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Acculturation to Western Society as a Risk Factor for High Blood Pressure: A Meta-Analytic Review

From the Brigham Young University, Provo, Utah (P.R.S., T.B.S.); University of Florida, Gainesville, Florida (M.L.); Auburn University, Auburn, Alabama (L.B.).

Address correspondence and reprint requests to Patrick R. Steffen, PhD, 284 Taylor Building, Brigham Young University, Provo, UT, 84602. E-mail steffen{at}byu.edu

Objective: A number of studies have documented that acculturation to western society is related to an increase in blood pressure (BP). Although there is evidence that higher socioeconomic status appears related to better cardiovascular health, increasing acculturation to western society appears related to worse cardiovascular health. The purpose of this meta-analysis was to investigate the association between acculturation and BP.

Methods: Literature searches yielded 125 relevant research manuscripts, which were coded by teams of two independent raters. This study was conducted in 2003 and 2004, and research databases such as MEDLINE and PsychINFO were searched through 2004. Measures of association (effect sizes) were extracted for both systolic blood pressure (SBP) and diastolic blood pressure (DBP) readings. Random effects models were used to analyze the resulting data.

Results: The overall effect sizes associated with acculturation were 0.28 for SBP and 0.30 for DBP, with increasing acculturation to western society related to higher BP. More acculturated individuals had an average of 4 mm Hg higher BP than less acculturated individuals, which is similar to the effect sizes of known risk factors for high BP such as diet and physical activity. The effects of acculturation on BP appear to be universal, with similar effect sizes found across all regions of the world. Change in BP due to acculturation was not related to body mass index (BMI) or cholesterol but was related to length of residence in the new culture, with the largest effect sizes seen on initial entry and then decreasing rapidly within the first few years. Sudden cultural changes, such as migration from rural to urban settings, resulted in the largest effect sizes, which finding supports the hypothesis that the stress of cultural change is important role in the acculturation effect.

Conclusions: Acculturation to western society is associated with higher BP, and the distress associated with cultural change appears to be more influential than changes in diet or physical activity. Future studies would benefit from investigating how cultural change affects health and examining whether some nonwestern cultural values and practices are health protective.

Key Words: acculturation • blood pressure • stress • health behavior • meta-analysis

Abbreviations: BP = blood pressure; SBP = systolic blood pressure; DBP = diastolic blood pressure; SES = socioeconomic status; BMI = body mass index.