Public Health Commons^™

Equine Bronchial Epithelial Cells Are Susceptible To Cell Entry With A Sars-Cov-2 Pseudovirus But Reveal Low Replication Efficiency, Rebecca M Legere, Angelica R Allegro, Yvonne Affram, Bibiana Petri Da Silveira, Jennifer L Fridley, Kelsey M Wells, Numan Oezguen, Robert C Burghardt, Gus A Wright, Jeroen Pollet, Angela I Bordin, Paul De Figueiredo, Julian L Leibowitz, Noah D Cohen

Faculty, Staff and Students Publications

Objective: To examine the susceptibility of cultured primary equine bronchial epithelial cells (EBECs) to a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pseudovirus relative to human bronchial epithelial cells (HBECs).

Sample: Primary EBEC cultures established from healthy adult horses and commercially sourced human bronchial epithelial cells (HBECs) were used as a positive control.

Methods: Angiotensin-converting enzyme 2 (ACE2) expression by EBECs was demonstrated using immunofluorescence, western immunoblot, and flow cytometry. EBECs were transduced with a lentivirus pseudotyped with the SARS-CoV-2 spike protein that binds to ACE2 and expresses the enhanced green fluorescent protein (eGFP) as a reporter. Cells were transduced …

Maternal Metabolism Influences Neural Tube Closure, Rachel A Keuls, Richard H Finnell, Ronald J Parchem

Faculty, Staff and Students Publications

Changes in maternal nutrient availability due to diet or disease significantly increase the risk of neural tube defects (NTDs). Because the incidence of metabolic disease continues to rise, it is urgent that we better understand how altered maternal nutrient levels can influence embryonic neural tube development. Furthermore, primary neurulation occurs before placental function during a period of histiotrophic nutrient exchange. In this review we detail how maternal metabolites are transported by the yolk sac to the developing embryo. We discuss recent advances in understanding how altered maternal levels of essential nutrients disrupt development of the neuroepithelium, and identify points of …

Il17a Blockade With Ixekizumab Suppresses Muvb Signaling In Clinical Psoriasis, Scott A Ochsner, Mesias Pedroza, Rudolf T Pillich, Venkatesh Krishnan, Bruce W Konicek, Ernst R Dow, So Young Park, Sandeep K Agarwal, Neil J Mckenna

Faculty, Staff and Students Publications

Unbiased informatics approaches have the potential to generate insights into uncharacterized signaling pathways in human disease. In this study, we generated longitudinal transcriptomic profiles of plaque psoriasis lesions from patients enrolled in a clinical trial of the anti-IL17A antibody ixekizumab (IXE). This dataset was then computed against a curated matrix of over 700 million data points derived from published psoriasis and signaling node perturbation transcriptomic and chromatin immunoprecipitation-sequencing datasets. We observed substantive enrichment within both psoriasis-induced and IXE-repressed gene sets of transcriptional targets of members of the MuvB complex, a master regulator of the mitotic cell cycle. These gene sets …

Retrospective Evaluation Of The Covid-19 Contact Tracing Program At The Maine Center For Disease Control And Prevention, Elisabeth Brewington Mha, Mph, Ben K. Greenfield Phd, Jessica Purser Phd

Journal of Maine Medical Center

Introduction: Despite the widespread use of contact tracing efforts throughout the COVID-19 pandemic, there are limited findings available about best practices and recommendations. The Maine Center for Disease Control and Prevention contracted staff to conduct COVID-19 contact tracing from August 2020 through February 2022. A retrospective evaluation of this program was conducted to share lessons learned with public health and health care leaders for future use.

Methods: Contracted contact tracing staff participated in facilitated discussions structured by the Strengths, Weaknesses, Opportunities, and Threats analysis framework. Three sessions were recorded and transcribed, and qualitative analysis through thematic review and evaluation coding …

Who Left The Hospital Against Medical Advice During The Early Covid-19 Pandemic?, Bryan Werner, Se Won Lee

HCA Healthcare Journal of Medicine

Background

Patients leaving against medical advice (AMA) presents a challenge to hospitals as they try to manage costs and improve patient outcomes in an ever-increasing competitive market. Investigating AMA discharges that occurred during the early COVID-19 pandemic presents a unique opportunity to better understand this phenomenon and be better prepared for the future.

Methods

This retrospective analysis of 34 379 patients from a nationwide private healthcare system across 20 states analyzed patients during the early stages of the pandemic who chose to leave against medical advice (AMA) after being admitted with COVID-19 infection and identified several patient characteristics associated with …

Evaluation Of A Faculty Fellows Program In Science Communication, Stacy Stanifer, Beverly Delidow, Kathy Rademacher, Luz Huntington-Moskos, Kelly Kennoy, Amanda Thaxton-Wiggins, Craig Wilmhoff, Ellen J. Hahn

Journal of Appalachian Health

Introduction: Science communication plays a crucial role in tackling pressing regional, national, and global health issues. Effective communication with various audiences is integral to dissemination of science findings.

Purpose: This study evaluates changes in self-efficacy and attitudes toward science communication skills over time and also assesses program outcomes and satisfaction with a Faculty Fellows in Science Communication (FFSC) program among faculty (N = 30) with interest in environmental health science and/or education in Appalachia Kentucky.

Methods: A mixed methods program evaluation was employed using longitudinal data on behaviors, attitudes, and program outcomes from three cohorts of Faculty Fellows who participated …

The Appalachian Gap In Preventable Hospitalizations: Are We Seeing Any Progress?, Rachel Hogg-Graham, Juan Lang, Teresa M. Waters

Journal of Appalachian Health

Introduction: Previous studies have documented geographic variation in preventable hospitalizations between rural and urban areas, but much less is known about preventable hospitalization patterns between heterogeneous rural areas. Unique challenges related to access of care and poverty may put the rural Appalachian Region at risk for higher rates of preventable hospitalizations.

Purpose: This study examines whether within-rural differences in Kentucky’s preventable hospitalization rates exist and how these differences may be changing over time.

Methods: Longitudinal and geographic trends in county-level preventable hospitalization rates were examined using Kentucky hospital discharge data from 2016 to 2019. Regression models were run to determine …

Impact Of Interprofessional Student Teams At A Remote Area Medical Event In Rural Appalachia, Emily K. Flores, Karilynn Dowling, Caroline Abercrombie Md, Rick L. Wallace

Journal of Appalachian Health

Introduction: Education in interprofessional collaboration is vital to expand healthcare access, especially in areas of higher disparity. To address this need, interprofessional faculty collaborators incorporated undergraduate and graduate health profession students into teams at an annual Remote Area Medical event in rural Appalachia between 2017 and 2020.

Purpose: This article evaluates the impact of an interprofessional student teams model on both patient care experience and students’ interprofessional collaboration attitudes and behaviors.

Methods: Student volunteers completed pre- and post-event surveys containing questions about demographics, open-ended questions, and questions from two instruments: the Student Perceptions of Interprofessional Clinical Education-Revised Instrument, Version 2 …

Knowledge, Awareness, And Perceived Barriers Regarding Cervical Cancer Screening Among Bangladeshi Women Suffering From Cervical Cancer: A Cross-Sectional Study, Muhammed Mohibul Islam, Farhana Sultana, Md Hasan Shahriar Rahman, Nandita Islam Pia, Md. Al Hasibuzzaman, Arman Ahmed, Mohammed Shamim Hasan, Md Kayes Mahmud, Rabeya Akter, Md. Saqline Mostaq, Mohammad Nurul Amin

Makara Journal of Health Research

Background: This study aimed to evaluate the knowledge, awareness, and perceived barriers regarding cervical cancer screening among women in Bangladesh.

Methods: A hospital-based survey was conducted from January to April 2021 among 200 female participants. Statistical analysis of this study was performed by using Stata 13 (StataCorp LP, 4905 Lakeway Drive, College Station, TX 77845, USA), where Chi-square test was used for the determination of the correlation among different variables.

Results: Among the participants, 86.5% were rural residents, 96% were married, 87.5% were housewives, 47% were uneducated, and 93.5% lived on a husband’s income. Moreover, 84.5% hadn’t …

A Qualitative Exploration Of Exclusive Breastfeeding Practices Among Karen Ethnicity Mothers In Northern Thailand Remote Rural Areas, Wanchalerm Ritthimon, Aksara Thongprachum, Jukkrit Wungrath

Kesmas

Low exclusive breastfeeding rates among the Karen ethnic group in Northern Thailand's remote rural areas underscore the need to understand knowledge, attitudes, and social support to develop targeted interventions. This qualitative study examined exclusive breastfeeding practices and the factors influencing breastfeeding behavior among 14 Karen Ethnicity Mothers (KEMs) in Northern Thailand. A structured interview was used to collect the data, a triangular method to determine the data's validity, and a content analysis method to examine the data revealed seven themes and 14 subthemes. This study identified three key factors for successful breastfeeding: self-motivation, social support, and effective problem management, which …

Healthy Lifestyle Behaviors And Sociodemographic Characteristics Among Medical Students In Indonesia During The New Normal Era: A Cross-Sectional Study, Sharren Shera Vionnetta, Tommy Nugroho Tanumihardja, Kevin Kristian

Kesmas

This study aimed to identify medical students’ healthy lifestyle behaviors during the new normal era and to determine its relationship with sociodemographic factors, bearing in mind that, as future physicians and health role models, medical students play an important role in adopting and promoting healthy lifestyle behaviors to reduce the risk of future health problems as well as optimize communities’ health status. This cross-sectional study was conducted at the School of Medicine and Health Sciences of Universitas Katolik Indonesia Atma Jaya, with 111 medical students selected through stratified random sampling. Data were collected using sociodemographic characteristics (sex, residence, year of …

Development Of A Medication Compliance Determinant Instrument For Low-Middle Literate Patients With Type 2 Diabetes Mellitus, Ivans Panduwiguna, Rani Sauriasari, Ratu Ayu Dewi Sartika, Woro Riyadina, Fransiskus Samuel Renaldi

Kesmas

Diabetes, a leading cause of 6.7 million deaths in 2021, poses a significant challenge despite existing interventions. Non-adherence to treatment remains a barrier to diabetes management. However, a comprehensive instrument to assess medication adherence determinants in diabetes patients’ population in Indonesia with low-medium literacy levels and following the sociocultural characteristics of Indonesian society has been lacking. This study aimed to develop and evaluate a valid and reliable instrument for measuring medication adherence in type 2 diabetes mellitus patients based on the Borg and Gall model. Through the input of an expert panel, a valid and reliable instrument was developed, which …

Effects Of Early Hospital-Based Palliative Care Consultation On Length Of Stay And Costs Of Care At Indonesian Tertiary Hospital, Rudi Putranto, Hamzah Shatri, Wulyo Rajabto, Sumariyono Sumariyono, Edward Faisal, Sihwastuti Sihwastuti

Kesmas

Despite the numerous benefits of palliative care for cancer patients, there have been few studies on palliative care services for terminal cancer patients, particularly near the end of life. This study aimed to evaluate whether there were differences in length of stay and cost of care associated with how early or late a patient received palliative care intervention. Another objective was to compare the length of stay and cost of care of those who received palliative care intervention and those who did not. This study used a cohort retrospective design at Hospital A, Jakarta, Indonesia, from January to December 2019. …

Risk Factors Of Worsening Of Systemic Lupus Erythematosus In Patients At Two Tertiary Hospitals In Jakarta, Giri Aji, Mondastri Korib Sudaryo, Ratna Djuwita, Sukamto Sukamto

Kesmas

Systemic Lupus Erythematosus (SLE) is a prototypical multiorgan autoimmune disease with a fluctuating and chronic disease course. As an emerging disease in this century, SLE will burden stakeholders and the country. This study was conducted to determine the prognostic factors for SLE worsening, especially in ambulatory patients. This ambispective study used logistic regression to view the risk factors for worsening SLE in patients. Anemia, age, body mass index, education level, employment status, marital status, hydroxychloroquine, and immunosuppressants were the independent variables in this study. This study concludes that anemia is statistically significant and, therefore, a risk factor for worsening SLE …

Maternal Factors Influencing Postpartum Depression In Indonesia, Nurhalina Sari, Nova Muhani, Friska Novira Maya Dewi

Kesmas

The estimated prevalence of postpartum depression differs in developed and developing countries. Due to the increasing number of cases in developing countries like Indonesia, postpartum depression has become a serious issue. This study aimed to identify factors influencing postpartum depression in Bandar Lampung, Indonesia, in 2023 using the Edinburgh Postnatal Depression Scale instrument. This study employed a cross-sectional design with a sample size of 251 respondents, selected based on inclusion and exclusion criteria using a purposive sampling technique. The multiple logistic regression results indicated that women with abortion records had a three times higher risk (95% CI = 1.394–7.648; p-value …

Analysis Of Climate And Environmental Risk Factors On Dengue Hemorrhagic Fever Incidence In Bogor District, Ririn Arminsih Wulandari, Tria Rahmawati, Al Asyary, Fajar Nugraha

Kesmas

Dengue Hemorrhagic Fever (DHF) is transmitted through the bites of Aedes aegypti and Aedes albopictus mosquitoes and is still becoming endemic in Bogor District. This quantitative correlation study with an ecological approach aimed to analyze how DHF incidence is influenced by climate factors, population density, Larvae Free Rate (LFR), and the area altitude factor. Secondary data were obtained from the Bogor Regency Health Office; the Central Bureau of Statistics of Bogor District; and the Meteorology, Climatology, and Geophysics Agency. In this study, the spatial analysis method was also used, but only on the area altitude factor. The study’s results showed …

Association Between Insurer Connectivity In Appalachian Population Health Networks And Preventable Hospitalizations: Evidence From Kentucky, Rachel Hogg-Graham, Kelsey R. Gatton, Rick Ingram, Glen P. Mays

Journal of Appalachian Health

Introduction: Addressing complex health and social needs requires cross-sector collaboration to deliver medical, social, and population health services at the community level. Capacity in community health and social services networks may be constrained in regions like Appalachia due to the combined effects of rurality and persistently poor health and social outcomes. One way that cross-sector networks serving low-resource communities can expand their capacity is by engaging partners, like health insurers, who can leverage resources from outside the local area.

Purpose: This study examines insurer connectivity in cross-sector networks across Kentucky’s geographic regions and the association between connectivity and the probability …

The Ninth Myth Of Appalachia, Randolph Wykoff

Journal of Appalachian Health

Many stereotypes afflict our much-maligned region, and the Jonesborough­­–Washington County History Museum displays eight of these "myths of Appalachia." Here, our Editor-in-Chief suggests a ninth—that the people of Appalachia "do not care" about their health—and argues that regional health disparities result not from apathy but from a confluence of socioeconomic factors.

Patient Engagement In Patient Portals In Appalachia V. Surrounding U.S. Census Regions: An Analysis Of Hints (Health Information National Trends Survey) Data, 2017–2020, Heather Lea Tudor, Rick Ingram, Sarah Wackerbarth

Journal of Appalachian Health

Introduction: Those living in the Appalachian Region face a greater number of significant health disparities than residents of other areas of the U.S. Patient portals can decrease disparities, increase health literacy, and improve health outcomes.

Purpose: This study explores if those living in the Appalachian Region are offered access to and use their patient portals differently than those in the surrounding U.S. Census regions. Additionally, the study aims to determine if there was a difference in reported reasons for the non-use of patient portals.

Methods: A secondary analysis was completed using data from the National Cancer Institute's Health Information National …

Self-Reported Consumption Of Bottled Water V. Tap Water In Appalachian And Non-Appalachian Kentucky, Jason W. Marion

Journal of Appalachian Health

Introduction: Quantitative studies on drinking water perceptions in Appalachia are limited. High-profile water infrastructure failures in the U.S. and Eastern Kentucky, coupled with human-made and natural disasters in the Appalachian Region, have likely impacted opinions regarding tap water.

Purpose: To use existing unexplored data to describe baseline tap water v. bottled water consumption in Kentucky.

Methods: Telephone-based cross-sectional data were obtained from the 2013 Kentucky Health Issues Poll (KHIP) directed by the Foundation for a Healthy Kentucky. Among many items in KHIP, self-reported consumption of bottled water over tap water, reasons for bottled water use, and demographic data were obtained. …

Comparison Of Prevalence And Associated Factors Of Multisystem Health Symptoms Among Workers In The Gas Station Area, Thailand, Chan Pattama Polyong, Anamai Thetkathuek

Kesmas

This cross-sectional study aimed to compare the prevalence of multisystem health symptoms (MHS) of workers in gas station areas before and after their employment and examine the factors affecting the MHS of workers. Data were collected by an interview questionnaire from 200 workers inside and outside refueling areas at eight gas stations in Rayong Province, Thailand. This study found that employees had a statistically significant increase in the prevalence of current MHS in comparison to before starting work (p-value<0.05), with 31.5%. Working overtime for more than 6 hours per week led to respiratory symptoms (OR = 2.63, 95% CI = 1.14–6.07) and psychological symptoms (OR = 2.69, 95% CI = 1.12–6.49). Wearing respiratory protective equipment for less than three hours affected ear/throat/nose systems (OR = 4.26, 95% CI = 1.43–12.65). Petrol refueling resulted in liver (OR = 2.32, 95% CI = 1.4–12.65) and eye symptoms (OR = 2.57, 95% CI = 1.10–5.39). Therefore, gas station owners should set up enclosed rooms to reduce the duration of fuel exposure, and workers should wear personal protective equipment when refueling or near the dispenser.

Workload And Stress Level In Non-Covid-19 Zoning Nurses At National Central Public Hospital Jakarta, Zakiyah Zakiyah, Ulfah Nuraini Karim, Aliana Dewi, Siti Nuraini, Aan Sutandi, Rony Darmawansyah Alnur

Kesmas

The COVID-19 pandemic has increased the workload for nurses directly handling COVID-19 patients and those working in non-COVID-19 zones. As the number of COVID-19 cases rises, nurses face psychological problems, including stress. This study aimed to determine the relationship between workload and stress levels in a non-COVID-19 zoning ward using a cross-sectional approach and Spearman’s correlation test conducted on 94 nurses at one hospital in Jakarta, Indonesia, selected through simple random sampling. The workload questionnaire with 15 items and the DASS 42 questionnaire were used to measure stress levels. The results indicated that most nurses (73.4%) experienced a heavy workload. …

Prediction Of Factors For Patients With Hypertension And Dyslipidemia Using Multilayer Feedforward Neural Networks And Ordered Logistic Regression Analysis: A Robust Hybrid Methodology, Wan Muhamad Amir W Ahmad, Mohamad Nasarudin Bin Adnan, Norhayati Yusop, Hazik Bin Shahzad, Farah Muna Mohamad Ghazali, Nor Azlida Aleng, Nor Farid Mohd Noor

Makara Journal of Health Research

Background: Hypertension is characterized by abnormally high arterial blood pressure and is a public health problem with a high prevalence of 20%–30% worldwide. This research combined multiple logistic regression (MLR) and multilayer feedforward neural networks to construct and validate a model for evaluating the factors linked with hypertension in patients with dyslipidemia.

Methods: A total of 1000 data entries from Hospital Universiti Sains Malaysia and advanced computational statistical modeling methodologies were used to evaluate seven traits associated with hypertension. R-Studio software was utilized. Each sample's statistics were calculated using a hybrid model that included bootstrapping.

Results: Variable …

Evaluation Of Self-Confidence In Women With Chronic Disease, Sebahat Atalıkoğlu Başkan, Sevinç Kose Tuncer, Demet Güneş

Makara Journal of Health Research

Background: Self-confidence, which is an important emotional need in women, affects women's quality of life. This research was conducted to evaluate the self-confidence of women with chronic diseases.

Methods: This study was conducted at the internal medicine clinic of Erzincan Mengücek Gazi Training and Research Hospital in Turkey between August 2019 and June 2020. The sample consisted of 339 female patients with chronic diseases who agreed to participate in this study. Data were collected through face-to-face interviews using information form and the Women’s Self-Confidence Scale.

Results: The mean total score of the participants was 136.40 ± 24.92. …

Related Factors With Self-Management Behaviors Among Patients With Predialysis Chronic Kidney Disease: A Multicenter Study In Myanmar, Yoon Zarchi Wint, Jiraporn Lininger, Sirirat Leelacharas

Makara Journal of Health Research

Background: Self-management behavior is key to managing patients with predialysis chronic kidney disease (CKD) and is effective in slowing disease progression in impoverished Burmese patients with CKD. This study aimed to outline the association of personal and environmental factors with the self-management behaviors of people with predialysis CKD.

Methods: Using convenience sampling, this cross-sectional study included 84 individuals with predialysis CKD from two private hospitals in Myanmar. The interviewer-administered questionnaire included demographic information, the Health Literacy Short Form-12, the CKD knowledge questionnaire, the self-efficacy questionnaire, the Multidimensional Scale of Perceived Social Support, and the self-management behavior questionnaire. This …

Risk Factors Associated With Occupational Stress Among Malaysian Construction Professionals, Nur Syafiqah Fauzan, Nur Alia Farahanin Mohd Tajuddin, Neroshini Thanarejee, Dayana Hazwani Mohd Suadi Nata, Ezrin Hani Sukadarin, Mirta Widia

Makara Journal of Health Research

Background: Construction industries that focus on project-based nature, pressure, and long hours may lead to job-related stress among workers. In many emerging nations, robust economic growth plans generate occupational depression, anxiety, and stress among construction industry personnel. This study aims to determine the relationship between these items and the risk factors (demographic) among Malaysian construction professionals.

Methods: A cross-sectional study was carried out among 173 Malaysian construction professionals. A DASS-21 questionnaire is used to survey eligible respondents.

Results: Findings show that construction professionals have a high level of stress (54.9%), anxiety (48.5%), and depression (37%). Gender is …

The Prevalence Of Human Papillomavirus Vaccination Among Racial And Ethnic Minority Adolescents During The Covid-19 Pandemic, Chinenye Lynette Ejezie, Lara S Savas, Casey Durand, Ross Shegog, Paula Cuccaro

Faculty, Staff and Student Publications

BACKGROUND: Human papillomavirus (HPV) vaccination among adolescents has steadily improved over the past several years. However, research conducted to determine whether the COVID-19 pandemic disrupted this positive trend in HPV vaccine initiation among racial and ethnic minority adolescents is limited. Therefore, this study was conducted to determine if the COVID-19 pandemic and the resulting changes in the US health-care sector affected the increasing HPV vaccine initiation among non-Hispanic Black and Hispanic adolescents aged 13-17 years.

METHODS: Using a cross-sectional design to examine data from the National Immunization Survey-Teen (2019-2021), logistic regression and moderation analysis were used to model race-specific variations …

A Polygenic Risk Score For Alzheimer’S Disease Constructed Using Apoe-Region Variants Has Stronger Association Than Apoe Alleles With Mild Cognitive Impairment In Hispanic/Latino Adults In The Us, Tamar Sofer, Nuzulul Kurniansyah, Einat Granot-Hershkovitz, Matthew O Goodman, Wassim Tarraf, Iris Broce, Richard B Lipton, Martha Daviglus, Melissa Lamar, Sylvia Wassertheil-Smoller, Jianwen Cai, Charles S Decarli, Hector M Gonzalez, Myriam Fornage

Faculty, Staff and Student Publications

INTRODUCTION: Polygenic Risk Scores (PRSs) are summaries of genetic risk alleles for an outcome.

METHODS: We used summary statistics from five GWASs of AD to construct PRSs in 4,189 diverse Hispanics/Latinos (mean age 63 years) from the Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA). We assessed the PRS associations with MCI in the combined set of people and in diverse subgroups, and when including and excluding the APOE gene region. We also assessed PRS associations with MCI in an independent dataset from the Mass General Brigham Biobank.

RESULTS: A simple sum of 5 PRSs ("PRSsum"), each constructed based on a …

The Impact Of Vaccinations And Chronic Disease On Covid Death Rates, James L. Doti

Economics Faculty Articles and Research

This study presents a theoretical and empirical regression model to measure the efficacy of vaccinations in reducing COVID death rates across states over the 3/10/21 to 12/28/22 period. During that period, it was estimated that the availability of vaccinations resulted in a reduction of 427,000 COVID deaths in the nation. To arrive at that estimate, other covariants were held constant. In particular, it was found that chronic disease should be included as an explanatory variable to arrive at unbiased measures of the efficacy of vaccinations in reducing deaths. In addition, the percentage of people over the age of 65 was …

Association Between Acculturation, Dental Floss Use, Dental Visits And Unmet Dental Needs Among Asians In The United States: Findings From National Health And Nutrition Examination Survey (Nhanes) 2011–2018, Ting Luo, Kaylin Beiter, Tung Sung Tseng

School of Graduate Studies Faculty Publications

Objectives: The objectives of this study were to examine the associations between acculturation and dental floss, regular dental visits and unmet dental care needs among Asian Americans, as well as the moderating effects of these associations. Methods: This study analysed national representative samples from the National Health and Nutrition Examination Survey (NHANES) 2011–2018. A total of 2763 Asian Americans aged 20 and older were included in this analysis. The primary predictor, acculturation score, was determined by three questions: (i) language spoken at home (higher score for English), (ii) country of birth (higher score for United States) and (iii) length of …