Showing papers in "Journal of Immigrant and Minority Health in 2011"
TL;DR: This review includes what has been published concerning the health of African immigrants in the U.S. and draws on European studies to supplement this assessment, finding that the acquisition of risk factors for chronic diseases is poorly understood among African immigrants.
Abstract: As the number and diversity of Africans in the U.S. increases, there is a growing need to assess their health care needs and practices. Although infectious diseases have been a traditional point of contact between health care systems and African immigrants, there is a clear and unmet need to determine the risks and prevalence for chronic diseases. This review includes what has been published concerning the health of African immigrants in the U.S. and draws on European studies to supplement this assessment. While African immigrants arrive in the U.S. with some unique health problems, namely infectious diseases, they are generally healthier than African Americans of the same age. This 'healthy immigrant effect' has been well documented, but the acquisition of risk factors for chronic diseases such as coronary artery disease, hypertension, diabetes and cancer is poorly understood among African immigrants. More information must be gathered in the broad categories of chronic disease, health attitudes and health access to better promote the health of African immigrants.
228 citations
TL;DR: The authors draw from the literatures on health disparities and immigrant/refugee health, as well as direct program and research experience, to propose an approach for assessment of the diachronic interaction of ecological factors contributing to health disparities among immigrant/Refugee populations.
Abstract: While numerous factors contributing to racial/ethnic health disparities have been identified, the clustering and interaction of these factors as a syndemic or trajectory has not been well-studied (Starfield in Soc Sci Med 64:1355–1362, 2007; Singer in Soc Sci Med 39(7):931–948, 1994). More importantly, for immigrant/refugee populations, the interaction of contributing factors is not documented adequately enough to provide a solid framework for planning, implementation and evaluation of interventions aimed at reducing disparities. In this paper, the authors draw from the literatures on health disparities and immigrant/refugee health, as well as direct program and research experience, to propose an approach for assessment of the diachronic interaction of ecological factors (a trajectory, or “diachronic ecology”) contributing to health disparities among immigrant/refugee populations. It is our hope that this approach will contribute to the important effort to collect data supporting the development of interventions and policies that effectively address the dynamic processes through which health disparities are created, maintained, and changed.
119 citations
TL;DR: Examination of health status and access to care among Asian Americans by acculturation indicators showed that foreign-born Asians who interviewed in English more closely resembled US- born Asians than foreign- Born Asians who interviews in languages other than English, suggesting interview language may serve as a better measure for acculturations.
Abstract: We examined health status and access to care among Asian Americans by the following acculturation indicators: nativity, percent lifetime in the US, self-rated English proficiency, and interview language, to assess whether any measure better distinguishes acculturation. Data from the 2003 California Health Interview Survey were used to study the sample of 4,170 US-born and foreign-born Asians by acculturation indicators. We performed t-tests to compare differences in demographics, health status and behaviors, and access to care between the foreign-born and US-born Asians, and between various classifications within foreign-born and the US-born Asian group. Our results showed that foreign-born Asians who interviewed in English more closely resembled US-born Asians than foreign-born Asians who interviewed in languages other than English. Compared to interview language, dichotomizing the sample by other acculturation indicators showed smaller differences between the divided groups. Interview language may serve as a better measure for acculturation especially among foreign-born populations with a high proportion of limited English proficiency. In immigrant public health research studies, interview language may be used as an important covariate for health disparities.
101 citations
TL;DR: Community-based interventions proved valuable for improving the mental health of refugees, however, additional interventions and evaluations are required to draw consistent and conclusive judgments on best practice in dealing with refugee mental health issues.
Abstract: With large numbers of refugee arrivals and numerous barriers to accessing services it is especially important that resources are efficiently and effectively directed to address the health needs of refugees. Ten databases were utilised to conduct the review, returning 156 titles which were assessed for validity based on specified criteria. The 14 critically appraised articles included in this review consist of experimental research and discussions on best practice. Articles consistently demonstrated the benefit of community-based mental health service in improving mental health outcomes. Themes of cultural awareness, language, setting, and post-migration stressors emerged across the articles. In addition, the studies also point to the gaps in research of a longitudinal nature and ones that deal with scattered populations post migration. Community-based interventions proved valuable for improving the mental health of refugees. However, additional interventions and evaluations are required to draw consistent and conclusive judgments on best practice in dealing with refugee mental health issues.
101 citations
TL;DR: Although at arrival, US immigrants have a lower prevalence of overweight compared to native born individuals, prevalence increases with increased length of residence, independent of age and body mass index, and was modified by age at immigration.
Abstract: Although at arrival, US immigrants have a lower prevalence of overweight compared to native born individuals, prevalence increases with increased length of residence. It is unknown whether length of residence similarly affects diabetes. Data on adults aged 18–74 years from the National Health Interview Survey were pooled from 1997 to 2005 (n = 33,499). Diabetes prevalence by length of residence was estimated by multivariable logistic regression. Diabetes prevalence was higher with increased length of residence in the US, independent of age and body mass index (<5 years residence: 3.3%; 5–<10 year, 3.4%; 10–<15 year, 4.5%; 15+ year, 5.3%; P for trend <0.001). Length of residence had the largest effect on diabetes prevalence among immigrants who arrive at 25–44 years of age (prevalence: 1.4% for <5 year vs. 11.1% for 15+ year; odds ratio = 9.7 (95% CI: 5.2–18.1)). Despite differences in the associations between diabetes prevalence and length of residence by age at immigration, diabetes prevalence at 10–≤15 and 15± years was statistically similar in each age at immigration strata. Diabetes prevalence increased with length of residence, independent of age and obesity, and was modified by age at immigration. Diabetes prevalence reaches a plateau at 10+ years of residence and diabetes prevention efforts should, therefore, start soon after migration.
93 citations
TL;DR: Among the demographic, socioeconomic, physical, and cultural aspects of neighborhood context examined in this study, the most modifiable environment features that could prevent weight gain and its associated problems would be the built environmental factors such as greenness, park access, and mixed land use.
Abstract: The prevalence rate of obesity in the United States has been persistently high in recent decades, and disparities in obesity risks are routinely observed. Both individual and contextual factors should be considered when addressing health disparities. This study examines how Latino-white spatial segregation is associated with the risk of obesity for Latinos and whites, whether neighborhood socioeconomic resources, the built environment, and subcultural orientation serve as the underlying mechanisms, and whether neighborhood context helps explain obesity disparities across ethnic and immigrant groups. The study was based on an extensive database containing self-reported BMI measures obtained from driver license records in Utah merged with census data and several GIS-based data. Multilevel analyses were performed to examine the research questions. For both men and women, Latino residential isolation is significantly and positively linked to the risk of obesity; after controlling for immigrant concentration, this effect gets amplified. Moreover, for men and women, the segregation effect is partly attributable to neighborhood SES and the built environment; and only for women is it partly attributable to obesity prevalence in the neighborhood. Place matters for individual risk of obesity for both men and women and there are multifarious pathways linking residence to obesity. Among the demographic, socioeconomic, physical, and cultural aspects of neighborhood context examined in this study, perhaps the most modifiable environment features that could prevent weight gain and its associated problems would be the built environmental factors such as greenness, park access, and mixed land use.
86 citations
TL;DR: Sleep may be a mechanism through which health disparities between Mexican immigrants and U.S.-born Mexican Americans emerge, and chronic partial sleep deprivation may increase health risks directly and indirectly through impaired judgment.
Abstract: Negative acculturation, the increase in high-risk profiles as immigrants live longer in the U.S., is found for a range of health behaviors and outcomes among Latino populations. Yet it has never been explored with regard to sleep duration. Using the National Health Interview Survey, we investigate Mexican immigrant and U.S.-born Mexican-American sleep durations. U.S.-born Mexican Americans are around 40% (P < 0.05) more likely to be short sleepers than Mexican immigrants after adjusting for demographic characteristics. These relationships are attenuated with the addition of health behavior variables (OR = 1.25, n.s.). This is explained because U.S.-born Mexican Americans have higher rates of smoking and stress levels, both of which are associated with increased risks of short sleeping. Because chronic partial sleep deprivation may increase health risks directly and indirectly through impaired judgment, sleep may be a mechanism through which health disparities between Mexican immigrants and U.S.-born Mexican Americans emerge.
85 citations
TL;DR: Policy makers should focus on expanding the availability of regular sources of health care and immigrant health coverage to reduce disparities on mental health care utilization and targeted interventions should also focus on addressing immigrants’ language barriers, and providing culturally appropriate services.
Abstract: Immigration status is a likely deterrent of mental health care utilization in the United States. Using the Medical Expenditure Panel Survey and National Health Interview survey from 2002 to 2006, multivariable logistic regressions were used to estimate the effects of immigration status on mental health care utilization among patients with depression or anxiety disorders. Multivariate regressions showed that immigrants were significantly less likely to take any prescription drugs, but not significantly less likely to have any physician visits compared to US-born citizens. Results also showed that improving immigrants’ health care access and health insurance coverage could potentially reduce disparities between US-born citizens and immigrants by 14–29% and 9–28% respectively. Policy makers should focus on expanding the availability of regular sources of health care and immigrant health coverage to reduce disparities on mental health care utilization. Targeted interventions should also focus on addressing immigrants’ language barriers, and providing culturally appropriate services.
83 citations
TL;DR: Self reported indicators of a substantial burden of depression, and thoughts of self-harm among laborers surveyed are identified, and policy level intervention and implementation, is needed to improve working conditions, including minimum wages and regulation of working hours.
Abstract: Migrant workers comprise 80% of the population of the United Arab Emirates, but there is little research on their mental health. To determine the prevalence and correlates of depression among workers living in labor camps, we conducted a cross-sectional survey in labor camps in Al Ain city. The Depression Anxiety and Stress Scale (DASS-42) was used to assess depression and suicidal ideation among the study participants. Off the 319 contacted workers agreed to participate, however 239 fully completed the DASS-42. The prevalence of a score >=10 ("depression") was 25.1% (60/239). Depression was correlated with physical illness (97/301), (adjusted odds ratio-AOR = 2.9; 95% CI 2.26-5.18), working in construction industry (prevalence 124/304), AOR = 2.2; 95%CI 1.56-3.83), earning less than 1,000 UAE Dirham per month (prevalence 203/314), (AOR = 1.8; 95%CI 1.33-3.16), and working more than 8 h a day (prevalence 213/315), (AOR = 2.7; 95%CI 1.19-6.27). 20/261 (6.3%) of the study participants reported thoughts of suicide and 8/265 (2.5%) had attempted suicide. People with suicidal ideation were more likely to have a physical illness (AOR = 8.1, 95%CI 2.49-26.67), earn less than 1,000 UAE Dirham per month (AOR = 5.98, 95%CI 1.26-28.45), and work for more than 8 h a day (AOR = 8.35, 95%CI 1.03-67.23). The study identified self reported indicators of a substantial burden of depression, and thoughts of self-harm among laborers surveyed. Policy level intervention and implementation, is needed to improve working conditions, including minimum wages and regulation of working hours is recommended.
82 citations
TL;DR: In this paper, the authors identified contextual factors as well as attitudes, experiences and beliefs affecting HIV risk among recent Hispanic immigrants in New York and identified challenges to participant recruitment were identified which were related to the environments, characteristics of the populations, and the sensitive nature of the topic to be studied.
Abstract: Hidden/special populations such as new immigrants are hard-to-reach due to issues such as stigma, discrimination, fear of immigration authorities, and cultural norms. Such factors can affect the recruitment of participants for behavioral research, especially research which addresses stigmatizing conditions such as HIV/AIDS. This research involved a qualitative approach and methods. The study identified contextual factors as well as attitudes, experiences and beliefs affecting HIV risk among recent Hispanic immigrants in New York. During the course of this research, challenges to participant recruitment were identified which were related to the environments, characteristics of the populations, and the sensitive nature of the topic to be studied. Strategies including exploratory fieldwork and sensitivity to participants’ fear of “the system” were effective in recruiting individuals from this population. The authors discuss the strategies which facilitated recruitment of research subjects from these new Hispanic immigrant communities and the importance of behavioral research among these vulnerable communities.
76 citations
TL;DR: The foreign-born respondents had lower rates of alcohol abuse than the US-born, but some variations were noted by race-ethnicity, and the risk of clinical diagnosis due to traumatic events was higher for the foreign- born population.
Abstract: The knowledge of racial and ethnic variations in alcohol abuse among US immigrants is limited. We compared the prevalence and correlates of alcohol abuse among US foreign-born versus US-natives by race-ethnicity using data from the National Epidemiological Survey on Alcohol and Related Conditions. Alcohol abuse outcomes included clinical diagnosis, excessive drinking, and intoxication. The foreign-born respondents had lower rates of alcohol abuse than the US-born, but some variations were noted by race-ethnicity. The risk of clinical diagnosis due to traumatic events was higher for the foreign-born population. Future research should continue to investigate the role of stress, the specific traumatic events most problematic for immigrant groups, and the interplay of the original and host culture in shaping the patterns of alcohol abuse in the immigrant population.
TL;DR: Evidence is lacking to support that better oral health of acculturated immigrants is attributable to their improved dental attendance, and further researches involving other oral health behaviors and diseases and incorporating refined acculturation scales are needed.
Abstract: The impact of acculturation on systemic health has been extensively investigated and is regarded as an important explanatory factor for health disparity. However, information is limited and fragmented on the oral health implications of acculturation. This study aimed to review the current evidence on the oral health impact of acculturation. Papers were retrieved from five electronic databases. Twenty-seven studies were included in this review. Their scientific quality was rated and key findings were summarized. Seventeen studies investigated the impacts of acculturation on the utilization of dental services; among them, 16 reported positive associations between at least one acculturation indicator and use of dental services. All 15 studies relating acculturation to oral diseases (dental caries and periodontal disease) suggested better oral health among acculturated individuals. Evidence is lacking to support that better oral health of acculturated immigrants is attributable to their improved dental attendance. Further researches involving other oral health behaviors and diseases and incorporating refined acculturation scales are needed. Prospective studies will facilitate the understanding on the trajectory of immigrants’ oral health along the acculturation continuum.
TL;DR: Health promotion strategies aimed at South Asians in the US should take into account this holistic model of health and disease, while also recognizing that variations exist within South Asians, by gender and religion.
Abstract: To identify concepts of health and disease as part of a study on designing culturally-targeted heart disease prevention messages for South Asians. We conducted qualitative, semi-structured interviews in English, Hindi and Urdu with 75 respondents from a federally qualified health center and at a community center for South Asian immigrants in Chicago, Illinois. Age ranged from 20 to 70 years; 60% were women; 60% held advanced degrees; 70% migrated to the US in the last 10 years; and 60% of the interviews were in Hindi or Urdu. Concepts of health and disease fell into four domains: behavioral, physical, psycho-social and spiritual. Muslim participants consistently evoked spiritual factors such as faith and prayer. Women more frequently included performing home duties and positive affect in their concept of health. Men more frequently cited behavioral factors such as smoking and drinking as the cause of disease. Many South Asians have a holistic conceptualization of health and disease, incorporating spiritual, physical and psycho-social factors. Health promotion strategies aimed at South Asians in the US should take into account this holistic model of health and disease, while also recognizing that variations exist within South Asians, by gender and religion.
TL;DR: Perceived neighborhood environment was found to make a significant contribution to both outcomes and individuals less satisfied with their overall neighborhood environment were more likely to have negative perceptions of health and depressive symptoms.
Abstract: This study examined how subjective perceptions of the neighborhood environment (e.g., perceived ethnic density, safety, social cohesion, and satisfaction) influenced the physical and mental health of Korean American older adults. Using data from 420 residents of the New York City metropolitan area (Mage = 71.6, SD = 7.59), health perceptions and depressive symptoms were estimated with hierarchical regression models entered in the order of (1) demographics and acculturation, (2) health-related variables, and (3) perceived neighborhood environment. After controlling for the effects of the individual-level variables, perceived neighborhood environment was found to make a significant contribution to both outcomes. Individuals less satisfied with their overall neighborhood environment were more likely to have negative perceptions of health and depressive symptoms. A strong linkage between perceived neighborhood safety and depressive symptoms was also observed. Findings from the study highlight the importance of subjective evaluations of neighborhood environment and provide implications for health promotion.
TL;DR: The results of this study highlight the importance of diverse cultural beliefs and practices as factors that should be taken into consideration when tailoring interventions to improve asthma outcomes in vulnerable populations, including patients from ethno-cultural communities.
Abstract: The objectives of this study were to investigate how asthma patients from new immigrant groups are being informed and educated about asthma and its management, and to identify barriers to knowledge transfer. Four focus groups (n = 29) from Latino, Chinese, Iranian and Punjabi cultural communities were conducted with asthmatic patients in the Greater Vancouver Area. Our results from the focus group discussions can be summarized in four broad areas (a) perceptions of and ways of coping with asthma, (b) perceptions of whether the healthcare system is culturally competent, (c) perceptions of language barriers in regards to accessing the healthcare system, and (d) perceptions of how to access reliable asthma information. The results of this study highlight the importance of diverse cultural beliefs and practices as factors that should be taken into consideration when tailoring interventions to improve asthma outcomes in vulnerable populations, including patients from ethno-cultural communities.
TL;DR: Regression analysis revealed acculturation as a significant moderating variable between food insecurity and BMI percentile, and this relationship may serve to facilitate in the development of future weight-gain prevention interventions in primary care settings within Latino immigrant populations.
Abstract: As Latino children acculturate to the United States, they are at risk for excess weight gain. Existing literature suggests that higher levels of food insecurity may predict obesity, but the role of acculturation is not well understood. Latino children ages 2–17 of both immigrant and non-immigrant parents (n = 63) were recruited from a primary care clinic serving low income families. Child anthropometric measures, and parent acculturation and food insecurity measures were collected via self-administered questionnaires. Over 63% of the patients were either overweight or obese according to criteria established by the Center for Disease Control and Prevention (CDC). Regression analysis revealed acculturation as a significant moderating variable between food insecurity and BMI percentile, F(5,12) = 4.836, P = .017, R
2 = .707 in children of Latino immigrants. The identification of this relationship may serve to facilitate in the development of future weight-gain prevention interventions in primary care settings within Latino immigrant populations.
TL;DR: This study has implications for informing public health and social service programming as it provides thick description regarding the context and circumstances associated to increased vulnerability to substance abuse and lack of well-being among this hard-to-reach population of Latino immigrants.
Abstract: Day labor is largely comprised of young Latino immigrant men, many of who are undocumented, and thus vulnerable to a myriad of workers’ rights abuses. The difficult work and life conditions of this marginalized population may place them at heightened risk for mental health problems and substance use and abuse. However, factors related to Latino day laborers’ well-being and substance misuse are largely unknown. This article utilizes ethnographic and focus group methodology to elucidate participant identified factors associated to well-being and substance use and abuse. This study has implications for informing public health and social service programming as it provides thick description regarding the context and circumstances associated to increased vulnerability to substance abuse and lack of well-being among this hard-to-reach population of Latino immigrants.
TL;DR: In CA and MX, having an obese mother was significantly associated with being overweight or obese, and hypotheses for how migration may influence the high prevalence of overweight among the Mexican children in California are offered.
Abstract: The prevalence of childhood obesity is high among young children of Mexican origin in the United States, however, the determinants are poorly understood. We conducted a binational study with a sample from California (CA) and Mexico (MX), to identify and compare the most important factors associated with overweight and obesity among children of Mexican descent. Significantly more children were classified as overweight or obese in CA compared to MX (53.3 vs. 14.9%, P < 0.01). In CA and MX, having an obese mother was significantly associated with being overweight or obese. In MX, male gender, high socioeconomic status and very low food insecurity were associated with being overweight or obese. These data offer hypotheses for how migration may influence the high prevalence of overweight among the Mexican children in California.
TL;DR: Improved HIV prevention efforts are needed to reduce the risk vulnerability of migrants who relocate to high disease prevalence areas and increase the likelihood of detection and treatment of HIV-positive migrants.
Abstract: Although the dire life circumstances of labor migrants working in Russia are well-known, their HIV risk vulnerability and prevention needs are understudied. Low socioeconomic status, lack of access to services, separation from family, and limited risk awareness all contribute to migrants’ HIV vulnerability. Male labor migrants in St. Petersburg (n = 499) were administered assessments of their sexual behavior practices, substance use, and psychosocial characteristics related to risk and well-being. Thirty percent of migrants reported multiple female partners in the past 3 months. Condom use was low, ranging from 35% with permanent to 52% with casual partners. Central Asian migrants had very low AIDS knowledge, low levels of substance use, moderate sexual risk, high depression, and poor social supports. Eastern European migrants had higher AIDS knowledge, alcohol and drug use, and sexual risk. Improved HIV prevention efforts are needed to reduce the risk vulnerability of migrants who relocate to high disease prevalence areas.
TL;DR: Compared to the general Canadian population, incidence of all-site cancer was lower among immigrants overall, by sex and refugee status, and significantly higher SIRs resulted for liver, nasopharyngeal and cervical cancers, including liver cancer among South-EastAsian and North-East Asian immigrants, and nasopharygeal cancer among North- east Asian non-refugees.
Abstract: Canadian immigrants have lower overall cancer risk than the Canadian-born population. Less is known about risks for immigrant subgroups and site-specific cancers. Linked administrative data sets were used to compare cancer incidence between subgroups of immigrants to Canada and the general Canadian population. The study involved 128,962 refugees and 241,010 non-refugees. Standardized incidence ratios (SIRs) were calculated for all-site and site-specific cancers by immigration categories and regions of birth. Relative to the general Canadian population, incidence of all-site cancer was lower among immigrants overall, by sex and refugee status (non-refugee SIRs 0.25: men, 0.24: women; refugee SIRs 0.31: both). Significantly higher SIRs resulted for liver, nasopharyngeal and cervical cancers, including liver cancer among South-East Asian and North-East Asian immigrants, and nasopharyngeal cancer among North-East Asian non-refugees. Hypothesized explanations for variation in cancer incidence include earlier viral infection in the country of origin.
TL;DR: The data suggest a high prevalence of impaired glucose regulation in Chinese immigrants even among individuals with normal BMI, and the mechanisms of increased susceptibility of IFG and diabetes in this population should be evaluated.
Abstract: Asians have an increased susceptibility to type 2 diabetes, despite relatively low prevalence of obesity in this population. Asian American is a diverse population and there are yet limited data on the prevalence of diabetes among different Asian subgroups and existing studies are limited by small sample size. Hence, we conducted a cross-sectional survey to estimate the prevalence of diabetes and impaired fasting glucose (IFG) in this population among Chinese Americans, the largest Asian subgroup in the US. Our study population consisted 2,071 individuals (52.8% women; mean age: 52.7 ± 13.8 years and mean body mass index (BMI): 23.9 ± 3.2 kg/m2) living in New York City. Data on sociodemographic factors, anthropometric measurements and medical history is obtained during a 1 day clinic visit. In addition, a fasting blood sample was collected to perform measurements on plasma glucose and lipids. Diabetes was defined as self-reported treatment or a fasting glucose ≥126 mg/dl) and IFG was defined as fasting glucose of 100–125 mg/dl. The age-adjusted prevalence of diabetes in this population was 8.6% and that of IFG was 34.6%. The prevalence of IFG/diabetes was high (38.3%) even among those with low BMI by Asian standards (<23.0 kg/m2) and showed a linear increasing trend with increasing waist circumference. These data suggest a high prevalence of impaired glucose regulation in Chinese immigrants even among individuals with normal BMI. Future studies should focus on evaluating the mechanisms of increased susceptibility of IFG and diabetes in this population.
TL;DR: The findings indicate that the primary correlate of a household’s food security status is income, which suggests the potential for strategies to improve the financial power of new immigrants to purchase sufficient, nutritious, and culturally acceptable food.
Abstract: Food security is an important social determinant of health. The 2004 Canadian Community Health Survey, Cycle 2.2 reported high prevalence of food insecurity among low income households and those formed by recent immigrants. Exploration of the extent and correlates of food insecurity among recent Latin Americans (LA) immigrants is essential considering they encompasses an increasing number of young immigrants, many of whom, despite relatively high education, are unemployed or have low wage positions. This study examines the extent of food insecurity and its correlates among recent Latin American (LA) immigrants in Toronto. A cross-sectional study was conducted with a convenience sample of 70 adult LA recent immigrants. Participants were recruited from selected community health centres across Toronto using snow ball sampling. Data were collected using questionnaires in face-to-face interviews with primary household care givers. A considerably high rate of food insecurity (56%) was found among participants. Household food insecurity was highly related to: being on social assistance; limited proficiency in English; and the use of foodbanks. Our findings indicate that the primary correlate of a household’s food security status is income, which suggests the potential for strategies to improve the financial power of new immigrants to purchase sufficient, nutritious, and culturally acceptable food. Enhancing the employability of new immigrants, reforming the income structure for working adults beyond social assistance, and providing more subsidized English language and housing programs may be effective.
TL;DR: Although Cambodian refugees are older and poorer than the general population, their poor health cannot be fully attributed to these risk factors and research is needed to guide health policy and practices aimed at eliminating this health disparity.
Abstract: To better document the health status of Cambodian refugees, the physical health functioning, disability, and general health status of Cambodian refugees was compared to that of non-refugee Asian immigrants with similar demographic characteristics. Data were collected between October 2003 and February 2005, from 490 face-to-face interviews conducted with a stratified probability sample of households from the Cambodian community in Long Beach, California. Data on the health status of the general adult population (n = 56,270) was taken from the California Health Interview Survey, a telephone interview of a representative sample California residents. Cambodian refugees reported exceedingly poor health when compared to both the general population to the Asian participants. This disparity was only slightly reduced when Cambodian refugees were compared to the subsample of Asian immigrants who were matched on gender, age, income, and urbanicity. Although Cambodians refugees are older and poorer than the general population, their poor health cannot be fully attributed to these risk factors. Research is needed to guide health policy and practices aimed at eliminating this health disparity.
TL;DR: Behavioral interventions must provide culturally-centered behavioral strategies addressing some of the difficulties identified in this study, and specific suggestions are provided for the development of weight-loss interventions for this population.
Abstract: There is an urgent need for effective and accessible culturally-sensitive weight-loss interventions for the Mexican-American population. It is imperative that cultural factors be taken into account when designing weight-loss interventions targeting this population. As a first step in this direction, this study examined the experiences, concerns, and beliefs regarding diet, weight and weight loss of Mexican-American immigrant women. Focus groups were conducted with Mexican-American women (n = 25) between the ages of 20 and 63, from the Portland, Oregon metropolitan area. Major themes identified in the discussions included important lifestyle changes brought about by immigration, the challenges of adopting “American ways,” lack of nutritional information, and the difficulties in making food choices given the complexities of the family context. Behavioral interventions must provide culturally-centered behavioral strategies addressing some of the difficulties identified in this study. Specific suggestions are provided for the development of weight-loss interventions for this population.
TL;DR: A range of multifaceted facilitators and barriers must be considered when developing interventions to increase the rates of cervical screening in this population.
Abstract: Understanding the different facilitators and barriers to screening within cultural and ethnic groups is important for developing appropriate education and outreach programs to underserved groups. Qualitative methods were employed to gain a rich understanding of participant views. In-depth interviews were conducted with 18 Chinese Australian women in their native languages and analysed using content analysis. Knowledge of cervical cancer was low, and few participants understood the benefits and purpose of screening. Having a doctor’s recommendation was a strong motivator, and returning for screening was encouraged by having a female Chinese doctor perform the exam, receiving a reminder letter and the absence of cost for screening participation. However, participation was inhibited by logistical barriers, cultural beliefs and previous painful screening experiences. A range of multifaceted facilitators and barriers must be considered when developing interventions to increase the rates of cervical screening in this population.
TL;DR: Findings suggest that social support buffers against the negative influence of household food insecurity on depression risk, and a comprehensive approach is necessary to address the mental health needs of low income Latinos with T2D.
Abstract: Prevalence of depression is high among individuals with type 2 diabetes (T2D). The objective of the current study was to identify the socio-demographic, psychosocial, cultural, and clinical risk factors that predispose to depression, and resources that protect from depression among low income Latinos with T2D. Participants (N = 211) were interviewed in their homes upon enrollment. Multivariate logistic regression was used to identify factors associated with depressive symptoms based on a score of ≥21 on the Center for Epidemiological Studies Depression scale. Lower household income, interference of diabetes with daily activities, and more T2D clinical symptoms were associated with depression risk in the multivariate analyses. At each level of food insecurity the risk of depression was lower the higher the level of social support (P < 0.05). Findings suggest that social support buffers against the negative influence of household food insecurity on depression risk. A comprehensive approach is necessary to address the mental health needs of low income Latinos with T2D.
TL;DR: The mortality patterns of ME immigrants by origin, acculturation, and generation are described, with some of the observed differences may be based on ethnic characteristics, including genetic makeup, early exposures, and culturally determined values.
Abstract: Migrant studies in the United States (US) have rarely covered the Middle Eastern population (ME), and have never distinguished the first and second generations born in the US. This study aims to describe the mortality patterns of ME immigrants by origin, acculturation, and generation. Death certificates issued from 1997 through 2004 were used to calculate, for Middle Eastern immigrants, the proportional odds ratios (POR) for major causes of death, with comparison to non-Hispanic Whites born in the US to US-born parents. First generation immigrants had higher odds for colorectal cancers, diabetes, and diseases of the heart, while their odds for chronic obstructive pulmonary disease (COPD) and suicide were lower. Men had higher odds for all cancers combined, cancers of the lymphatics, and pancreas. Women had lower odds for lung cancer, and dementia, and higher odds for breast cancer. The second generation men had higher odds for all cancers combined, and diseases of the heart, whereas women had lower odds for lung cancer and cerebrovascular accidents. Higher odds for colorectal cancers and lower odds for COPD were noted in both sexes. Some of the observed differences may be based on ethnic characteristics, including genetic makeup, early exposures, and culturally determined values. Time since immigration is associated with convergence of most odds to that of the native population.
TL;DR: Safe infant discharge from the NICU must address families’ needs and deficits in knowledge about their infant’s medical condition and available resources that place these vulnerable infants at further risk are addressed.
Abstract: Assess the needs of Latino families with limited English proficiency (LEP) whose infant is discharged from the NICU. Parent interviews at discharge and 1 month later. Thirty-six mothers were interviewed. Thirty nine percentage had <8th grade education; half earned <$10,000 annually. Twenty-eight percentage had no primary support person inside the US. Only half felt very prepared for their infants' discharge. Many expressed general worry about their infant's medical condition (53%) and development (81%), but few (15%) could identify specific risk factors. One-third of families sought emergency medical care for their infant within 1 month of discharge. Less than half were aware of early intervention programs. Safe infant discharge from the NICU must address families' needs. Latino parents with LEP have deficits in knowledge about their infant's medical condition and available resources that place these vulnerable infants at further risk.
TL;DR: Culturally relevant education materials that consider specific Asian ethnicity and language are needed to increase awareness of cervical cancer, Pap testing, and HPV among Asian American young adults.
Abstract: Cervical cancer is a major health disparity among Asian Americans, with cervical cancer rates of Vietnamese women being significantly higher than for the general US female population and low screening rates reported for Asian American females. Focus groups and interviews were conducted with young Vietnamese, Filipino, and Korean adults (ages 18–29) to collect information on knowledge, perceptions and sources of information regarding cervical cancer, Pap tests and the human papillomavirus. 16 Korean, 18 Vietnamese, and 18 Filipino (50% female) adults participated in the study. Many participants had never heard of HPV, cervical cancer and Pap testing. Cervical cancer screening rates were low for Korean and Vietnamese females and were influenced by moral beliefs and lack of awareness. Culturally relevant education materials that consider specific Asian ethnicity and language are needed to increase awareness of cervical cancer, Pap testing, and HPV among Asian American young adults
TL;DR: The relationship between distance to the nearest SNC and access in non-rural uninsured adults in California and whether this relationship differs by language proficiency was assessed and interactions between distance and language proficiency were included.
Abstract: Studies suggest that proximity to a safety net clinic (SNC) promotes access to care among the uninsured. Distance-based barriers to care may be greater for people with limited English proficiency (LEP), compared to those who are English proficient (EP), but this has not been explored. We assessed the relationship between distance to the nearest SNC and access in non-rural uninsured adults in California, and examined whether this relationship differs by language proficiency. Using the 2005 California Health Interview Survey and a list we compiled of California's SNCs, we calculated distance between uninsured interviewee residence and the exact address of the nearest SNC. Using multivariate regression to adjust for other relevant characteristics, we examined associations between this distance and interviewee's probability of having a usual source of health care (USOC) and having visited a physician in the prior 12 months. To examine differences by language proficiency, we included interactions between distance and language proficiency. Uninsured LEP adults living within 2 miles of a SNC were 9.3% less likely than their EP counterparts to have a USOC (P = 0.046). Further, distance to the nearest SNC was inversely associated with the probability of having a USOC among LEP, but not among EP; consequently, the difference between LEP and EP in the probability of having a USOC widened with increasing distance to the nearest SNC. There was no difference between LEP and EP adults living within 2 miles of a SNC in likelihood of having a physician visit; however, as with USOC, distance to the nearest SNC was inversely associated with the probability of having a physician visit among LEP but not EP. The effect sizes diminished, but remained significant, when we included county fixed effects in the models. Having LEP is a barrier to health care access, which compounds when combined with increased distance to the nearest SNC, among uninsured adults. Future studies should explore potential mechanisms so that appropriate interventions can be implemented.