Investigating acculturation in context as a framework for understanding cognition in Hispanics/Latinos of the Hispanic Community Health Study/Study of Latinos.

OBJECTIVES: Traditional risk factors for cognitive impairment in non-Latino White adults do not manifest the same level of risk in Latinos. Despite research investigating culturally relevant factors, including acculturation, as it relates to Latino cognition, few studies have incorporated contextual factors for a more wholistic approach. We investigated acculturation-related factors within the context of socioenvironmental factors to study cognition in 8,476 self-identified Hispanic/Latino adults 45 years and older participating in the Hispanic Community Health Study/Study of Latinos baseline visit (2008-2011). METHODS: Acculturation-related (e.g., nativity, social/language-based) and socioenvironmental contextualizing factors at the individual-level (e.g., social network size, social isolation) as well as the neighborhood-level (e.g., income inequality, deprivation) were determined via questionnaire or geospatial coding. Cognitive tests included verbal learning and memory, letter fluency and digit symbol substitution. We included all acculturation in context variables in the same regression models as predictors of the separate cognitive outcomes (i.e., global and the four test-specific cognitive scores) adjusting for age at baseline, sex, and education. RESULTS: Higher language- and social-based acculturation scores, later ages of migration, US-based parental nativity, greater familial structural support, fewer experiences of unfair treatment, as well as lower levels of neighborhood gentrification, income inequality, and deprivation were associated with higher global cognition. Many of these same variables were associated with test-specific cognitive performance. CONCLUSION: This study, one of the first of its kind in Hispanic Community Health Study/Study of Latinos, suggests that contextualizing acculturation as it relates to cognition may point toward specific factors that may influence successful aging in middle-aged and older Hispanics/Latinos.