Long-Term Refugee Health: Health Behaviors and Outcomes of Cambodian Refugee and Immigrant Women.

Refugees in the United States have high rates of chronic disease. Both long-term effects of the refugee experience and adjustment to the U.S. health environment may contribute. While there is significant research on health outcomes of newly resettled refugees and long-term mental health experiences of established refugees, there is currently little information about how the combined effects of the refugee experience and the U.S. health environment are related to health practices of refugees in the years and decades after resettlement. We examined cross-sectional survey data for Cambodian refugee and immigrant women 35 to 60 years old (n = 160) from an established refugee community in Lowell, Massachusetts, to examine the potential contributors to health behaviors and outcomes among refugees and immigrants postresettlement. In our representative sample, we found that smoking and betel nut use were very low (4% each). Fewer than 50% of respondents walked for at least 10 minutes on 2 or more days/week. Using World Health Organization standards for overweight/obese for Asians, 73% of respondents were overweight/obese and 56% were obese, indicating increased risk of chronic disease. Depression was also high in this sample (41%). In multivariate models, higher acculturation and age were associated with walking more often; lower education and higher acculturation were related to higher weight; and being divorced/separated or widowed and being older were related to higher risk of depression. The interrelated complex of characteristics, health behaviors, and health outcomes of refugees merits a multifaceted approach to health education and health promotion for long-term refugee health.

Health behaviors among Cambodian adults in Lowell, Massachusetts.

Physical activity, maintaining healthy weight, eating fruits and vegetables, and non-smoking are health behaviors that reduce risk for a variety of poor health outcomes. This analysis reports frequencies and socio-demographic correlates of these behaviors among 381 Cambodians aged 25 and older surveyed in Lowell, MA. The majority reported some physical activity (72 %), healthy weight (62 %), and not smoking (77 %). Only 28 % reported adequate fruit and vegetable consumption. Four multivariable models indicate that (1) physical activity was associated with higher income, lower levels of US education, reading English, and living in the US 11-19 years; (2) healthy weight with living in the US 20 or more years; (3) not smoking with being female and living in the US less than 11 years; and (4) adequate fruit and vegetable consumption with lower levels of US education and reading English. These results inform public health planning for Cambodians.

Long-term development of a "whole community" best practice model to address health disparities in the Cambodian refugee and immigrant community of Lowell, Massachusetts.

Cambodians in Lowell, Massachusetts, experience significant health disparities. Understanding the trauma they have experienced in Cambodia and as refugees has been the starting point for Lowell Community Health Center's whole community approach to developing community-based interventions. This approach places physical-psychosocial-spiritual needs at the center of focus and is attentive to individual and institutional barriers to care. Interventions are multilevel. The effect of the overall program comes from the results of each smaller program, the collaborations and coordination with the Cambodian community and community-based organizations, and the range and levels of services available through the health center.

Community-university partnerships: achieving the promise in the face of changing goals, changing funding patterns, and competing priorities.

An important challenge that community-university partnerships face is how to maintain themselves in the face of changing goals, priorities, and funding. Partnerships often form as a result of some sort of "spark:" an incident, perhaps, or the identification of a shared need or common concern. Often, external funding is sought to provide the majority of resources for the establishment of a partnership and for the implementation of the partnership's action plan. Whatever external funding is obtained is typically of short duration. The funding will not continue over time. And usually the funding comes with stipulations about allowable partnership approaches; inevitably the priorities of one funder will differ from those of another. These issues of the maintenance of partnership in the face of shifting funding and priorities are ones that confront most community-university partnerships. This article examines these issues through the lens of an environmental justice partnership that has existed for nearly a decade, has undergone many changes in who is involved, and has operated with funding from many different sources, including the National Institute of Environmental Health Sciences, Housing and Urban Development, and the Environmental Protection Agency. In addition, the entities in the partnerships, while they share certain environmental objectives, are sometimes at odds on particular goals when the needs of the agencies differ. Further complicating this issue of continuity is the reality that partners, on occasion, must shift priorities after partnership goals are established. The experiences of this environmental justice partnership shed light on the kinds of struggles community-university partnerships face when they hope to avoid being undermined by the larger concerns of the funders or by the power brokers in their individual organizations. This article examines approaches that community-university partnerships might take to remain resilient in the face of changing goals, priorities and funding.

Building on the strengths of a Cambodian refugee community through community-based outreach.

Literature and practice are limited on strategies to reach elder Southeast Asian refugees by using their strengths and resilience. This article presents the Centers for Disease Control and Prevention-funded Cambodian Community Health 2010 Program in Lowell, Massachusetts, as a case example and provides refugee history, project background, community survey results about strengths and risks, literature on strengths-based approaches, outreach activities, and evaluation. The focus is elimination of health disparities in cardiovascular disease and diabetes. "Community conversations" and a daylong forum with community leaders were used to develop plans for outreach. A Cambodian Elders Council provided information and guidance used to refine the program. Key findings highlight involving elders in organizing events, avoiding reliance on literacy, integrating health promotion with socialization, using ties with Buddhist temples, developing transportation alternatives, and utilizing local Khmer-language media. Implications include applicability to other refugee communities with low literacy, high levels of trauma, limited English, and strong religious involvement.