic. However, self-report data has been identified to be consistent with medical audits of vaccines (Grimaldi-Bensouda et al., 2013; Llupia et al., 2012) and prostate cancer screenings (Hall et al., 2004).

This study using national data suggests that Arab American men are less likely to receive flu or pneumonia vaccines compared with U.S.-born non-Hispanic White men. The findings move forward the discourse on Arab American health and the importance of disaggregating Arab Americans from the non-Hispanic White population given that there are differences in their health behaviors. Health care providers addressing the immunization and cancer screening needs of this population should be trained to provide culturally competent care and health education, which may lessen the potential barriers due to discrimination, spirituality, fatalism, and immigration fears addressed above. Future research should collect qualitative data to better understand attitudes, behaviors, and knowledge as they relate to preventive health behaviors among Arab American men.

Footnotes

Authors’ Note

The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the Research Data Center, the National Center for Health Statistics, or the Centers for Disease Control and Prevention.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research and/or authorship of this article: This study was funded by an internal grant from Oakland University’s Prevention Research Center.

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