Diabetes Distress and Associated Factors Among Chinese Americans with Type 2 Diabetes in New York City.

Purpose: The purpose of this study is to describe diabetes distress and related factors among Chinese Americans with type 2 diabetes in New York City (NYC). Methods: We conducted a secondary data analysis of the baseline data from three research studies conducted among community-dwelling Chinese American adults with type 2 diabetes. Diabetes Distress Scale (DDS) was used to measure sources of diabetes distress including emotional-, regimen-, interpersonal-, and physician-related distress. A score of 2 or greater indicates moderate diabetes distress or higher. Patient Health Questionnaire-2 (PHQ-2) was used to measure depressive symptoms. Participants' sociodemographic information was also collected. Descriptive statistics were used to describe diabetes distress, and logistic least absolute shrinkage and selection operator (LASSO) regression was used to examine factors associated with diabetes distress level. Results: Data from 178 participants (mean age 63.55±13.56 years) were analyzed. Most participants were married (76.40%), had a high school degree or less (65.73%), had a household annual income < $25,000 (70.25%), and reported limited English proficiency (93.22%). About 25.84% reported moderate or higher overall distress. The most common sources of distress were emotional burden (29.78%), followed by regimen- (28.65%), interpersonal- (18.54%), and physician-related distress (14.04%). Participants who were younger, female, limited English proficient, and had elevated depressive symptoms were more likely to have higher diabetes distress. Conclusion: Diabetes distress is prevalent among Chinese immigrants with type 2 diabetes, especially emotional- and regimen-related distress. Given the known link between diabetes distress and poor glycemic control, it is critical to screen for diabetes distress at primary care clinics and incorporate psychological counseling in diabetes care in this underserved population.

Strengthening the Voices of Hispanic/Latine Immigrants Managing Chronic Disease: A Mixed Methods Approach to Understanding Perspectives of Health.

Individuals who migrate from their home country face a variety of challenges while adapting to the culture in the United States. Immigrant communities are at a significantly higher risk for poor health outcomes; therefore, assessing healthcare treatment for diverse and resilient immigrant populations, including Hispanic/Latine communities, is crucial to preserving their health, culture, and spirit. A paucity of literature exists surrounding perceptions of well-being in immigrant, Hispanic/Latine adults managing chronic diseases. Past studies have shown a discrepancy between providers' and patients' perceptions of healthcare options for overall well-being. We aim to share varying perspectives found within our work geared towards improving the quality of life for Hispanic/Latine immigrants managing chronic disease, especially type 2 diabetes mellitus and hypertension. The primary objective of this article is to strengthen the understanding of intersections between social, physical, financial, and spiritual health within an (im)migrant Hispanic/Latine community using semi-structured ethnographic interviews. These interviews have highlighted community resilience, demonstrating that individuals can adapt to major life transitions while maintaining balance across dimensions of health. This knowledge could be implemented by actively listening to patient concerns regarding their health dimensions to improve individualized and patient-centric care.

Discrimination and Racial Inequities in Self-reported Mental Health Among Immigrants and Canadian-Born Individuals in a Large, Nationally Representative Canadian Survey.

We examined the link between discrimination and self-rated mental health (SRMH) among immigrants and Canadian-born individuals, stratified according to an individual's identification as racialized or white. Using data from Canada's General Social Survey (2014) (weighted N = 27,575,000) with a novel oversample of immigrants, we estimated the association of perceived discrimination with SRMH separately among immigrants and Canadian-born individuals and stratified by racialized status. Among immigrants, we also investigated whether age-at-arrival attenuated or strengthened associations. The prevalence of discrimination was higher among racialized compared to white immigrants (18.9% versus 11.8%), and among racialized compared to white non-immigrants (20.0% versus 10.5%). In the adjusted model with immigrants, where white immigrants not reporting discrimination were the referent group, both white (adjusted prevalence odds ratio [aPOR] 6.11, 95% confidence interval [CI] 3.08, 12.12) and racialized immigrants (aPOR 2.28, 95% CI 1.29, 4.04) who experienced discrimination reported poorer SRMH. The associations were weaker among immigrants who immigrated in adulthood. In the adjusted model with non-immigrants, compared to unexposed white respondents, Canadian-born white respondents who experienced discrimination reported poorer SRMH (aPOR 3.62, 95% CI 2.99, 4.40) while no statistically significant association was detected among racialized respondents (aPOR 2.24, 95% CI 0.90, 5.58). Racialized respondents experienced significant levels of discrimination compared to white respondents irrespective of immigrant status. Discrimination was associated with poor SRMH among all immigrants, with some evidence of a stronger association for white immigrants and immigrants who migrated at a younger age. For Canadian-born individuals, discrimination was associated with poor SRMH among white respondents only.

The Immigrant Mortality Advantage Among Over-65 Middle Eastern and North African Immigrants to the United States.

Immigrants to the United States often have longer life expectancies than their U.S.-born counterparts, however it is unclear whether a similar "immigrant advantage" exists for immigrants from the Middle East and North Africa (MENA). This study uses a novel machine-learning name classifier to offer one of the first national-level examinations of MENA mortality patterns by nativity in the United States. A recurrent neural network model was developed to identify MENA individuals based on given name and surname characteristics. The model was trained on more than 2.5 million mortality-linked social security records in the Berkeley Unified Numident Mortality Database (BUNMD). Mortality rates and life expectancy were estimated using a Gompertz distribution and maximum likelihood estimation, focusing on high-coverage years between 1988 and 2005 and deaths over age 65. Foreign-born MENA men over 65 showed a significant immigrant mortality advantage with a hazard ratio (HR) of 0.64 and an estimated 3.13 additional years of life expectancy at age 65 compared to U.S.-born counterparts. Foreign-born MENA women also exhibited an advantage, with a HR of 0.71 and an additional 2.24 years of life expectancy at age 65. This study is one of the first national-level analyses of mortality outcomes among the over-65 MENA population in the United States, finding a MENA immigrant mortality advantage. The results suggest further research is needed to identify and disaggregate the MENA population in health research.

Perinatal outcome of immigrant women with and without refugee status compared to non-immigrant women: results of the pregnancy and obstetric care for refugees (PROREF) cross-sectional study.

PURPOSE: International studies show conflicting evidence regarding the perinatal outcome of immigrant women with and without refugee status compared to non-immigrant women. There are few studies about the situation in Germany. The research question of this article is: Is the perinatal outcome (Apgar, UApH (umbilical artery pH), NICU (neontatal intensive care unit) transfer, c-section rate, preterm birth, macrosomia, maternal anemia, higher degree perinatal tear, episiotomy, epidural anesthesia) associated with socio-demographic/clinical characteristics (migration status, language skills, household income, maternal education, parity, age, body mass index (BMI))? METHODS: In the Pregnancy and Obstetric Care for Refugees (PROREF)-study (subproject of the research group PH-LENS), funded by the German Research Foundation (DFG), women giving birth in three centers of tertiary care in Berlin were interviewed with the modified Migrant Friendly Maternity Care Questionnaire between June 2020 and April 2022. The interview data was linked to the hospital charts. Data analysis was descriptive and logistic regression analysis was performed to find associations between perinatal outcomes and migration data. RESULTS: During the research period 3420 women (247 with self-defined (sd) refugee status, 1356 immigrant women and 1817 non-immigrant women) were included. Immigrant women had a higher c-section rate (36.6% vs. 33.2% among non-immigrant women and 31.6% among women with sd refugee status, p = 0.0485). The migration status did not have an influence on the umbilical artery pH, the preterm delivery rate and the transfer of the neonate to the intensive care unit. Women with self-defined refugee status had a higher risk for anemia (31.9% vs. 26.3% immigrant women and 23.4% non-immigrant women, p = 0.0049) and were less often offered an epidural anesthesia for pain control during vaginal delivery (42.5% vs. 54% immigrant women and 52% non-immigrant women, p = 0.0091). In the multivariate analysis maternal education was explaining more than migration status. CONCLUSION: Generally, the quality of care for immigrant and non-immigrant women in Berlin seems high. The reasons for higher rate of delivery via c-section among immigrant women remain unclear. Regardless of their migration status women with low degree of education seem at increased risk for anemia.

Supporting Underserved Communities for Health Care: US Immigrants' Experiences with Social Support.

Background: Social support is associated with improved clinical outcomes but is understudied among US immigrants. We examined two types of social support, perceived health provider support and community support, and characterized perceptions of social support among US immigrants compared with nonimmigrants. Methods: We conducted cross-sectional data analysis on self-reported data from Health Information National Trends Survey 5, Cycle 2. Population-level estimates were obtained using jack-knife replicate weights. Results: Immigrant status was not associated with perceived health care provider support or community support. However, compared with nonimmigrants, US immigrants were more likely to report rarely (adjusted odds ratio [aOR]=3.07) or never (aOR=3.18) having access to emotional support. Conclusions: Further research that incorporates nuanced factors (eg, time since arrival) that may influence social support in diverse US immigrant groups is needed to determine the impact of social support on health outcomes in an underserved and often overlooked population.

Immigrant and Refugee Health Curricula in US-Based Medical Training: A Scoping Review to Inform Integration Into Pediatric Residency Programs.

OBJECTIVE: Despite increases in the US foreign-born population, medical education opportunities in immigrant and refugee health (IRH) remain limited. We summarize findings for published IRH curricula and offer recommendations for integrating IRH into pediatric residency programs. METHODS: We performed a literature review of articles describing the design, implementation, or assessment of IRH curricula for US-based undergraduate and graduate medical trainees. RESULTS: The literature review identified 36 articles from 21 institutions describing 37 unique curricula. Three curricula included pediatric residency programs. Commonly taught topics included cultural humility, interpreter use, and immigration status as a social determinant of health. Immigrant-focused training experiences existed at continuity clinics, clinics for refugees or asylum seekers, and dedicated electives/rotations. Curricula were most frequently described as stand-alone electives/rotations. CONCLUSIONS: IRH curricula provide opportunities to develop skills in clinical care, advocacy, and community partnerships with immigrant populations. Pediatric residency programs should align the IRH curriculum with existing learning priorities, support and hire faculty with expertise in IRH, and partner with community organizations with expertise. Programs can also consider how to best support learners interested in careers focusing on immigrant populations. Further work is needed to establish competencies and validated tools measuring trainee satisfaction and clinical competency for IRH curricula.

The Intergenerational Effects From Structural Racism Cost Our Society Greatly.

Structural racism is historically rooted, and has been a foundation for United States immigration policy. This injustice has intergenerational effects that cost society greatly - with impacts on social cohesion, individual and collective health, and well-being, and ultimately our ability to function as a civil society. Limited pathways to citizenship and major restrictions to resources that promote integration have adverse consequences for immigrants and, their families. Research shows that children experience toxic stress that negatively impacts their long-term health and development from heightened immigration enforcement, regardless of any personal impact. In embracing the next generation of children, we will not succeed unless we support sound integration policies that promote the health and well-being of immigrant families across this nation. We must recognize how intricately our fates and our health are tied to each other; we all depend on immigrants being well. We must advance new a social contract, one that counters the 'othering' of immigrants" and recognizes that we must invest in the health and well-being of all families.

Second-Class Care: How Immigration Law Transforms Clinical Practice in the Safety Net.

This article examines how U.S. immigration law extends into the health care safety net, enacting medical legal violence that diminishes noncitizens' health chances and transforms clinical practices. Drawing on interviews with health care workers in three U.S. states from 2015 to 2020, I ask how federal citizenship-based exclusions within an already stratified health care system shape the clinical trajectories of noncitizens in safety-net institutions. Focusing specifically on cancer care, I find that increasingly anti-immigrant federal policies often reshape clinical practices toward noncitizens with a complex, life-threatening condition as they approach a "specialty care cliff" by (1) creating time penalties that keep many noncitizens in a protracted state of injury and (2) deterring noncitizens from seeking care through threats of immigration enforcement. Through these processes, medical legal violence also creates the potential for moral injury among health care workers, who must adapt clinical practices in response to socio-legal boundaries of belonging.

Immigrant and Racialized Populations' Cumulative Exposure to Discrimination and Associations with Long-Term Conditions During COVID-19: A Nationwide Large-Scale Study in Canada.

BACKGROUND: This cross-sectional study examines associations between the race-migration nexus, cumulative exposure to intersectional discrimination (2 years before and during the COVID-19 pandemic), and long-term conditions. METHODS: A nationwide self-selected sample (n = 32,605) was obtained from a Statistics Canada's Crowdsourcing online survey from August 4 to 24, 2020. Binary and multinomial logistic regression models were used to examine disparities by the race-migration nexus in accumulative experiences of multiple situations- and identity-based discrimination and their relations with long-term conditions, after controlling for sociodemographic covariates. RESULTS: During the pandemic, discrimination stemming from racialization - such as race/skin color (24.4% vs 20.1%) and ethnicity/culture (18.5% vs 16.5%) - and cyberspace (34.1% vs 29.8%) exaggerated relative to pre-pandemic period; compared to Canadian-born (CB) whites, the likelihood of experiencing multiple discrimination increased alongside the domains of discrimination being additively intersected (e.g., identity-based, all p's < 0.001) among CB racialized minorities (ORs 2.08 to 11.78), foreign-born (FB) racialized minorities (ORs 1.99 to 12.72), and Indigenous populations (ORs 1.62 to 8.17), except for FB whites (p > 0.01); dose-response relationships were found between cumulative exposure to multiple discrimination and odds of reporting long-term conditions (p's < 0.001), including seeing (ORs 1.63 to 2.99), hearing (ORs 1.83 to 4.45), physical (ORs 1.66 to 3.87), cognitive (ORs 1.81 to 3.79), and mental health-related impairments (ORs 1.82 to 3.41). CONCLUSIONS: Despite a universal health system, Canadians who are CB/FB racialized and Indigenous populations, have a higher prevalence of cumulative exposure to different aspects of discrimination that are associated with multiple long-term conditions during the COVID-19 pandemic. Equity-driven solutions are needed to tackle upstream determinants of health inequalities through uprooting intersectional discrimination faced by racialized and immigrant communities.

A collaboration to harmonize COVID-19 health messaging and fill communication gaps during initial U.S. refugee resettlement.

To communicate with U.S.-bound refugees during travel to the United States during the onset of the COVID-19 pandemic, five federal and international organizations collaborated in a strategic work group to synergize COVID-19 prevention health messaging and COVID-19 considerations before, during, and after travel, as well as promote shared resources. This work group sought to establish consistent COVID-19 messaging, disseminate messages to partners, and identify message gaps as the pandemic evolved. In early Fall 2020, CDC released new communication materials, including a fact sheet, a welcome booklet, and infographics translated into 19 languages, to address refugee health partners' need for culturally and linguistically concordant educational materials for refugees. Rapidly changing health communications needs during the pandemic fostered opportunities for collaboration among federal and refugee health partners and highlighted a long-standing need among agencies to address health messaging across the continuum of care for refugees.

Association of depression and self-reported health status by birthplace and citizenship status: Results from the 2010-2018 National Health Interview Survey.

BACKGROUND: Self-reported health (SRH) is an important indicator of mental health outcomes. More information, however, is needed on whether this association varies by birthplace (defined as US-born or non-US-born) and citizenship status (i.e., non-US-born citizen, non-US citizen, and US-born citizen). METHODS: We examined the associations between SRH and depression among non-US-born US citizens, non-US citizens, and US-born citizens aged 18 years and older using weighted cross-sectional data from the 2010-2018 National Health Interview Survey (n = 139,884). Logistic regression models were used to assess the association between depression and SRH by citizenship status, adjusting for covariates. RESULTS: US-born citizens reported the highest prevalence of depression (40.3 %), and non-US-born citizens reported the highest prevalence of poor/fair SRH (14.5 %). Individuals with fair/poor SRH had a significantly increased likelihood of depression relative to those with good/very good/excellent for non-US-born US citizens (Adjusted Odds Ratio [AOR] = 2.42, 95 % Confidence Interval [95 % CI] = 2.04-2.88), non-US citizens (AOR = 2.80, 95 % CI = 2.31-3.40), and US-born citizens (AOR = 2.31, CI = 2.18-2.45). LIMITATIONS: The study is cross-sectional, reducing the strength of determining causal relationships. Also, there is a possible response bias due to the self-reported nature of the data. CONCLUSIONS: Our study indicates that fair/poor SRH is significantly associated with an increased likelihood of depression regardless of an individual citizenship status. Additionally, immigrants with fair/poor SRH had higher increased odds of depression. Therefore, mental healthcare interventions tailored for immigrants can reduce mental health problems and disparities among immigrants.

Patient Time Spent With Professional Medical Interpreters and the Care Experiences of Patients With Limited English Proficiency.

INTRODUCTION/OBJECTIVES: More time spent with interpreters may support clinician-patient communication for patients with limited English proficiency (LEP), especially when interpreter support before and after clinical encounters is considered. We assessed whether more time spent with interpreters is associated with better patient-reported experiences of clinician-patient communication and interpreter support among patients with LEP. METHODS: Patients with LEP (n = 338) were surveyed about their experiences with both the clinician and interpreter. Duration of interpreter support during the encounter (in min) and auxiliary time spent before and after encounters supporting patients (in min) were documented by interpreters. Multivariable linear regression models were estimated to assess the association of the time duration of interpreter support and patient experiences of (1) clinician-patient communication, and (2) interpreter support, controlling for patient and encounter characteristics. RESULTS: The average encounter duration was 47.7 min (standard deviation, SD = 25.1), the average auxiliary time was 43.8 min (SD = 16.4), and the average total interpreter time was 91.1 min (SD = 28.6). LEP patients reported better experiences of interpreter support with a mean score of 97.4 out of 100 (SD = 6.99) compared to clinician-patient communication, with a mean score of 93.7 out of 100 (SD = 14.1). In adjusted analyses, total patient time spent with an interpreter was associated with better patient experiences of clinician-patient communication (ß = 7.23, P < .01) when auxiliary time spent by interpreters supporting patients before and after the encounter was considered, but not when only the encounter time was considered. CONCLUSIONS: Longer duration of time spent with an interpreter was associated with better clinician-patient communication for patients with LEP when time spent with an interpreter before and after the clinician encounter is considered. Policymakers should consider reimbursing health care organizations for time interpreters spend providing patient navigation and other support beyond clinical encounters.

Infant Feeding Outcomes From a Culturally-Adapted Early Obesity Prevention Program for Immigrant Chinese American Parents.

OBJECTIVE: To examine whether a cultural adaptation of an early childhood obesity prevention program promotes healthy infant feeding practices. METHODS: Prospective quasi-experimental study of a community-engaged multiphasic cultural adaptation of an obesity prevention program set at a federally qualified health center serving immigrant Chinese American parent-child dyads (N = 298). In a group of historical controls, we assessed early infant feeding practices (breastfeeding, sugar-sweetened beverage intake) in 6-month-olds and then the same practices alongside early solid food feeding practices (bottle weaning, fruit, vegetable, sugary or salty snack consumption) in 12-month-olds. After implementation, we assessed these practices in an intervention cohort group at 6 and 12 months. We used cross-sectional groupwise comparisons and adjusted regression analyses to evaluate group differences. RESULTS: At 6 months, the intervention group had increased odds of no sugar-sweetened beverage intake (aOR: 5.69 [95% confidence interval (CI): 1.65, 19.63], P = .006). At 12 months, the intervention group also had increased odds of no sugar-sweetened beverage intake (aOR: 15.22 [95% CI: 6.33, 36.62], P < .001), increased odds of bottle weaning (aOR: 2.34 [95% CI: 1.05, 5.23], P = .03), and decreased odds of sugary snack consumption (aOR: 0.36 [0.18, 0.70], P = .003). We did not detect improvements in breastfeeding, fruit, vegetable, or salty snack consumption. CONCLUSIONS: A cultural adaptation of a primary care-based educational obesity prevention program for immigrant Chinese American families with low income is associated with certain healthy infant feeding practices. Future studies should evaluate cultural adaptations of more intensive interventions that better address complex feeding practices, such as breastfeeding, and evaluate long-term weight outcomes.

Does an Immigrant Health Advantage Exist Among US Whites? Evidence from a Nationally-Representative Examination of Mental and Physical Well-Being.

This study examines whether an immigrant health advantage exists among US Whites, a group often used as a reference category in research on racial and ethnic health disparities. Using recent data from the National Health Interview Survey (2019-2022), I disaggregate non-Hispanic White adults (n = 41,752) by nativity status and use logistic regression models to assess differences in six measures of mental and physical health. The analysis includes self-reported conditions (depression, anxiety, fair/poor self-rated health) and diagnosed conditions that require interaction with the healthcare system (hypertension, diabetes, and chronic obstructive pulmonary disease, COPD). Foreign-born Whites have a significantly lower prevalence of each health outcome relative to US-born Whites. The immigrant health advantage remains significant for depression, anxiety, fair/poor health (i.e., self-reported conditions) and diagnosed hypertension, after adjusting for sociodemographic and healthcare characteristics. In contrast, the inclusion of these explanatory factors reduces the nativity gap in diagnosed diabetes and COPD to non-significance. Overall, the results indicate important variation in health among Whites that is missed in studies that focus on US-born Whites, alone. Scholars must continue to monitor the health of White immigrants, who are projected to grow to 20% of the US immigrant population in the years to come.

Meeting a need: development and validation of PubMed search filters for immigrant populations.

Objective: There is a need for additional comprehensive and validated filters to find relevant references more efficiently in the growing body of research on immigrant populations. Our goal was to create reliable search filters that direct librarians and researchers to pertinent studies indexed in PubMed about health topics specific to immigrant populations. Methods: We applied a systematic and multi-step process that combined information from expert input, authoritative sources, automation, and manual review of sources. We established a focused scope and eligibility criteria, which we used to create the development and validation sets. We formed a term ranking system that resulted in the creation of two filters: an immigrant-specific and an immigrant-sensitive search filter. Results: When tested against the validation set, the specific filter sensitivity was 88.09%, specificity 97.26%, precision 97.88%, and the NNR 1.02. The sensitive filter sensitivity was 97.76%when tested against the development set. The sensitive filter had a sensitivity of 97.14%, specificity of 82.05%, precision of 88.59%, accuracy of 90.94%, and NNR [See Table 1] of 1.13 when tested against the validation set. Conclusion: We accomplished our goal of developing PubMed search filters to help researchers retrieve studies about immigrants. The specific and sensitive PubMed search filters give information professionals and researchers options to maximize the specificity and precision or increase the sensitivity of their search for relevant studies in PubMed. Both search filters generated strong performance measurements and can be used as-is, to capture a subset of immigrant-related literature, or adapted and revised to fit the unique research needs of specific project teams (e.g. remove US-centric language, add location-specific terminology, or expand the search strategy to include terms for the topic/s being investigated in the immigrant population identified by the filter). There is also a potential for teams to employ the search filter development process described here for their own topics and use.

Association Between Discrimination and Depressive Symptoms Among Hispanic or Latino Adults During the COVID-19 Pandemic: Cross-Sectional Study.

BACKGROUND: Discrimination and xenophobia toward Hispanic and Latino communities increased during the COVID-19 pandemic, likely inflicting significant harm on the mental health of Hispanic and Latino individuals. Pandemic-related financial and social instability has disproportionately affected Hispanic and Latino communities, potentially compounding existing disparities and worsening mental health. OBJECTIVE: This study aims to examine the association between discrimination and depressive symptoms during the COVID-19 pandemic among a national sample of Hispanic and Latino adults. METHODS: Data from a 116-item web-based nationally distributed survey from May 2021 to January 2022 were analyzed. The sample (N=1181) was restricted to Hispanic or Latino (Mexican or Mexican American, Puerto Rican; Cuban or Cuban American, Central or South American, and Dominican or another Hispanic or Latino ethnicity) adults. Depression symptoms were assessed using the 2-item Patient Health Questionnaire. Discrimination was assessed using the 5-item Everyday Discrimination Scale. A multinomial logistic regression with a block entry model was used to assess the relationship between discrimination and the likelihood of depressive symptoms, as well as examine how controls and covariates affected the relationship of interest. RESULTS: Mexican or Mexican American adults comprised the largest proportion of the sample (533/1181, 45.13%), followed by Central or South American (204/1181, 17.3%), Puerto Rican (189/1181, 16%), Dominican or another Hispanic or Latino ethnicity (172/1181, 14.6%), and Cuban or Cuban American (83/1181, 7.03%). Approximately 31.26% (367/1181) of the sample had depressive symptoms. Regarding discrimination, 54.56% (634/1181) reported experiencing some form of discrimination. Compared with those who did not experience discrimination, those who experienced discrimination had almost 230% higher odds of depressive symptoms (adjusted odds ratio [AOR] 3.31, 95% CI 2.42-4.54). Also, we observed that sociodemographic factors such as age and gender were significant. Compared with participants aged 56 years and older, participants aged 18-35 years and those aged 36-55 years had increased odds of having depressive symptoms (AOR 3.83, 95% CI 2.13-6.90 and AOR 3.10, 95% CI 1.74-5.51, respectively). Women had higher odds of having depressive symptoms (AOR 1.67, 95% CI 1.23-2.30) than men. Respondents with an annual income of less than US $25,000 (AOR 2.14, 95% CI 1.34-3.41) and US $25,000 to less than US $35,000 (AOR 1.89, 95% CI 1.17-3.06) had higher odds of depressive symptoms than those with an annual income of US $50,000 to less than US $75,000. CONCLUSIONS: Our findings provide significant importance especially when considering the compounding, numerous socioeconomic challenges stemming from the pandemic that disproportionately impact the Hispanic and Latino communities. These challenges include rising xenophobia and tensions against immigrants, inadequate access to mental health resources for Hispanic and Latino individuals, and existing hesitations toward seeking mental health services among this population. Ultimately, these findings can serve as a foundation for promoting health equity.

Female genital mutilation and cutting: a survey of child abuse pediatricians.

BACKGROUND: As global immigration from countries with a high prevalence of female genital mutilation and cutting (FGM/C) has grown in the United States (US), there is need for pediatricians to have adequate training to care for these patients. The objective of this study is to determine the level of knowledge and attitudes of child abuse pediatricians (CAPs) towards FGM/C in the US. METHODS: This cross-sectional study distributed a peer-reviewed survey to US CAPs-members of the Helfer Society-to assess their attitudes, knowledge, clinical practice, and education about FGM/C. Data was analyzed using descriptive statistics, Kruskal-Wallis tests, and Fisher's exact test. RESULTS: Most of the 65 respondents were aware that FGM/C is illegal (92%) and agreed that it violated human rights (99%). Individuals reporting previous training related to FGM/C were significantly more likely to correctly identify World Health Organization types of FGM/C (p < 0.05) and report confidence in doing so (p < 0.05). Only 21% of respondents felt comfortable discussing FGM/C with parents from countries with a high prevalence of FGM/C. Sixty-three percent were not aware of the federal law, and 74% were not aware of their own state's laws about FGM/C. CONCLUSIONS: US CAPs have high rates of training related to FGM/C; however, they need additional training to increase confidence and ability to identify FGM/C. FGM/C remains a topic that CAPs find difficult to discuss with families. With culturally sensitive training, CAPs have the opportunity to help manage and prevent the practice by serving as educators and experts for general pediatricians.

Zika Virus Infection Knowledge and Communication Preferences Among Women of Reproductive Age in Central Brooklyn, New York: A Thematic Analysis.

The 2016 outbreak of Zika virus (ZIKV) infected millions and resulted in thousands of infants born with malformations. Though the clusters of severe birth defects resulting from this outbreak have subsided, ZIKV continues to be a concern throughout much of Latin America and the Caribbean. Travel and sexual intercourse remain the dominant transmission risk factors for women of reproductive age and their partners. This is particularly true for communities in Brooklyn, New York, that comprise large immigrant and foreign-born populations. Practitioners of public health understand little about how women at risk for ZIKV are most likely to receive information about the virus or who they trust most to provide that information. In the context of five focus group discussions, this study explored the knowledge and communication preferences of 20 women of reproductive age in Central Brooklyn. Results derived from a thematic analysis suggest that while most women are familiar with mosquitos as ZIKV vectors, knowledge of sexual transmission is considerably lower. Many respondents believe that only women who are pregnant or trying to become pregnant are at risk, and public health agencies, such as the U.S. Centers for Disease Control and Prevention, remain the most trusted sources of information. These findings can support more effective communication about the risks of ZIKV infection and other vector-borne diseases to women in New York City and similar urban communities.