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Understanding the relationship between race/ethnicity, birthplace, and health outcomes is important for reducing health disparities. CUNY SPH MPH graduate John Croft and colleagues assessed the relationship between racial/ethnic identity and minority racial/ethnic status in country of birth on influenza vaccination among New York City (NYC) adults. The study used data from the 2015–2019 NYC Community Health Surveys (CHS), annual telephone surveys conducted by the NYC Department of Health and Mental Hygiene.
There are notable racial and ethnic disparities in influenza vaccination and mortality rates. Discrimination and unequal treatment in the healthcare system significantly impact health outcomes for racial/ethnic minorities. Higher levels of perceived discrimination correlate with decreased likelihood of receiving healthcare services, including vaccinations.
Nativity also influences vaccination uptake, with U.S.-born adults generally having higher vaccination rates than foreign-born counterparts. However, previous studies have found that foreign-born Black adults exhibit higher vaccination rates than U.S.-born Black adults, illustrating the “healthy immigrant paradox” where immigrants often have better health outcomes despite facing socioeconomic challenges and discrimination.
The current study captured self-reported influenza vaccination status, racial and ethnic identity, and minority status in country of birth. (Minority status in country of birth was determined by comparing participants’ self-reported race/ethnicity with the racial/ethnic makeup of their country of birth.)
While various studies have addressed the associations between race/ethnicity and vaccine uptake, as well as nativity status and vaccine uptake, the authors know of no other study that has assessed these factors together with an analysis of minority status by country of birth.
Before adjusting for racial/ethnic minority status in country of birth and confounders, the team found lower influenza vaccination prevalence for Black adults compared with White adults, which agrees with previous studies. Similar to a prior study of nativity and influenza vaccination, their univariate model demonstrated U.S.-born adults had higher vaccination prevalence compared with foreign-born adults.
Notably, the study found that minority status in country of birth modified the relationship between race/ethnicity and influenza vaccination uptake. Among those participants classified as belonging to the racial/ethnic minority in their country of birth, Black and Hispanic adults had lower vaccination rates compared with White adults; however, among those belonging to the racial/ethnic majority in their country of birth, Black and Hispanic adults had higher rates compared with White adults.
This finding provides insight into the “healthy immigrant paradox” and suggests the influence of early life experiences on health behaviors. The “socio-ecological resilience model” suggests that positive early experiences can buffer against later adversity, potentially explaining better health outcomes for those who grew up as racial/ethnic majorities in their birth countries.
“The study highlights the complex relationship between race/ethnicity, nativity, and influenza vaccination,” says Croft. “Understanding these dynamics is crucial for addressing health disparities and improving vaccination rates among minority groups. But further research is needed for us to understand the underlying mechanisms driving these differences.”
The publication of this paper is the long-term outcome of Croft’s master’s essay. His instructor, Associate Professor Elizabeth Kelvin found his study to be both innovative and important, and encouraged him to pursue getting it published. Croft then worked with Kelvin and with Assistant Professor Chloe Teasdale and Associate Professor Sasha Fleary to strengthen the study and prepare it for publication. “I learned so much in this process,” Croft observes. “Beyond helping me publish my first peer-reviewed paper, it prepared me for the job I’m doing now at DOHMH.”
As an MPH graduate, Croft won a Council of State and Territorial Epidemiology (CSTE) Applied Epidemiology Fellowship with a two-year placement at the New York City Department of Health and Mental Hygiene (DOHMH), where he currently conducts surveillance and investigation of food- and water-borne disease outbreaks within the Bureau of Communicable Diseases.
“Earning my public health degree from one public institution and starting my career at another public institution just makes sense to me,” Croft says. “Affordability was key in that equation. And CUNY SPH offered so much flexibility, making it possible for me to continue working full-time while earning my master’s degree. I was able to graduate debt-free, which in turn enabled me to pursue my interests rather than focusing on how to pay down loans.”
John L. Croft, Chloe A. Teasdale, Sasha Fleary, Elizabeth A. Kelvin, Racial and ethnic minority status in country of birth modifies racial and ethnic disparities in influenza vaccination among New York City adults, Annals of Epidemiology, Volume 95, 2024, ISSN 1047-2797, https://doi.org/10.1016/j.annepidem.2024.05.008
