Language discordance and testing for latent tuberculosis infection among recent Asian and Latino immigrants.

The foreign-born population is disproportionately affected by tuberculosis (TB). Testing to identify persons with latent TB infection is critical. The aim of this study was to assess clinic-based testing for latent tuberculosis infection among recent Asian and Latino immigrants. A randomized controlled trial of interpreting methods and their impact on medical outcomes was conducted at the primary care clinic of a New York City municipal hospital. This study is a nested cohort of recruited patients with an indication to receive tuberculin testing, based on recent migration to the US from endemic areas. Medical record data were abstracted to determine referral for, and completion of, tuberculin testing. Bivariate analyses were used to test for differences in tuberculin testing between language concordant and discordant groups. Seven hundred and eighty-two patients were enrolled. One hundred and ninety-one had migrated within 5 years of enrollment from endemic areas. None spoke English as a primary language. Seventy percentage of patient-provider encounters were language discordant. Seventeen of 191 were referred for testing. Fifteen (88%) completed testing. Six (40%) had positive results. There were no significant differences between language concordant and discordant patients. In this at-risk population, every patient in clinical care should be considered for testing if indicated by country of origin.

Diabetes care and language discordance among Chinese and Latino primary care patients.

OBJECTIVES: To assess differences in diabetes processes of care among Chinese and Latino patients across medical interpreting methods. DESIGN AND SETTING: This is a nested cohort study of patients with diabetes, comparing interpreting methods and their impact on medical outcomes at the primary care clinic of a New York City municipal hospital. PARTICIPANTS: 54 Spanish and Chinese-speaking language discordant diabetic patients were enrolled and followed for one year. INTERVENTION: Language discordant patients received either Remote Simultaneous Medical Interpreting (RSMI), or usual and customary (U&C) interpreting. MAIN OUTCOME MEASURES: Composite medical care scores were calculated for physician ordering and patient completion of diabetes care measures. RESULTS: RSMI patients, compared with U&C patients, had trends towards higher mean patient completion (.29 vs .25) and physician ordering (.41 vs .37) scores. Overall rates of completion of diabetes care measures in both groups were very low. CONCLUSIONS: Overall rates of physician ordering and patient completion of diabetes care measures were distressingly low in our study. Further studies are needed to explore the potential role of RSMI in addressing the language barrier and improving diabetes care for Chinese- and Spanish-speaking patients.

Reducing clinical errors in cancer education: interpreter training.

Over 22 million US residents are limited English proficient. Hospitals often call upon untrained persons to interpret. There is a dearth of information on errors in medical interpreting and their impact upon cancer education. We conducted an experimental study of standardized medical interpreting training on interpreting errors in the cancer encounter, by comparing trained and untrained interpreters, using identical content. Nine interpreted cancer encounters with identical scripts were recorded and transcribed. Using an "Error Analysis Tool," a bilingual linguist and two bilingual medical providers scored the transcripts for interpreting errors made, including their potential clinical severity. Trained interpreters were 70% less likely to have clinical errors than untrained ones. The likelihood of medical error increased with the length of the concept and decreased with the precision of vocabulary. It is important to train medical interpreters and to ensure their availability in cancer education encounters to minimize the risk for errors.

Patient satisfaction with different interpreting methods: a randomized controlled trial.

BACKGROUND: Growth of the foreign-born population in the U.S. has led to increasing numbers of limited-English-proficient (LEP) patients. Innovative medical interpreting strategies, including remote simultaneous medical interpreting (RSMI), have arisen to address the language barrier. This study evaluates the impact of interpreting method on patient satisfaction. METHODS: 1,276 English-, Spanish-, Mandarin-, and Cantonese-speaking patients attending the primary care clinic and emergency department of a large New York City municipal hospital were screened for enrollment in a randomized controlled trial. Language-discordant patients were randomized to RSMI or usual and customary (U&C) interpreting. Patients with language-concordant providers received usual care. Demographic and patient satisfaction questionnaires were administered to all participants. RESULTS: 541 patients were language-concordant with their providers and not randomized; 371 were randomized to RSMI, 167 of whom were exposed to RSMI; and 364 were randomized to U&C, 198 of whom were exposed to U&C. Patients randomized to RSMI were more likely than those with U&C to think doctors treated them with respect (RSMI 71%, U&C 64%, p < 0.05), but they did not differ in other measures of physician communication/care. In a linear regression analysis, exposure to RSMI was significantly associated with an increase in overall satisfaction with physician communication/care (beta 0.10, 95% CI 0.02-0.18, scale 0-1.0). Patients randomized to RSMI were more likely to think the interpreting method protected their privacy (RSMI 51%, U&C 38%, p < 0.05). Patients randomized to either arm of interpretation reported less comprehension and satisfaction than patients in language-concordant encounters. CONCLUSIONS: While not a substitute for language-concordant providers, RSMI can improve patient satisfaction and privacy among LEP patients. Implementing RSMI should be considered an important component of a multipronged approach to addressing language barriers in health care.

The impact of medical interpretation method on time and errors.

BACKGROUND: Twenty-two million Americans have limited English proficiency. Interpreting for limited English proficient patients is intended to enhance communication and delivery of quality medical care. OBJECTIVE: Little is known about the impact of various interpreting methods on interpreting speed and errors. This investigation addresses this important gap. DESIGN: Four scripted clinical encounters were used to enable the comparison of equivalent clinical content. These scripts were run across four interpreting methods, including remote simultaneous, remote consecutive, proximate consecutive, and proximate ad hoc interpreting. The first 3 methods utilized professional, trained interpreters, whereas the ad hoc method utilized untrained staff. MEASUREMENTS: Audiotaped transcripts of the encounters were coded, using a prespecified algorithm to determine medical error and linguistic error, by coders blinded to the interpreting method. Encounters were also timed. RESULTS: Remote simultaneous medical interpreting (RSMI) encounters averaged 12.72 vs 18.24 minutes for the next fastest mode (proximate ad hoc) (p = 0.002). There were 12 times more medical errors of moderate or greater clinical significance among utterances in non-RSMI encounters compared to RSMI encounters (p = 0.0002). CONCLUSIONS: Whereas limited by the small number of interpreters involved, our study found that RSMI resulted in fewer medical errors and was faster than non-RSMI methods of interpreting.

An academic dental center grapples with oral cancer disparities: current collaboration and future opportunities.

This article reviews the epidemiology of oral cancer in the United States, explores the complex reasons for its disproportionate burden in minority groups, and describes the efforts of New York University's College of Dentistry to address these oral cancer disparities. These efforts include the development of state and regional consortia and networks, public education and community screening efforts, undergraduate dental curriculum development, professional education, intensive research efforts, and significant dental-medical collaborations. Future directions include the need to develop and assess oral cancer education/awareness programs, specifically customized to the various dental-medical professionals/trainees and to populations at risk. Improving the quality of life of patients during and following treatment for oral cancer is another important area that has great opportunity for dental-medical collaboration.

Pedometer assessed physical activity in urban pubertal children: first report from India.

BACKGROUND: Inadequate physical activity is a risk factor for several lifestyle diseases. In the current study we have tried to evaluate the physical activity levels in urban Indian pubertal children as well as investigate the relationship between step counts and body composition. METHODS: A total of 1032 children aged 12 to 15 years wore pedometers for 2 weekdays and 2 weekend days, the final cohort included 910 subjects with 467 boys and 443 girls. RESULTS: Mean weekday steps were 11,062 ± 4741 for boys and 9619 ± 4144 for girls; weekend steps were 10,842 ± 5034 for boys and 9146 ± 5159 for girls, which were both significantly different. The weekend steps were consistently lower in both genders. Analysis of children not meeting a cut-off of 10,000 steps indicated that 45% of the boys aged 12; 54% aged 13; 43% to 48% aged 14 and 50% in the aged 15 did not meet the cut-off. In girls higher levels of inactivity were seen with 58% to 65% aged 12; 69% to 73% aged 13; 49% to 58% aged 14 and 50% to 100% in age-group 15 did not meet the cut-off on weekdays and weekends respectively. CONCLUSIONS: The high level of physical inactivity in the representative urban Indian children is a cause of grave concern and necessitates urgent intervention strategies to be formulated.

Culturally tailored health camps and cardiovascular risk among South Asian immigrants.

INTRODUCTION: South Asians have a high prevalence and early age of onset of diabetes, metabolic syndrome, and cardiovascular disease (CVD). We assess the potential of a culturally responsive intervention, health camps, to identify and inform U.S. South Asian community members at risk for CVD. METHODS: We held four culturally and linguistically tailored health camps between October 2009 and November 2010 to educate participants about and screen for CVD risk factors, including diabetes, hypertension, and hypercholesterolemia. Data analysis was conducted in December 2010. RESULTS: Nearly 300 (289) South Asians registered at the health camps: 20% reported a previous diagnosis of diabetes, 34% elevated blood pressure, and 22% hypercholesterolemia. Most (240) participants had their blood glucose measured; 13% had values >200 mg/dl. Most (265) had their blood pressure measured; 32% had elevated values. Over half (57%) of LDLs were <100 mg/dl. DISCUSSION: Health camps are a potentially important component in addressing increased CVD risk in this vulnerable population.

Detection of depression with different interpreting methods among Chinese and Latino primary care patients: a randomized controlled trial.

Language barriers may contribute to the under-detection of depression in Latinos and Asians. A total of 782 English, Spanish, and Chinese-speaking primary care patients were enrolled in a randomized controlled trial. Language discordant patients were randomized to Remote Simultaneous Medical Interpreting (RSMI) or usual and customary (U&C) interpreting. The Beck Depression Inventory-Fast Screen (BDI-FS) was administered. Patients were tracked for 1 year. A total of 462 patients completed the BDI-FS. Thirty-three percent had a positive (> or = 4) screen. Twenty-seven percent of BDI-FS positive patients were diagnosed with depression. Among BDI-FS positive patients, Chinese-speakers were less likely to be diagnosed compared with English speakers (31% vs. 10%, P < 0.05). There was a trend towards greater diagnosis with RSMI (27% detection with RSMI vs. 20% U&C, P = 0.41). The diagnosis of depression among BDI-FS positive patients in our population was low, particularly among Chinese-speakers. RSMI could be an important part of a multi-faceted approach to improving the detection of depression.

New York City's immigrant minorities. Reducing cancer health disparities.

One million newcomers arrive in the United States every year; 11.7% of the total U.S. population is foreign-born. Immigrants face cancer care and research access barriers, including economic, immigration status, cultural, and linguistic. In 2000, the Center for Immigrant Health, NYU School of Medicine, launched the Cancer Awareness Network for Immigrant Minority Populations (CANIMP), a network comprising community- and faith-based organizations, local and national government health institutions, clinical service providers, researchers, and immigrant-service and advocacy organizations. This community-based participatory program chose as its priorities high- incidence cancer sites in the overall immigrant community (colorectal, lung, breast, cervical, prostate), as well as sites with strikingly high incidence in specific immigrant groups (gastric, liver, oral). CANIMP has developed successful outreach, education, screening, survivorship, training, and research programs to decrease cancer disparities. Over 2500 at-risk community members have been reached, 25 junior minority researchers trained, 60 minority interns mentored, numerous cancer disparities research projects funded and conducted, and vital partnerships to improve cancer data developed. These initiatives serve as models to address community, systems, physician, and cancer research gaps in immigrant communities. Cancer 2006. (c) 2006 American Cancer Society.

Attitudes, knowledge, and health-seeking behaviors of five immigrant minority communities in the prevention and screening of cancer: a focus group approach.

Despite an observed decrease in overall cancer death rates in the USA, immigrant minorities continue to experience disproportionately higher cancer incidence and mortality rates. Thirteen focus groups were conducted in the Haitian, English-Speaking Caribbean, Latino, Korean, and Chinese communities of New York City to better understand their health-seeking behaviors with respect to cancer prevention, screening, and treatment. Focus groups addressed the degree to which cultural, linguistic, and systematic barriers impact these behaviors and explored methods to support salutary behaviors. Findings underscored that, while there are many similarities across immigrant groups, there are significant variations between the immigrant groups to necessitate a tailored community-based approach. The prevalent misinformation observed among all groups warrants the prompt development of culturally competent programs for cancer control with immigrant minorities.

Paan and Gutka Use in the United States: A Pilot Study in Bangladeshi and Indian-Gujarati Immigrants in New York City.

Smokeless tobacco and areca nut are popular with South Asians and South Asian immigrants, most commonly used as paan and gutka. Their regular use leads to oral cancer. The South Asian community in the U.S. is rapidly growing, where paan and gutka are readily available. The study was the first exploration of the migration of the paan and gutka habits, and their use in the U.S.A 108-item questionnaire on paan and gutka usage and beliefs was administered to 138 first-generation Bangladeshi and Indian-Gujarati immigrant adults at community sites in the New York metropolitan area. Forty-five percent Indian-Gujaratis reported ever-regular paan use; of which 5% are current users. Thirty-one percent reported ever-regular gutka use; of which 77% are current users. Thirty-five percent Bangladeshis reported ever-regular paan use; of which 70% arc current users. Nine percent reported ever-regular gutka use; of which 67% are current users. Bangladeshis are more likely to identify paan as causing oral cancer. Indian-Gujaratis are more likely to identify gutka as causing oral cancer.Between the two communities, there were significant differences in paan and gutfca usage, migration effects, and oral career risk perception. There is a need for comprehensive migration studies on the determinants of usage, and for community-specific interventions for these carcinogenic products.

Paan and Gutka in the United States: an emerging threat.

Smokeless tobacco and areca nut usage are integral cultural traditions in South Asia. Paan and gutka are two commonly used products which contain these ingredients. They are immensely popular in South Asia and with South Asian immigrants. Regular paan and gutka use is associated with several deleterious health consequences, most significantly oral cancer. Of particular concern is the markedly increased risk of oral cancer in South Asian immigrants when compared with the natives in new areas of settlement. The South Asian community in the United States is large and rapidly growing. Paan and gutka are legal in the United States, and readily available in ethnic enclaves. Smokeless tobacco prevention and cessation research and interventions have not yet addressed the unique sociocultural circumstances of this growing, at-risk community. The medical, dental, and public health communities need to join forces to combat this emerging threat.

Online cancer education and immigrants: effecting culturally appropriate websites.

UNLABELLED: The online population is becoming increasingly diverse. Cancer information websites are a popular destination. However, culturally-appropriate cancer information websites are lacking. METHODS: An Internet behavior and preference study was conducted in Caribbean immigrant women. 60 English-speaking Caribbean immigrant women in New York City participated in website review sessions. RESULTS: Three-quarters of the participants used computers regularly. Over 80% accessed the Internet from home. Over 50% felt confident using the Internet. However, only 6% used the Internet to search for health information. CONCLUSION: A "cultural digital divide" exists. The Internet should be tailored to immigrants to facilitate web-based cancer education.

Drive-by readings: a creative strategy for tuberculosis control among immigrants.

OBJECTIVES: We explored an innovative strategy for targeted testing and disease management among immigrant communities at risk for tuberculosis. METHODS: Taxi drivers were recruited at an airport holding lot to undergo tuberculin skin testing (Mantoux). After receiving their test results in a location convenient for them, drivers with positive results were referred for evaluation and treatment. We conducted baseline and follow-up assessments. RESULTS: Of 123 drivers who participated, two thirds (82) were at high risk for tuberculosis. Seventy-eight (63%) of the 123 returned for test readings; 62% of these drivers had positive test results. All drivers with positive results received a complete physician evaluation, but 64% of those evaluated were not treated for latent TB infection. Of the untreated drivers, 37.5% were at high risk. Systemic and physician barriers (e.g., lack of knowledge, erroneous beliefs regarding vaccines) affected adherence to evaluation and treatment. CONCLUSIONS: Targeted testing and treatment are important to the control of tuberculosis. The results of this study highlight the need for an aggressive physician educational campaign to identify latent tuberculosis infection and to tailor service delivery to meet the unique needs of foreign-born communities.