Immigration stress and internalizing symptoms among Latinx and Asian American students: The roles of school climate and community violence.

Immigration-related problems and stressors are prevalent and pressing concerns among Latinx and Asian American school-age youth. Youth fears related to family deportation have been associated with adverse mental health outcomes. This study used an ecological framework to examine the impact of immigration stress and school- and community-level resources and protective factors on Latinx and Asian American youth internalizing symptoms. The sample included 1309 Asian American and 701 Latinx students (N = 2010) who participated in a routine school-based mental health needs assessment survey. Multilevel regressions analyses revealed that first-generation youth, Latinx youth, and female youth were more vulnerable to experiencing immigration-related problems and worry. Student perceptions of negative school climate and community violence were associated with greater internalizing symptoms regardless of immigration worry. Moderation analyses revealed that immigration-related problems and worry were positively associated with internalizing symptoms and that this relationship did not differ by race/ethnicity. However, immigration worry was a particular risk factor for students who perceived their neighborhood community as safe. Findings highlight that a sociopolitical climate that sows immigration-related challenges fuels youth distress and that students' experiences of their community environment can play an essential role as a psychological resource.

The estimated 10-year risk of first-onset cardiovascular disease in Swedish-born and non-Swedish-born primary healthcare patients.

BACKGROUND: SCORE2 has been introduced as an updated risk assessment tool for calculating the 10-year risk of first-onset cardiovascular disease (CVD). However, it does not account for ethnicity or socioeconomic status, known to affect CVD risk. This study investigated and compared SCORE2 estimates in Swedish-born and non-Swedish-born primary healthcare patients. The second aim was to examine if several risk factors could explain differences in CVD risk between the groups. METHODS: This was an observational, cross-sectional study. Data were obtained from the 4D Diabetes Project study, providing a total of 444 participants aged between 40 and 69 years. All participants had complete risk variable data necessary for the SCORE2 tool and no history of previous CVD. Descriptive analysis was conducted to compare distributions of risk factors between Swedes and immigrants and odds ratios of risk factors amongst these two groups in correlation to elevated CVD risk were calculated using logistic regression. RESULTS: Swedish-born patients showed a significantly higher risk of elevated CVD risk estimates (≥ 2.5% CVD risk increase for individuals < 50 years, respectively, ≥ 5% for individuals aged 51-69) than the non-Swedish-born population, even after adjustment for educational level (OR = 1.61, 95% CI 1.08-2.39). Weekly alcohol consumption implicated a risk of being classified as high risk of CVD risk, regardless of country of birth (OR = 1.93 CI 1.25-3.00). However, Swedes accounted for most of the alcohol consumption (62.6% vs. 19.6%). No other explanatory variable showed significance in association with elevated CVD risk. CONCLUSIONS: Swedish-born patients were found to be at higher risk of an increased 10-year CVD risk. The association of alcohol consumption with elevated CVD risk needs to be further studied in longitudinal studies in representative populations, notably among Sweden's diverse ethnic groups.

[Current Outpatient Psychotherapeutic Care for People with Migration and Refugee Experience in Germany - An Overview]. / Die aktuelle ambulante psychotherapeutische Versorgung von Menschen mit Migrations- und Fluchterfahrung in Deutschland ­ Eine Übersicht.

Although mental health is a human right, even in a country with a well-developed healthcare system like Germany, it is not possible to ensure non-discriminatory access to mental health care for all people, regardless of their origin. For individuals with a history of flight or migration it is particularly difficult to gain access to adequate psychotherapeutic care. This review addresses key barriers contributing to the lack of outpatient care for people with a history of flight or migration. Lack of knowledge about the treatment system, fear of stigma, structural barriers, language barriers, lack of networking of healthcare providers, lack of knowledge of mental health practitioners, as well as stereotypes, discrimination, and racism towards people with a refugee or migration history were identified as the most important barriers with sufficient evidence. Innovative concepts such as peer support can enable non-discriminatory treatment access. In addition, there is an urgent need to train the profession of psychotherapists in racism- and discrimination-sensitive work and to integrate these aspects into psychotherapeutic education and training.

Higher education as a pathway for female immigrants' establishment and well-being in Sweden.

PURPOSE: This study focuses on higher education as a pathway to establishment in a new society for female immigrants and its role in well-being. Building on previous research that highlights social capital and empowerment as significant factors for successful establishment in a new society, and experiencing well-being, this study aims to explore if higher education can promote female immigrants' establishment in Swedish society. METHODS: Interviews were used to explore female immigrants' experiences of higher education and establishment in Swedish society. Thematic analysis was used to analyse the empirical material, generating a nuanced understanding of the studied topic. RESULTS: Higher education was found to promote establishment in Swedish society, ultimately leading to an experience of well-being. Pursuing higher education was perceived as a means of achieving personal fulfilment and success while fostering new social connections. Important factors in pursuing higher education included favourable living conditions, personal motivation, and a positive educational attitude. CONCLUSION: The study provides insights into female immigrants' higher education experiences in a context that promotes establishment in Swedish society and well-being. However, more research is needed to fully investigate the driving factors for female immigrants pursuing higher education, considering their migrant background and living conditions.

Social support as perceived, provided and needed by family-members of migrants with type 2 diabetes - a qualitative study.

BACKGROUND: Social support provided by a family member has been found to have a buffering effect on distress and is associated with better diabetes self-care. This study explores the meaning of social support, as described by close family members of foreign-born people living with type 2 diabetes (PWDM) in Sweden. It also explores the support provided by family members, and the support they need to be able to support the PWDM. METHODS: Qualitative explorative study, semi-structured interviews for data collection. Qualitative content analysis based on a theoretical framework on social support. Purposive sample of 13 family members, 18-52-years-old, born in countries in the Middle East, Africa, and Russia. RESULTS: The meaning of support was described as social and emotional. Most participants described a stressful situation; feelings of sadness/worry about the risk of the PWDM developing complications added to a strained life situation from which one could not opt out. Frequent daily contacts in a family network were evident, particularly by children trained as healthcare professionals. Caring for a family member was considered a filial piety, but it was also a chance to reciprocate. The support provided was mainly informational (e.g., reminders about nutritional intake), but it was also instrumental/practical (administering medicines, helping with economy/logistics, planning/cooking meals, basic care) and emotional (sharing meals, thoughts, and activities). The support the family members needed was getting first-hand information by attending the physician visits, being able to book appointments themselves at suitable times, and preventing the withholding of important information about the PWDM. They also desired an open telephone-line, oral and written information, particularly on diet. CONCLUSIONS: To family-members, supporting the PWDM was normal and a filial piety. Support provided and needed was not only informational but also instrumental/practical and emotional. In diabetes care, addressing foreign-born individuals, diabetes education needs to be developed, also including family members. Informational material, particularly on diet, and improved access to healthcare and information about the healthcare system have the potential to increase family members' control over the situation and prevent a negative trajectory in caregiving with perceived demands causing high levels of stress.

An epidemiological analysis of TB trends in native and migrant populations, New Mexico, 1993-2021.

To analyze the epidemiological, demographic, clinical, laboratory, radiographic and treatment outcome trends in non-US-born individuals with TB in New Mexico.We retrospectively analyzed TB data from New Mexico TB surveillance system from (1993-2021), comparing variables between non-US-born and US-born individuals.Of the 1,512 TB cases, 876 (56.5%) were non-US-born and 653 (43.3%) were US-born. The incidence rate among non-US-born patients declined from 15.3/100,000 (1993) to 7.8/100,000 (2021) (54.6% reduction), while among US-born patients it declined from 3.3/100,000 (1993) to 0.5/100,000 (2021) (84.8% reduction). The majority of non-US-born individuals were from Mexico (n = 482, 73.5%). Non-US-born were typically younger adults (median age: 54 vs. 61), predominantly male (64.8% vs. 59.4%), less likely to consume excess alcohol and have extrapulmonary TB. However, they were more likely to exhibit resistance to standard TB drugs (P < 0.01). Non-US-born individuals were less likely to die (7.8% vs. 15.4%), but more likely to be lost to follow-up (P < 0.007). Treatment by providers outside the Department of Health was associated with noncompletion (OR 0.18, 95% CI 0.09-0.35; P < 0.001).These results highlight the need for a detailed understanding of the impact of migration on TB epidemiology and the development of tailored interventions to improve treatment outcomes..

The Effect of Stigma and Social Networks on Role Expectations among African Immigrants Living with HIV.

This paper examines how African immigrants living with HIV negotiate and reconstruct their productive (i.e., educational and career opportunities), sexual, and reproductive identities. We used data from a mixed-methods study to explore how stigma and social networks in which participants were embedded shaped how they understood and negotiated their role expectations and responsibilities. Participants revealed how HIV not only changed their identities and limited their sex life, partner choices, and fundamental decisions about fertility and reproduction, but also presented them with the opportunity to reinvent/reshape their lives. Our analysis revealed that the cultural discourses about illness and HIV in participant's countries of origin, the acculturative and migratory stressors, and the competing influences and expectations from family and friends in their home and host countries shape their illness experience, and how they adjust to life with HIV. This paper builds on sociological understanding of illness experience as a social construct that shapes the ill person's identity, role, and function in society. Specifically, the paper contributes to discourses on how (i) participants' social location and identity (as transnational migrants adjusting to acculturative stressors associated with resettlement into a new country), (ii) cultural discourses about illness and HIV in their countries of origin, and (iii) embeddedness in transnational social networks influence health outcomes, including lived experiences with chronic illnesses and stigmatized conditions such as HIV.

Providing Compassionate, Evidence-Based Care for Refugee, Immigrant, and Migrant Children.

Immigrant children experience diverse migration paths to the United States facing unique challenges that impact their health and well-being. This article provides an overview of the pathways to health care and physical, mental, and behavioral health considerations for refugee and immigrant children. Health equity and cultural humility frameworks are reviewed. Approach to care guidance and clinical pearls are provided for the initial medical assessment in addition to medical screening, mental health, education, and developmental health. The importance of health literacy and advocacy are highlighted, emphasizing their ability to address health inequities and improve care.

Associations of Household and Neighborhood Contexts and Hair Cortisol Among Mexican-Origin Adolescents From Low-Income Immigrant Families.

Although neighborhood contexts serve as upstream determinants of health, it remains unclear how these contexts "get under the skin" of Mexican-origin youth, who are disproportionately concentrated in highly disadvantaged yet co-ethnic neighborhoods. The current study examines the associations between household and neighborhood socioeconomic status (SES), neighborhood racial-ethnic and immigrant composition, and hair cortisol concentration (HCC)-a physiological index of chronic stress response-among Mexican-origin adolescents from low-income immigrant families in the United States. A total of 297 (54.20% female; mage = 17.61, SD = 0.93) Mexican-origin adolescents had their hair cortisol collected, and their residential addresses were geocoded and merged with the American Community Survey. Neighborhoods with higher Hispanic-origin and foreign-born residents were associated with higher neighborhood disadvantage, whereas neighborhoods with higher non-Hispanic White and domestic-born residents were associated with higher neighborhood affluence. Mexican-origin adolescents living in neighborhoods with a higher proportion of Hispanic-origin residents showed lower levels of HCC, consistent with the role of the ethnic enclave. In contrast, adolescents living in more affluent neighborhoods showed higher levels of HCC, possibly reflecting a physiological toll. No association was found between household SES and HCC. Our findings underscore the importance of taking sociocultural contexts and person-environment fit into consideration when understanding how neighborhoods influence adolescents' stress physiology.

Illuminating health aspects for immigrant Thai women in Swedish transnational marriages.

BACKGROUND: Women who are migrants experience discrimination and face major risks, including sexual exploitation, trafficking, and violence, which affect their health and well-being. This study explored critical health incidents experienced by immigrant Thai women in marriage migration. METHODS: A qualitative explorative approach with in-depth interviews was used. Forty immigrant Thai women who currently or previously had a Swedish spouse were recruited for the study. An inductive critical incident technique was used to collect and analyze the data as the first step. In a second deductive step, the Newman system model was used to categorize health dilemmas. RESULTS: The women reported 438 critical health incidents in five main areas. Psychological health dilemmas included emotional abuse, feeling overwhelmed due to family responsibilities and the stress of leaving family behind. Sociocultural health dilemmas included transnational family duties or not performing family duties. Physiological health dilemmas included experiencing physical violence and environmental, domestic or work accidents. Developmental health dilemmas included failing health, difficulties upholding the duties expected of a spouse in the target culture and caring for an elderly husband. Spiritual health dilemmas included critical incidents in which the women perceived themselves to have failed in their hopes and duties as a wife, which intensified their dependence on faith, particularly the Buddhist concept of karma. CONCLUSION: Professionals in health and welfare practices in Thailand together with professionals in Western countries who work with women in marriage migration situations need to recognize the psychological, sociocultural, physiological, developmental, and spiritual health dilemmas experienced by these women. Furthermore, civil organizations that meet Thai women in foreign countries, such as Buddhist cultural associations, would benefit from the multicultural knowledge revealed by the present study. This knowledge can facilitate healthcare and welfare support for women in marriage migration situations.

Structural gendered racism as conceptualized by immigrant women in the United States.

RATIONALE: Immigrants represent a rapidly growing proportion of the population, yet the many ways in which structural inequities, including racism, xenophobia, and sexism, influence their health remains largely understudied. Perspectives from immigrant women can highlight intersectional dimensions of structural gendered racism and the ways in which racial and gender-based systems of structural oppression interact. OBJECTIVE: This study aims to show the multilevel manifestations of structural gendered racism in the health experiences of immigrant women living in New York City. METHOD: Semi-structured, in-depth interviews were conducted in 2020 and 2021 with 44 cisgender immigrant women from different national origins in New York City to explore how immigrant women experienced structural gendered racism and its pathways to their health. Interviews were thematically analyzed using a constant comparative approach. RESULTS: Participants expressed intersectional dimensions of structural gendered racism and the anti-immigrant climate through restrictive immigration policy and issues related to citizenship status, disproportionate immigration enforcement and criminalization, economic exploitation, and gendered interpersonal racism experienced across a range of systems and contexts. Participants weighed their concerns for safety and facing racism as part of their life course and health decisions for themselves and their families. CONCLUSIONS: The perspectives and experiences of immigrant women are key to identifying multilevel solutions for the burdens of structural gendered racism, particularly among individuals and communities of non-U.S. national origin. Understanding how racism, sexism, xenophobia, and intersecting systems of oppression impact immigrant women is critical for advancing health equity.

Barriers to primary care among immigrants and refugees in Peterborough, Ontario: a qualitative study of provider perspectives.

BACKGROUND: Canada's immigrants and refugees have often settled in large Canadian cities, but this is changing with rising costs of living and rural settlement initiatives. However, little consideration is made regarding systemic changes needed to accommodate this distribution, particularly in healthcare in medium-sized cities or smaller communities. For most Canadians, primary care is an entry point into the healthcare system but immigrants and refugees face unique barriers to accessing care compared to the general Canadian population. This project aimed to better understand the barriers to accessing primary care among newcomers in Peterborough, Ontario from the perspective of newcomer service providers. METHODOLOGY: Participants were recruited from community organizations identified by the local settlement agency, the New Canadians Centre, as having regular interactions with newcomer clients including clinics, not-for-profit organizations, and volunteer groups. Four focus groups were completed, each with three participants (n=12). A coding grid was deductively developed to guide thematic analysis by adapting Levesque et al.'s conceptual framework defining access to healthcare with five specific dimensions: approachability, acceptability, availability and accommodation, affordability, and appropriateness. RESULTS: Participants identified lack of awareness of the healthcare system, stigma, competing priorities, and direct costs as some of the barriers for newcomers. Participants highlighted barriers unique to Peterborough including proximity to services, social isolation, and a shortage of family physicians. The results also highlighted strengths in the community such as its maternal-child health programming. CONCLUSION: The results provide a glimpse of the challenges to accessing primary care among newcomers in medium-sized communities and identify opportunities to prepare for changing settlement patterns.

Health Insurance Coverage Predicts Health Care Use among Latine Immigrants in Two Policy Contexts.

This study analyzed electronic health record (EHR) data from 2016 through 2019 from a federally qualified health center (FQHC) serving predominantly low-income Latine immigrants in the Washington, D.C. metropolitan area to examine how changes in health insurance coverage relate to changes in health care use. Federally qualified health center clients were insured for an average of 59% to 63% of their annual visits, but about one-third had no coverage throughout the year. Findings from descriptive regression and within-client fixed effects models indicate that in years with higher proportions of insured visits, clients averaged more medical visits and interpreter services but fewer mental health and care coordination visits. Latine immigrant clients in D.C., a city with a universal health insurance option, had health insurance coverage for 89% of their visits, and averaged more medical and fewer coordination visits relative to those in a neighboring county in a state without a universal insurance option.

A Social-ecological Perspective on Understanding Facilitators to Access Primary Health Care Services among Ethiopian Immigrant Women in the United States.

Using a social-ecological model (SEM), this qualitative study explored the facilitators of access to primary health care (PHC) among Ethiopian immigrant women in the U.S. Data were collected through in-depth interviews (N=21, ≥18 years) and analyzed thematically using Nvivo12. At the individual level, stable employment, insurance, immigration status, proactivity, education, communication skills, and internet usage were identified as facilitators of PHC access. Interpersonal support from family and friends was highlighted as a key facilitator. Institutional facilitators included interpretation services and the sociocultural background of health care providers. On the community level, support from community organizations and residing in certain locations were recognized as facilitators of PHC access. No policy-level facilitators were identified. The findings underscore the importance of strengthening individual and interpersonal capacities, including job opportunities, social support, legal assistance for immigration status, and education and communication skills. Further research is needed to analyze policy gaps and suggest viable solutions.

Special Considerations for Brazilian Transgender Patients in the United States: A Commentary.

Despite facing many social and structural challenges inside and outside of health systems, transgender and gender diverse (TGD) Brazilian immigrants in the U.S. are understudied, and their barriers to care are largely unnamed. In this commentary, we build on existing literature and our experiences at a safety-net community health system that sees a high volume of Brazilian patients to discuss challenges facing TGD Brazilian immigrant populations. We highlight that while Brazilian TGD populations face discrimination in Brazil, major challenges persist upon immigrating to the U.S., and include: difficulty updating identity documents and changing immigration status, barriers seeking general and specialized health care (including finding bilingual and bicultural providers), challenges navigating complex health and insurance systems, and a lack of community supports. We end by recommending more coordinated efforts between health care and community organizations to help ensure the health and wellness of TGD Brazilian immigrants in the United States.

"They Don't Care If We Live or Die": A Qualitative Analysis Examining the US Immigration System's Treatment of Undocumented Communities during the COVID-19 Pandemic.

Historically, the US immigration system (ie, institutions, agencies, and laws) has served the goals and principles of white supremacy through its treatment of globally displaced people and this appears to have continued through the COVID pandemic. Yet, the implications for immigrant health are not routinely addressed in mainstream public health discourse, and especially so in regard to public health disasters. This study conducted a series of focus groups with participants from social justice organizations working with immigrants, migrants, undocumented persons, refugees, persons seeking asylum, and persons detained in immigration jails to collect stories on how the immigration system undermined efforts to control the spread of COVID-19 and exacerbated health inequity within immigrant jails and across related community contexts during the pandemic. Focus groups were conducted to explore issues related to immigrants and immigration detention during the COVID-19 pandemic. There was a total of N=14 participants across the 4 focus groups with a dedicated focus group on perspectives of Black immigrants/from Black immigrant organizations only. Each focus group consisted of 3 to 4 participants. Five key themes emerged: 1) dehumanization of immigrants and migrants and devaluation of their lives; 2) inhumane conditions of confinement that propagate risk of disease; 3) denial of resources for COVID-19 prevention and mitigation; 4) expansion of intersecting oppressive systems; and 5) community-based resistance and mobilization against immigration policies and enforcement. Our findings highlight the harms from policing, criminalization, and exclusion that racialized communities face as a result of the (in)actions within the immigration system during a public health disaster including the COVID context.

[The Connection between Objective and Subjective Attributions of a Migration Background with Perceived Discrimination and Racism]. / Der Zusammenhang zwischen objektiven und subjektiven Zuschreibungen eines Migrationshintergrundes mit wahrgenommener Diskriminierung und Rassismus.

BACKGROUND: The criteria-oriented assessment of the population with a migration background that is common in Germany is currently being criticized from a social science and methodological perspective, among others. In particular, its usefulness as an indicator of perceived discrimination against the population with a migration background can be critically questioned based on the current state of research METHOD: Based on a population-representative data set (N=1,989) for the city of Berlin, the subjective perception of a migration background based on self-attribution and anticipated external attribution of a migration background was recorded in addition to the objective assessment of a migration background. Furthermore, socio-demographic and migration-specific characteristics as well as perceived discrimination were assessed. Using descriptive and inferential statistical methods, differences between the objective and subjective assessment of a migration background and their relationship with perceived discrimination were analyzed. RESULTS: Less than half (38%, 154/400) of the respondents identified as having a migrant background using the criterion-oriented approach reported describing themselves as migrants. 36% (144/405) reported that they believed that others in Germany described them as a person with a migrantion background. Respondents with a migration background are significantly more likely to experience discrimination on grounds of skin color, religion or country of origin compared to respondents without a migration background. Furthermore, it was found that both the self-attribution and the anticipated attribution by others as a migrant are positively associated with experiences of discrimination and racism. DISCUSSION: The results suggest that migration-sensitive research should not simply differentiate between people with and without a migration background according to official criteria. Rather, the subjective perceptions of one's own attribution as a migrant seem more suitable as indicators of discrimination and should be taken into account in future research or surveys on experiences of discrimination.

Global Mental Health and Immigrant Families.

There are few human tragedies that stir sympathy and concern more deeply than seeing children suffer secondary to war, displacement, and increasingly frequent epidemics of violence around the world. Falling witness or victim to acts of war and terrorism and subsequent fleeing of millions of children across the world stirs an array of powerful human emotions. Such circumstances by definition involve destruction, pain, and death. It is, paramount that we all work collaboratively, to provide psychological assistance, training, and education and work with various stakeholders to decrease the psychological impact of displacement secondary to war, terrorism, and other social factors.

Cross-cultural nursing care for immigrant women during pregnancy and childbirth: experiences and vulnerabilities.

OBJECTIVE: To understand the experiences and vulnerabilities for cross-cultural nursing care for immigrant women during pregnancy and delivery. METHOD: Exploratory, qualitative research, in the light of the Theory of Diversity and Universality of Cultural Care, in Foz do Iguaçu, Brazil, through interviews with eight postpartum woman and 18 nurses, between February and September 2022. The interpretation of meanings was adopted for analysis. RESULTS: The categories of analysis emerged: Experiences, vulnerabilities and acculturation of immigrant women during pregnancy and delivery; Cross-cultural care and vulnerabilities experienced by immigrants in Brazilian health services. Vulnerabilities were identified in Cultural and Social Structure Dimensions expressed in access to work, low socioeconomic conditions, lack of family and social support and specific services for this population. The potentialities experienced included good care provided by health services, quality of the multidisciplinary team and appreciation of professional knowledge, however, the understanding of expectations and cultural aspects needs to be deepened. FINAL CONSIDERATIONS: Understand that immigrant women experience situations of vulnerability in pregnancy and childbirth, in the Brazilian context, mainly related to social and programmatic dimensions. However, potentialities were also experienced, evidenced by positive aspects in cross-cultural nursing care in Brazil.