The differential mental health impact of COVID-19 in Arab countries.

COVID-19 pandemic's mental health impact on Arab countries is under-researched. The goal of this investigation was to study the differential impact of COVID-19 on the mental health of Arab countries. A questionnaire including measures of COVID-19 traumatic stress, PTSD, depression, anxiety, and cumulative stressors and trauma was distributed anonymously online in seven Arab countries (Egypt (N = 255), Kuwait (N = 442), Jordan (N = 216), Saudi Arabia (N = 212, Algeria (N = 110), Iraq and Palestine (N = 139)). We used ANOVA and stepwise regression to analyze the data. For each country, regression, PTSD, depression, and anxiety were dependent variables; we entered in the first-step, gender, age, religion, education, and income. In the second step, we entered "cumulative stressors and traumas." In the third step, we entered COVID-19 traumatic stress. The ANOVA results indicated that the differences in COVID19 traumatic stress, PTSD, depression, and anxiety between the countries were significant. Post-hoc analysis indicated that Egypt is significantly higher than all the other Arab countries in COVID-19 traumatic stress, PTSD, anxiety, and depression. The subsample from Palestine and Iraq had a significantly higher cumulative trauma load than the other Arab countries but did not have higher levels of COVID-19 traumatic stress or PTSD. Stepwise regression indicated that COVID-19 traumatic stress accounted for significant variance above and beyond the variance accounted for by previous cumulative stressors and traumas for anxiety in all countries and PTSD and depression in all countries except for Algeria. We discussed the implications for these results for the urgent mental health needs of Arab countries.

The Development of Posttraumatic Stress Disorder and Depression Symptoms in Iraqi Refugees: Associations with Acculturation and C-reactive Protein.

ABSTRACT: Refugees experience distress from premigration trauma, often exacerbated by postmigration difficulties. To develop effective interventions, risk factors for mental health symptoms need to be determined. Male Iraqi refugees (N = 53) to the United States provided background information and reported predisplacement trauma and psychological health within 1 month of their arrival. An inflammatory biomarker-C-reactive protein (CRP) was assessed approximately 1.5 years after arrival, and a contextual factor-acculturation-and psychological health were assessed 2 years after arrival. We tested whether acculturation and CRP were associated with posttraumatic stress disorder (PTSD) and depression symptoms at the 2-year follow-up, controlling for baseline symptoms, age, body mass index, and predisplacement trauma. Acculturation was inversely related to depression, and CRP was positively related to both PTSD and depression at the 2-year follow-up. Interventions targeting acculturation could help reduce the development of depression symptoms in refugees. The role of CRP in the development of PTSD and depression symptoms warrants further research.

Neighborhood air pollution and household environmental health as it relates to respiratory health and healthcare utilization among elderly persons with asthma.

Objective: The study investigated the associations between fine particulate matter (PM2.5; <2.5 µm in diameter), indoor environment, pulmonary function, and healthcare utilization in a vulnerable group of elderly persons with asthma. We hypothesized that environmental conditions were associated with adverse pulmonary health outcomes. Methods: The study involved elderly (n = 76; mean age 64.6 years; 48 women) vulnerable persons in Detroit, Michigan, USA, with physician-diagnosed asthma. Exposure variables included measured outdoor PM2.5, self-rated outdoor and household environmental pollutants. Outcome variables were self-rated and measured pulmonary function, and asthma-related healthcare utilization. Results: Mean ambient PM2.5 concentrations during the study was 14.14 ± (S.D. 6.36) µg/m3 during the summer and 14.20 (6.33) during the winter (p = 0.95). In multiple regression analyses, adjusting for age and gender, mean 6-month concentration of PM2.5 was related to shortness of breath (SHOB; standardized ß = 0.26, p = 0.02) and inversely with self-rated respiratory health (SRRH; ß = 0.28, p = 0.02). However, PM2.5 did not predict lung function (FEV1% predicted and FEV1/FVC). However, PM2.5 was related to use of asthma controller drugs (ß = 0.38, p = 0.001). Participants' air pollution ratings predicted total healthcare utilization (ß = 0.33, p = 0.01). Conclusions: In elderly persons with asthma, living near heavy industry and busy highways, objective and perceived environmental pollution relate to participants' respiratory health and healthcare utilization. Importantly, air pollution might increase use of asthma controller drugs containing corticosteroids with implication for elderly persons' risk to develop osteoporosis and cardiovascular disease.

Waterpipe use in adolescents in Northern Sweden: Association with mental well-being and risk and health behaviours.

AIMS: There is a lack of studies examining the association between waterpipe smoking and mental well-being among adolescents. This study sought to determine whether waterpipe smoking is associated with mental well-being and other risk and health behaviours in adolescents. METHODS: A questionnaire was distributed to 1006 adolescents in grades 9-12 (with a response rate of >95%), containing questions on measures of stress, mental energy and sleep. In addition, the questionnaire assessed risk and health behaviours, including use of a waterpipe, cigarettes, e-cigarettes, snus, alcohol, narcotics, gambling and exercise. Logistic regression was used to assess factors associated with waterpipe use. RESULTS: Thirty-seven per cent ( n=371) of the participants had used a waterpipe at some point. Waterpipe use was associated with lower mental energy (odds ratio [OR] = 0.90, 95% confidence interval [CI] 0.81-0.99), higher stress (OR = 1.10, 95% CI 1.02-1.20) and use of cigarettes (OR = 3.82, 95% CI 2.33-6.03), e-cigarettes (OR = 3.26, 95% CI 2.12-4.99), snus (OR = 2.29, 95% CI 2.12-4.99), alcohol (OR = 1.92, 95% CI 1.07-3.44) and narcotics (OR = 3.64, 95% CI 1.75-7.58). Waterpipe use was not significantly associated with gambling, exercise or sleep quality. CONCLUSIONS: Waterpipe use in adolescents is associated with worse mental well-being, as well as use of other nicotine products, alcohol and narcotics. Prospective studies are needed to delineate causal and temporal relationships further between waterpipe use and mental well-being and its relationship to other risky behaviours in order to design effective prevention programs.

Determinants of resource needs and utilization among refugees over time.

PURPOSE: This study examined refugees' resource needs and utilization over time, investigated the relationships between pre-displacement/socio-demographic variables and resource needs and utilization, and explored the role of resource needs and utilization on psychiatric symptom trajectories. METHODS: Iraqi refugees to the United States (N = 298) were assessed upon arrival and at 1-year intervals for 2 years for socio-demographic variables and pre-displacement trauma experiences, their need for and utilization of 14 different resources, and PTSD and depressive symptoms. RESULTS: Although refugees reported reduction of some needs over time (e.g., need for cash assistance declined from 99 to 71 %), other needs remained high (e.g., 99 % of refugees reported a need for health care at the 2-year interview). Generally, the lowest needs were reported after 2 years, and the highest utilization occurred during the first year post-arrival. Pre-displacement trauma exposure predicted high health care needs but not high health care utilization. Both high need for and use of health care predicted increasing PTSD and depressive symptoms. Specifically, increased use of psychological care across the three measurement waves predicted more PTSD and depression symptoms at the 2-year interview. CONCLUSIONS: Differences emerged between need for and actual use of resources, especially for highly trauma-exposed refugees. Resettlement agencies and assistance programs should consider the complex relationships between resource needs, resource utilization, and mental health during the early resettlement period.

Unemployment in Iraqi refugees: The interaction of pre and post-displacement trauma.

Previous refugee research has been unable to link pre-displacement trauma with unemployment in the host country. The current study assessed the role of pre-displacement trauma, post-displacement trauma, and the interaction of both trauma types to prospectively examine unemployment in a random sample of newly-arrived Iraqi refugees. Participants (N = 286) were interviewed three times over the first two years post-arrival. Refugees were assessed for pre-displacement trauma exposure, post-displacement trauma exposure, a history of unemployment in the country of origin and host country, and symptoms of posttraumatic stress disorder (PTSD) and depression. Analyses found that neither pre-displacement nor post-displacement trauma independently predicted unemployment 2 years post-arrival; however, the interaction of pre and post-displacement trauma predicted 2-year unemployment. Refugees with high levels of both pre and post-displacement trauma had a 91% predicted probability of unemployment, whereas those with low levels of both traumas had a 20% predicted probability. This interaction remained significant after controlling for sociodemographic variables and mental health upon arrival to the US. Resettlement agencies and community organizations should consider the interactive effect of encountering additional trauma after escaping the hardships of the refugee's country of origin.

Obesity and overweight in ethnic minorities of the Detroit metropolitan area of Michigan.

Race, ethnicity and socioeconomic factors influence the prevalence of obesity and overweight, which are major public health problems. Our objectives were (1) to calculate the prevalence of self-reported obesity and overweight in whites, blacks, Chaldeans, and Arabs in the Detroit metropolitan area; and (2) to examine the odds for self-reported overweight and obesity in the racial and ethnic minorities when compared to whites. The responses to a self-administered survey conducted among the adult residents (n = 2,883) of the Detroit metropolitan area of Michigan were analyzed. Prevalence of overweight and obesity were 47.4 and 34.6 % respectively for the whole sample, while it was 39.9 and 43.6 % for whites, 42.3 and 47.8 % for blacks, 46.2 and 30.3 % for Chaldeans, and 52.2 and 28.5 % for Arabs. The odds for obesity was significantly lower in Arabs [odds ratio (OR) 0.31; 95 % confidence interval (CI) 0.13-0.72] and Chaldeans (OR 0.14; 95 % CI 0.06-0.33) when compared to whites. Chaldeans (OR 0.36; 95 % CI 0.15-0.86) had significantly decreased likelihood for being overweight compared to whites. Odds for obesity and overweight can vary in the different ethnic minorities within whites. Sharing similar living conditions decreases the differences in the odds for overweight and obesity between whites and blacks. Taking into consideration the racial and ethnic differences of the target population may help in developing better programs for fighting overweight and obesity.

Resilience as a protective factor against the development of psychopathology among refugees.

Refugee research, to date, has predominantly focused on factors that make refugees more vulnerable for developing posttraumatic stress disorder (PTSD) and/or psychological distress. Few articles have studied potential protective factors such as resilience. A targeted nonrandom sample of Iraqi refugees (n = 75) and a control group of non-Iraqi Arab immigrants (n = 53) were recruited from a number of Iraqi/Arab community institutions in Michigan to complete a questionnaire that included measures for psychological distress, PTSD symptoms, exposure to trauma, and resilience. The refugees reported significantly more PTSD symptoms (t-test, p < 0.01) and psychological distress (p < 0.05) compared with the immigrants. There was no difference in resilience between the two groups. In linear regression, premigration exposure to violence was a significant predictor of psychological distress (p < 0.01) and PTSD symptoms (p < 0.01). After controlling for migrant status and violence exposure, resilience was a significant inverse predictor of psychological distress (p < 0.001) but not of PTSD. Resilience is associated with less trauma-related psychological distress and should be considered in assessing risk and protective factors among victims of war-related violence.

Prevalence of antibodies to the hepatitis C virus among Arab and Chaldean Americans in southeast Michigan, USA.

OBJECTIVE: The prevalence of antibodies to the hepatitis C virus (anti-HCV) in the United States is estimated to be 1.6%. There are no published studies on the prevalence of anti-HCV among the Arab/Chaldean American population in the United States. DESIGN: Retrospective review of data collected during an HCV public awareness program conducted by the Arab American and Chaldean Council. Inclusion criteria were that subjects had to be of Arab/Chaldean descent, born in an Arab country, and test positive or negative for anti-HCV using the "Home Access Hepatitis C Test." MAIN OUTCOME MEASURES: The overall estimated prevalence of anti-bodies to HCV was 5.4% among Arab/Chaldean Americans residing in southeast Michigan. RESULTS: Four hundred and eighty four participants were tested for anti-HCV. The estimated prevalence among Chaldeans was 2% vs 5.9% among Arabs, which varied according to their country of origin. Anti-HCV positive results were more common in participants with a history of hepatitis (30.4%), jaundice (21.1%), blood transfusion (14.6%), treatment by nonsterile injection (13.6%), and tattoo/body piercing (10%). On binary logistic regression analysis, significant predictors for positive anti-HCV included history of hepatitis (OR: 19, 95% CI 2.58-139.93), blood transfusion (OR: 4.7, 95% CI 1.09-20.56), tattoo or body piercing CONCLUSION: To our knowledge, this is the first study to report the estimated prevalence of anti-HCV and risk factors among the Arab and Chaldean Americans in the United States. The estimated prevalence of anti-bodies to HCV is 5.4% in this population, a rate that is more than triple the national average. Because of the relatively small sample size and limited geographic region, more studies are needed to evaluate the true prevalence of HCV antibodies in this and other ethnic minority population.

The Impact of COVID-19 Traumatic Stressors on Mental Health: Is COVID-19 a New Trauma Type.

COVID-19 is a new type of trauma that has never been conceptually or empirically analyzed in our discipline. This study aimed to investigate the impact of COVID-19 as traumatic stress on mental health after controlling for individuals' previous stressors and traumas. We utilized a sample of (N = 1374) adults from seven Arab countries. We used an anonymous online questionnaire that included measures for COVID-19 traumatic stress, posttraumatic stress disorder, anxiety, depression, and cumulative stressors and traumas. We conducted hierarchical multiple regression, with posttraumatic stress disorder, depression, and anxiety as dependent variables. In the first step, in each analysis, we entered the country, gender, age, religion, education, and income as independent variables (Kira, Traumatology 7(2):73-86, 2001; Kira, Torture, 14:38-44, 2004; Kira, Traumatology, 2021, https://doi.org/10.1037/trm0000305). In the second step, we entered cumulative stressors and traumas as an independent variable. In the third step, we entered either COVID-19 traumatic stressors or one of its subtypes (fears of infection, economic, and lockdown) as an independent variable. Finally, we conducted structural equation modeling with PTSD, depression, and anxiety as predictors of the latent variable mental health and COVID-19 as the independent variable. Results indicated that COVID-19 traumatic stressors, and each of its three subtypes, were unique predictors of PTSD, anxiety, and depression. Thus, COVID-19 is a new type of traumatic stress that has serious mental health effects. Supplementary Information: The online version contains supplementary material available at 10.1007/s11469-021-00577-0.

Obstructive sleep apnea, posttraumatic stress disorder, and health in immigrants.

OBJECTIVE: To determine whether obstructive sleep apnea mediates the relationship between posttraumatic stress disorder (PTSD) and psychosomatic and somatic disorders and its implications for self-rated health (SRH) among Iraqi immigrants in the United States. METHODS: A random sample of immigrants who had left Iraq before the 1991 Gulf War (n = 145) or after (n = 205) and are residing in metropolitan Detroit responded to a structured interview covering questions on sociodemographics, premigration trauma, SRH, physician-diagnosed and -treated obstructive sleep apnea, somatic disorders, and psychosomatic disorders. Structural equation modeling was used to evaluate the relationship between premigration trauma scores and health, as well as to explore mediating pathways between PTSD, obstructive sleep apnea, and health. RESULTS: The prevalence of obstructive sleep apnea among post-Gulf Warimmigrants (30.2%) was significantly higher than among pre-Gulf War immigrants (0.7%; p < .001). Premigration trauma scores were positively associated with depression and PTSD. Structural equation modeling supported a model in which obstructive sleep apnea mediated the relationship between PTSD and psychosomatic and somatic disorders. Premigration trauma also related directly to SRH. CONCLUSIONS: Part of the PTSD-associated adverse health effects observed in Iraqi immigrants is mediated by obstructive sleep apnea. Because sleep apnea in the current study is based on medical history and current treatment, there is a need for future confirmatory polysomnographic studies.

The Burden of and Factors Associated with Age-Related Eye Diseases in Arab American Adults.

To estimate the age- and sex-adjusted proportions of cataract, diabetic retinopathy, glaucoma, and macular degeneration among the Arab American community, a notably understudied minority that is aggregated under whites. The Arab American Eye Study is a multicenter retrospective chart review involving 10 years of electronic medical records (1/1/2010 through 1/1/2020). The study sample included 1390 Arab Americans and 4950 whites 45 years of age and older, totaling 6340 subjects. Arab Americans were identified using an Arab American name algorithm. Subjects with race variables other than white or Arab American or those under age 45 were excluded from the study. Age- and sex-adjusted proportions of cataract, diabetic retinopathy, glaucoma, and macular degeneration were determined. Odds ratios with 95% confidence intervals were used to examine the association between race/ethnicity and eye diseases. Of the 6340 participants (4950 whites and 1390 Arab Americans), males comprised 46.3% and the median age group was 55-64 years. Arab Americans displayed higher age- and sex-adjusted proportions of cataracts (45.4% versus 40.7%), dry age-related macular degeneration (10% versus 8.9%), glaucoma (8% vs 6%), and diabetic retinopathy (11.7% versus 4.2%). Fully adjusted logistic regression revealed that Arab Americans were 19% more likely to have cataracts (OR 1.19; 95% CI 1.05, 1.35) and 272% more likely to have diabetic retinopathy (OR 2.72; 95% CI 2.17; 3.41). Results from the Arab American Eye Study suggest that the burden of cataract and diabetic retinopathy is significantly higher among Arab Americans in comparison to whites.

Intersected discrimination through the lens of COVID-19: The case example of Christian minority in Iraq.

Compelling evidence proved that coronavirus disease (COVID-19) disproportionately affects minorities. The goal of the present study was to explore the effects of intersected discrimination and discrimination types on COVID-19, mental health, and cognition. A sample of 542 Iraqis, 55.7% females, age ranged from 18 to 73, with (M = 31.16, SD = 9.77). 48.7% were Muslims, and 51.3% were Christians (N = 278). We used measures for COVID-19 stressors, executive functions, intersected discrimination (gender discrimination, social groups-based discrimination, sexual orientation discrimination, and genocidal discrimination), posttraumatic stress disorder (PTSD), depression, anxiety, status and death, existential anxieties, and health. We conducted independent samples t test between Muslims and Christians. We conducted hierarchical regression analyses using the Christian minority subsample to see if intersected discrimination is predictive of COVID-19 hospitalization. We conducted two-path analyses, one with intersected discrimination as an independent variable and the second with the different discrimination types as independent variables. Intersected discrimination predicted COVID-19 hospitalization. The primary discrimination type for Christians was genocidal discrimination. Christians had higher existential anxiety about status and death than Muslims. Intersected discrimination and discrimination types had a significant association with mental health, health, and cognition variables, with intersected discrimination, had a higher impact than each. Existential anxiety about the person's social and economic status was the critical outcome of intersected discrimination that trickles down to other variables. COVID-19 stressors had significant effects on depression, PTSD, generalized anxiety, and Status existential annihilation anxiety (EAA). COVID-19 hospitalization and stressors are associated with inhibition and working memory deficits. We discussed the conceptual and clinical implications of the results. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Association Between Inflammatory Biomarkers and Mental Health Symptoms in Middle Eastern Refugees in the US.

INTRODUCTION: Refugees are at increased risk for trauma-related mental health disorders, including anxiety, depression, and post-traumatic stress disorder (PTSD). The underlying biological mechanisms linking trauma to mental disorders need additional study, and the possible pathophysiological role of the immune system is attracting increasing interest. In this study, we investigated whether two well-known pro-inflammatory cytokines (interleukin (IL-8) and IL-6) are associated with mental health symptoms in Middle Eastern refugees displaced to the United States. METHODS: Refugees (n=64, mean age=37.6 years) ages ranged from 21 to 74 years (mean=37.62, SD=11.84) were interviewed one month after arrival in Michigan, United States, using a validated survey in Arabic. Questions covered pre-displacement trauma, current anxiety, depression, and PTSD symptoms. Blood, collected immediately following the interview, was analyzed for the levels of interleukins. Multivariate linear regression was used to determine the association between mental health symptoms and IL-6 and IL-8. RESULTS: In multivariate modeling, older age (ß=0.37; p<0.01) and anxiety (ß=0.31; p<0.05) were positively associated with IL-8. Age (ß=0.28; p<0.05) and pre-displacement trauma (ß=0.40; p<0.05) were positively associated with IL-6. Depression (ß=-0.38) was negatively associated with IL-6. CONCLUSION/RELEVANCE: This study of inflammatory biomarkers suggests the possibility of differential associations between mental health symptoms (anxiety and depression) and pro-inflammatory markers (IL-6 and IL-8). To enhance our ability to prevent and more effectively treat trauma-exposed refugees, we need to better understand the neuroinflammatory mechanisms contributing to mental disorders.

Do household smoking behaviors constitute a risk factor for hookah use?

INTRODUCTION: Much research has focused on the role played by families in cigarette smoking behavior. However, there is a lack of such research for hookah (waterpipe) smoking. This study focuses on the role of family members' hookah smoking behaviors as a possible risk factor for hookah smoking. METHODS: Eight hundred and one adults in southeast Michigan responded to an anonymous self-administered survey regarding personal and family members' hookah smoking behavior and perceptions of health risks related to hookah smoking. Multinomial logistic regression modeling was used to examine risk factors for hookah use. RESULTS: The prevalence of current hookah smoking in the study population was 26%. The odds ratio for an individual to smoke hookah were 9.5 (95% CI = 2.37-38.47, p < .01), 8.6 (95% CI = 3.92-19.02, p < .001), and 1.2 (95% CI = 1.14-1.41, p < .05) if the father, mother, or sibling, respectively, smoked hookah at home. Male gender and younger age were also significantly associated with hookah smoking. Household hookah smoking behaviors were also significant risk factors among former hookah smokers compared with nonsmokers, but there were no significant risk factors when comparing former hookah smokers with current hookah smokers. CONCLUSIONS: Having a father, mother, or sibling smoking hookah at home, male gender and younger age are significant risk factors for current hookah smoking.

Cancer knowledge increases after a brief intervention among Arab Americans in Michigan.

The objective of this study was to examine which factors are associated with increased cancer knowledge among a sample of 866 Arab Americans 40 years of age or older. Individuals were invited to attend a cancer educational intervention and obtain a free cancer health screening. They were asked to complete a precancer and postcancer knowledge survey after the brief educational intervention. Using logistic regression, we found that the intervention increased cancer knowledge and the variables most associated with this improvement were having low education, being unemployed, having lived in the USA for 0-5 years, older age, not having insurance, and not exercising. Our study showed that these interventions may be more effective if tailored to the participant's educational, employment, duration in the US, and health behavior status. Future studies should examine whether cancer screening actually increases after an educational intervention.

Lead poisoning among Arab American and African American children in the Detroit metropolitan area, Michigan.

This study explored the hypothesis that acculturation is a risk factor for childhood lead poisoning in the Detroit area of Michigan. Blood lead levels (BLLs) were determined in 429 Arab American and African American children, aged 6 months to 15 years, who were receiving well-child examination in three Women, Infant, and Children (WIC) clinics in the city. Mean BLL was 3.8 ± 2.3 µg/dL (range: 1-18 µg/dL) and 3.3% of the children tested had blood lead values above the 10 µg/dL level of concern. Neither the age of the dwelling units nor ethnicity of the child was significantly associated with the BLL. Multivariable analyses instead identified a number of acculturation-related factors that are associated with elevation in blood lead including paternal education, language spoken at home (English only, English and Arabic, or Arabic only), home ownership, smoking in the home, and exposure of child to home health remedies. The difference in blood lead between Arab American children from families where Arabic only versus Arabic and English is spoken at home was found to be statistically significant. This study provides information showing that immigrant children are at heightened risk of being poisoned by lead which can be useful in identifying groups at risk of atypical exposures.

IL-10: A possible immunobiological component of positive mental health in refugees.

Objective: As the number of refugees continues to rise, there is growing concern about the impact from trauma exposures on their mental health. However, there is a limited understanding of possible biological mechanisms contributing to the substantial inter-individual differences in trauma-related outcomes, especially as it relates to positive mental health. Only sparse work has focused on the biology of positive mental health, including energy and sleep, in trauma-exposed persons. In this study, we analyzed cytokines in blood from newly arrived refugees with differential trauma exposures in relationship to self-reported energy, as a key marker of positive mental health. Methods: Within the first month of arrival in the USA, 64 refugees from Iraq and Syria were interviewed. Refugees completed the clinical DSM-IV PTSD-Checklist Civilian Version (PCL-C), the Beck Anxiety Inventory (BAI), and the Hospital Anxiety and Depression Scale (HADS). Ten psychiatrically healthy non-refugee persons were used as healthy controls to compare levels of cytokines. Blood samples were collected at the time of the interview and subsequently analyzed for IL-1ß, IL-6, IL-8, IL-10, and TNF-α concentrations. Results: Energy correlated positively with current concentration ability and sleep quality, and negatively with stress, PCL-C, BAI and HADS scores (Spearman correlations, all p<0.05). Refugees had lower levels of IL-10 compared to controls (p<0.05). IL-10 levels in refugees correlated with higher energy levels (p<0.01). Conclusions: Results suggest that self-reported energy is a key component of positive mental health in newly arrived traumatized refugees. Additionally, the anti-inflammatory cytokine IL-10 could be a marker of, or causally associated with positive mental health. A better understanding of the balance between pro- and anti-inflammatory states in highly traumatized individuals has the potential to create more targeted and effective treatments with implications for long-term health outcomes.

Sociodemographic risk indicators of hookah smoking among White Americans: a pilot study.

BACKGROUND: Despite the sustained public health efforts to decrease cigarette smoking, there is an increasing trend in the use of alternative tobacco products that are perceived by some as less harmful. One example is hookah smoking. This study aimed to assess hookah trends among White Americans. METHODS: Two hundred and forty-five White American adults residing in southeast Michigan answered a self-administered standardized questionnaire that included basic demographics, socioeconomic status, and questions related to hookah smoking behavior. Logistic regression was used to determine risk indicators for hookah smoking. RESULTS: The combined prevalence of hookah smoking in the White American study population was 19%, with 10% of the sample smoking hookah only and 9% smoking both hookah and cigarettes. Approximately 19% of respondents believed that smoking hookah was less harmful than smoking cigarettes. Significant risk indicators for smoking hookah were being younger than 22 years and living with a family member who used tobacco. DISCUSSION: In addition to reporting the prevalence of use in this important group of potential users, we outline important sociodemographic risk factors for hookah use in a non-Arab American population. More research is needed with a larger population to better understand this new tobacco trend in order to curb a new potential health threat.

Pre- and post-displacement stressors and time of migration as related to self-rated health among Iraqi immigrants and refugees in Southeast Michigan.

The objective of this study was to determine whether perceived health status of Iraqi immigrants and refugees residing in the United States was related to pre-migration environmental stress, current unemployment, and if they had emigrated before or after the 1991 Gulf War. A random sample of Iraqis residing in Southeast Michigan, US, was interviewed using an Arab language structured survey. The main outcome measure was self-rated health (SRH). Major predictors included socioeconomics, employment status, pre-migration environmental stress, and health disorders. Path analysis was used to look at mediating effects between predictors and SRH. We found that SRH was significantly worse among participants that had left Iraq after the 1991 Gulf War. Unemployment and environmental stress exposure were inversely related to SRH. There was a direct path between Gulf War exposure and poor health. In addition, there were indirect paths mediated through psychosomatic and psychiatric disorders to SRH. Another path went from Gulf War exposure, via environmental stress and somatic health to poor health. Unemployment had a direct path, as well as indirect paths mediated through psychiatric and psychosomatic disorders, to poor self-rated health. In conclusion, these results suggest that pre- as well as post-migration factors, and period of migration, affect health.