"The perfect storm": community worker perspectives on the impact of COVID-19 on New York City immigrants and migrant-serving organizations.

Background: Immigrants in New York City (NYC) have higher COVID-19 mortality than the general population. While migrant-serving organizations (MSOs) provide access to a breadth of services, they are disproportionately impacted by the COVID-19 pandemic due to staffing limitations, funding cuts, and resource limitations of communities served. Methods: Six focus-group discussions were conducted to explore the experiences of MSOs in NYC during the COVID-19 pandemic from November 2021 to March 2022. Study participants csomprised a subsample of survey respondents from a larger study identified via lists of MSOs. Results: Twenty-seven organizational representatives from 11 MSOs across NYC participated in the discussions. In addition to providing information on communities served, services offered, and organizational characteristics, the following themes emerged from the convenings: mental health challenges and resources needed for immigrants; immigration-related challenges; factors exacerbating hardships for immigrants during COVID-19; interorganizational collaborations and partnerships; policy change; and needs/requests of MSOs. MSOs provide a wide range of services as non-profit organizations and use interorganizational collaboration to improve service delivery. The proximity of MSOs to immigrant communities helps providers understand the needs of immigrants relating to the COVID-19 pandemic and factors that shape telehealth services. Conclusion: MSOs are important providers and advocates for immigration policy in the US given their relationship with the populations they serve. These findings have implications for how to support MSOs that serve immigrants in NYC. Strategies to achieve this include timelier availability and exchange of information, policies, and research as well as strengthening the experience-based advocacy of these groups.

'You never know when you will need an antibiotic': A qualitative study of structural barriers and cultural assumptions in antibiotic misuse among immigrants in the United States.

OBJECTIVES: The use of nonprescribed antibiotics increases the risk of antibiotic resistance, which is a primary public health concern of the 21st century. This study explores structural and cultural determinants of antibiotic misuse among immigrants living in the United States who arrived from home countries with easier access to antibiotics. METHODS: Adopting a qualitative approach, we interviewed 34 immigrants living in the United States and who had traveled back to their home countries within 1 year of the interview. We followed the steps of constructive grounded theory to analyze the data. RESULTS: We found two primary influences of immigrants' use of nonprescribed antibiotics. The first was structural barriers to health care access in the host country, including insurance coverage, cost of an emergency department visit, cost of missing a paid day of work, complexity of the healthcare system, and communication issues with health care providers. The second was participants' cultural assumptions, including their experiences of antibiotics use, beliefs about antibiotics, a habit of self-medication, and uncertainty about future medical needs. CONCLUSIONS: This study informs policymakers concerned with combating antibiotic resistance. Promoting antibiotic stewardship among immigrants from countries with lax antibiotic-prescribing practices and improving access to appropriate channels for preventative and same-day care may reduce the inappropriate use of antibiotics.

Telemedicine for the Underserved Racial and Ethnic Minorities During COVID-19 and Beyond.

Objective: To demonstrate that a culturally and linguistically appropriate telehealth protocol can be implemented to improve the glycemic control of patients as an extension of regular clinical services and provide continuity of care. Methods: A telehealth platform was established during COVID-19 pandemic and from numerous telehealth encounters we sampled 498 patients who received telehealth intervention over a 12-month period for specific services: Rx refill, consultation for laboratory results, wellness evaluation and education, and acute or sick visits with appropriate referrals. This telehealth platform was integrated with a remote patient monitoring system utilizing a Bluetooth-enabled glucometer for patients with diabetes compared to their abnormal baseline hemoglobin A1C (HgA1C). The Blood sugar values were recorded at predefined intervals to monitor controls for diabetes. The ethnic diversity and level of education of patients required addressing the digital divide, language interpretation, and navigation at each monitoring step. Results: This method demonstrated that a culturally and linguistically appropriate telehealth protocol can be implemented to improve the glycemic control of patients in an intervention group compared with a control group. Validation of the glycemic control was based on 70 patients identified as eligible for participation based on the inclusion criteria: a HgA1C level of 7% or higher obtained within the last 10 months. Informed consent was obtained for 42 participants based on patient participation constraints during the COVID-19 pandemic. Conclusions: We conclude that telemedicine procedures utilized for patients with little or no prior knowledge of remote self-monitoring methods can support their treatment of chronic diseases, such as diabetes. The outcomes from the implementation of telemedicine services were observed in a well-defined group of underserved racial and ethnic minority patients at our clinic. We now have a protocol to expand this to other chronic diseases and used as a regular clinical procedure.

Socio-spatial analysis of migrant school students according to Bourdieu's capitals in Santiago de Chile (2017-2020).

Chile has experienced a substantial immigration boom in the last 10 years. The urban areas of this nation present high levels of residential segregation, represented in its main city, Santiago. This article presents results of an exploratory analysis of the relationship between residential segregation, immigration rate by educational institutions and changes in school performance. Based on the generation of clusters characterized by cultural, social, economic and symbolic capital, an analysis of the changes in school performance in those schools that received the greatest number of migrants is generated.

Evaluation of autism awareness and knowledge levels among Syrian migrants living in Türkiye.

This study was conducted to evaluate the autism knowledge level and awareness of individuals over the age of 18 who applied to immigrant health centers in Istanbul, Gaziantep and Kilis, where the Syrian immigrant population is dense. This cross-sectional study was conducted between December 2022 and April 2023 in 896 immigrants. The sample of the research consists of immigrants residing in Türkiye and who applied to the immigrant health centers in Istanbul, Gaziantep and Kilis for any reason at the time of the research. A questionnaire consisting of three parts was applied to the immigrant people face-to-face. While 38.4% of the participants were female, 61.6% were male. The mean age of the participants is 34.63 ± 10.74. It was determined that people's place of residence, whether they have children, marital status and income status have significant effects on autism knowledge levels (p < 0.001). Since the importance of early diagnosis in autism is known, it is of great importance for people to have knowledge and awareness on this issue. This study will investigate the awareness of the immigrant population, who are faced with traumatic events such as war and migration, and will shed light on future intervention studies.

Sociocultural determinants of children's oral health among immigrants in Canada.

OBJECTIVE: A conceptual model was designed and tested to predict immigrant children's oral health in Canada by examining parental acculturation and perceived social support (PSS) using structural equation modelling. METHODS: A convenience sample of first-generation immigrant parents and their children aged 2-12 years were recruited by multilingual community workers in Edmonton, Canada. Parents completed a validated questionnaire on demographics, child's oral health (OH) behaviours, parental acculturation and PSS. Dental examinations determined children's dental caries rate using DMFT/dmft index. Structural equation modelling (SEM) was used to analyse the data. RESULTS: A total of 336 families participated in this study. The average parental acculturation level was 10.46 with a maximum of 15, and the average PSS was 63.27 with a maximum of 75. SEM showed that 77% of the variance of DMFT/dmft scores in children was explained by parental PSS, acculturation level, immigration-related variables, socioeconomic variables and children's OH behaviours. The direct effect of parental PSS was associated with a significantly reduced rate of dental caries (ß = -.076, p-value = .008) and lower sugar consumption (ß = -.17, p-value = .04). While the mediation effect of parental acculturation on PSS was associated with positive OH behaviours of children (e.g., toothbrushing frequency and dental care utilization), the indirect effect was negatively associated with caries rate (ß = .77, p-value = .00). CONCLUSIONS: The direct effect of Parental Perceived Stress Scale (PSS) was associated with more favourable oral health behaviours and a lower prevalence of dental caries, while the mediation effect of acculturation was linked to a higher prevalence of dental caries.

A controlled weight loss intervention study among women of Somali background in Norway.

Background: Women of Somali background in Norway have a high prevalence of overweight and obesity, compared with women in the general Norwegian population. For lifestyle interventions to be applicable for immigrants to Norway, it is important to culturally tailor interventions in collaboration with relevant communities. The primary outcome was a difference in weight change between the intervention and control groups. Methods: In this interventional study, Somali women living in one borough of Oslo Municipality in Norway with body mass index (BMI) ≥27.0 kg.m-2 received a co-created, culturally tailored 12-month weight loss intervention consisting of 24 interactive sessions during the first three months, and monthly sessions for the next nine months, compared to a control group. Both groups were measured at baseline and 12 months. Results: A total of 169 participants were recruited, and 101 participants completed the follow-up. After multiple imputation, the mean difference in weight change adjusted for baseline weight, age, education, employment, marital status, number of children in the household and length of Norwegian residency was -1.6 kg (95 % CI -3.57, 0.43, p = 0.12) in the intervention compared to the control group. Conclusion: This culturally tailored intervention study demonstrated a modest non-significant effect on weight change after 12 months, possibly due to the short intervention duration and COVID-19. Further studies of a longer duration and considering the provision of childcare are needed to understand whether this approach can be transferred to other immigrant groups and genders.Trial registration: The study was registered at clinicaltrials.gov NCT04578067, 2020-09-29.

South Asians and the Role of Bystanders in Domestic Violence Prevention: Results from a Pilot Study.

PURPOSE: Domestic violence manifests in unique ways in South Asian immigrant communities. Given the need to uphold family honor, formal help-seeking remains minimal within this community. Individuals experiencing victimization rely on friends and family members as informal sources of support. These friends and family members may also be bystanders who witness victimization. Therefore, the goal of this study was to examine differences in participant responses to an online interactive bystander intervention developed for South Asians. METHODS: To get community response to the intervention, B.R.A.K.E. The Cycle, a Qualtrics link with all the intervention scenarios was posted on 21 sub-Reddit pages. Screeners to ensure that participants were of South Asian origin, 18 or older and currently residing in the United States (US) were added. True to the study purpose, to examine differences across gender and generational position, we conducted descriptive analysis and chi-square tests. RESULTS: There were differences in scenarios by gender and immigration position. Some of the main findings point to the need to report domestic violence, seek help (formal or informal) as well as surprisingly some responses justified the use of force by a male partner. We discuss these in-depth by scenarios. DISCUSSION: This is the first study to examine differences in bystander preference and response to using an intervention that was developed specifically for the South Asian community. Social workers can utilize this intervention to create dialogue around domestic violence prevention and the role of bystander within the South Asian and potentially other immigrant communities.

Older Chinese and Filipino American Immigrants with Type 2 Diabetes and their Adult Child: A Qualitative Dyadic Exploration of Family Support.

Type 2 Diabetes (T2D) among older Asian American immigrants (AA) is a growing concern. Asian Americans represent 9% of diagnosed diabetes. Very little is known on how older Asian American immigrants with T2D navigate diabetes management, in particular the role of family support. This qualitative study examines Chinese and Filipino Americans, the two largest Asian subgroups in the US (4.2 million, and 3.6 million, respectively), and family support dynamics among adult children and their parents diagnosed with T2D. Ten dyads (n = 20) made up of adult children and aging parents participated in in-depth and dyadic interviews. Results indicate that family support occurs in a trajectory of stages. The following thematic patterns emerged in these dyads around support: independence, transitions, partnership, and stepping in. The findings point to various supportive stages that Asian American adult children and aging parents with T2D experience and the importance of developing supportive interventions for both adult children and aging parents at these various stages.

Meaning-focused coping as a cultural process: A mixed quantitative and PhotoVoice study of adolescents with Arab backgrounds overcoming stigma and harassment.

Poor mental health among U.S. adolescents has reach epidemic proportions, with those from the Middle East and North African region exhibiting increased risk for distress and suicide ideation. This mixed-methods study analyzes quantitative data from first- and second-generation Arab adolescents (n = 171) and qualitative data from a participatory study conducted with 11 adolescents of the same population to understand the role of cultural resources in coping. Drawing on the Intersectional Theory of Cultural Repertoires in Health, we show that: 1) cultural resources underlie meaning-making throughout coping; 2) coping strategies are inseparable from the influence of peer and familial relationships, as dictated through the social norms and other cultural resources; 3) collectively held repertoires of coping can promote belonging, affirm identity, and protect against discrimination; and 4) the outcomes of coping strategies, and the culturally informed meaning individuals make of these outcomes, influence their future coping behaviors.

High-Risk Human Papilloma Virus Genotype Distribution and Correlation with Cervical Cytomorphological Data in Turkish and Immigrant Women in Mersin Province.

Human papilloma virus (HPV) is the most common sexually transmitted viral agent in the world and the most common cause of cervical cancer. HPV prevalence and genotype distribution vary by region and demographic data. In a province in the south of Turkey that constantly receives immigration, we aimed to determine the prevalence of high-risk HPV (HR-HPV) genotypes, evaluate the compatibility between cervical Pap smear cytology results patients and HR-HPVs, and make an up-to-date contribution to the elucidation of epidemiological data. In this single-centre study, a total of 12,641 women aged 18 and over were evaluated retrospectively from January 2019 to July 2022. HPV detection and genotyping were analysed by the PCR method. Bethesda scoring was used for Pap smear cytological evaluation. The overall prevalence of HR-HPV was 12.6% (12.7% in Turkish women, 11.2% in foreign women). Among the typed HPVs that were detected, HPV-16 (31%) was found first, followed by HPV-18 (8%). The prevalence of HR-HPV was higher in women with abnormal cytology (977/1762, 55.4%) than in women with normal cytology (620/10879, 5.7%) (p<0.001). Turkey doesn't yet have a national HPV immunisation program. We think that determining the specific regional frequency of other HR-HPVs separately will be useful in the follow-up of the natural course of the type-specific infection and in vaccine studies in the future.

Pakikisama: Filipino Patient Perspectives on Health Care Access and Utilization.

PURPOSE: Filipinos have unique social determinants of health, cultural values, and beliefs that contribute to a higher prevalence of cardiovascular comorbidities such as hypertension, diabetes, and dyslipidemia. We aimed to identify Filipino values, practices, and belief systems that influenced health care access and utilization. METHODS: We conducted 1-on-1 semistructured interviews with self-identified Filipino patients. Our qualitative study utilized a constant-comparative approach for data collection, thematic coding, and interpretive analysis. RESULTS: We interviewed 20 Filipinos in a remote rural community to assess structural and social challenges experienced when interacting with the health care system. Our results suggest that Filipinos regard culture and language as pillars of health access. Filipinos trust clinicians who exhibited positive tone and body language as well as relatable and understandable communication. These traits are features of Pakikisama, a Filipino trait/value of "comfortableness and getting along with others." Relatability and intercultural values familiarity increased Filipino trust in a health care clinician. Filipinos may lack understanding about how to navigate the US Health care system, which can dissuade access to care. CONCLUSIONS: For the Filipino community, culture and language are fundamental components of health access. Health care systems have the opportunity to both improve intercultural clinical training and increase representation among clinicians and support staff to improve care delivery and navigation of health services. Participants reported not routinely relying on health care navigators.

Satisfaction With Primary Care Among the Foreign-Born and the General Population in Finland: A Survey-Based study.

Foreign-born people have been found to be less satisfied with health care than native populations across countries. However, studies on differences in satisfaction with treatment between different foreign-born groups are lacking. This study explores differences in satisfaction with primary health care between the foreign-born population from different regions of origins and the general population of Finland. The study uses survey data on foreign-born population (n = 2708) and general population (n = 6671) living in Finland who report using health services. Satisfaction with experienced respect for privacy during treatment, benefit of treatment and smoothness of treatment are predicted by region of origin using logistic regression. Almost all foreign-born groups were less likely to consider treatment appointments beneficial as compared to the general population. Some foreign-born groups (people from Southeast Asia and South and Central Asia) were more satisfied with smoothness of care compared to general population. People from East Asia were less likely than the general population to consider that their privacy had been respected during the examinations and treatment. While we made the positive finding of high overall satisfaction with treatment, we also found important differences between groups. In particular, appointments were found less useful among the foreign-born population. Perceived unusefulness of treatment might lead to underuse of health care, which might result in accumulation of untreated health problems. The results point toward potential development points in the health care system. Addressing these issues might help decrease health disparities between population groups.

Madrid immigrants' perceptions of urban food environments and their dietary behaviours.

Large cities are home to several groups of immigrants who undergo important changes in their environmental conditions and lifestyles that significantly modify their risk of chronic diseases. Quantitative evidence indicates that both their health and diet worsen over time; much less is known about the qualitative mechanisms that cause these changes. The aim of this article is to understand how immigrants in the city of Madrid perceive the relation between the urban food environment and dietary behaviour. Based on a Social Ecological Framework, we conducted a secondary qualitative analysis derived from data from 41 immigrant residents, collected in eight focus groups (FGs), conducted in two neighbourhoods in the city of Madrid. We identified the following main categories: 1) Transnational identity and dietary behaviour in the neighbourhood; 2) Transitions in dietary behaviour; and 3) Societal/structural factors determining dietary behaviour in the neighbourhood. The participants in the FGs mentioned that they try to maintain traditional dietary customs and perceive that the taste of their typical dishes is better than those of Spanish dishes. Contradictorily, some participants considered their traditional dietary patterns to be less healthy than Mediterranean ones (consuming olive oil, vegetables, fish). Some participants acknowledged having adapted to the latter voluntarily or through dietary negotiations with their children. Immigrant families with two working parents have difficulties cooking homemade food and resort to less healthy options, such as eating fast food or ready-made meals. Due to their low purchasing power, they buy both ethnic products and other products, as well as considering the prices and offers in supermarkets. Our study highlights several structural mechanisms connecting the physical and social urban food environment with dietary behaviours among immigrant residents of a large city.

Risk Factors for Elder Mistreatment Among Older Korean Americans.

Using data from a sample of older Korean Americans (n = 2,150), we examined the prevalence and associated factors of physical, emotional, and financial mistreatment. Given the importance of contextual factors, we examined the effect of immigration-related (years in the U.S. and acculturation) and interpersonal/community-related (family solidarity, social network, and ethnic community social cohesion) factors in addition to sociodemographic and health-related characteristics. The rate of experiencing physical, emotional, and financial mistreatment during the past year was 3%, 37.9%, and 16.1%, respectively. Younger age and lower family solidarity were common risk factors for emotional and financial mistreatment. The experience of emotional mistreatment was also more likely among females and those with higher level of acculturation, smaller social networks, and lower ethnic community social cohesion. Chronic disease was an additional risk factor for financial mistreatment. The findings suggest targeted prevention and intervention strategies for elder mistreatment.

The Association Between Perceived Discrimination, Age and Proportion of Lifetime in the United States Among Somali Immigrants: A Cross-Sectional Analysis.

Discrimination is detrimental to health. Little is known about perceived discrimination among Somali immigrants. We examined whether age or proportion of lifetime in the United States was associated with perceived discrimination among Somali immigrants. Guided by Intersectionality, we described a secondary analysis of Everyday Discrimination Scale (EDS) survey data from the Healthy Immigrant Community study. Younger participants ( ≤40 years) experienced more discrimination than older participants ( >40 years). Higher education, being male, and earning $20,000-$39,999 was associated with more perceived discrimination. These findings suggest that Somali immigrants who are younger, more formally educated, male, and/or earn $20,000-$39,000 report more discrimination than their counterparts. Possible explanations include exposure to discrimination outside the Somali community or more awareness about racism. Alternatively, the EDS may not capture the discrimination experienced by Somali women or older adults. Further research is needed to address the discrimination experienced by Somali immigrants. Clinical Trial Registration: NCT05136339, November 29,2021.

Unemployed, Immigrant, and Older Asian Workers in a U.S.-Based Job-Training Program: Their Experiences and Well-Being, and Strategies for Reaching This Important Population.

The Senior Community Service Employment Program (SCSEP) is a U.S.-based job-training program that serves unemployed workers aged 55 and older with incomes at or below 125% of the federal poverty level. While federal funds are set aside to serve Asian workers in SCSEP, little is known about their characteristics and experiences. In response, this pilot study aimed to document the health, well-being, and experiences of older Asian SCSEP participants in Massachusetts through the completion of a survey. Respondents (N = 39) ranged in age from 58 to 73 and identified as either Chinese (72%) or Vietnamese (28%). All were immigrants, and almost all spoke a language other than English at home. Most reported "good" health as well as financial difficulties. They also stated that their supervisors in their placements were supportive. On average, respondents noted moderate interest in searching for a paid job after exiting SCSEP, although more reported interest in searching for a volunteer role. Key to the success of this study was a robust collaboration with a local human services organization with strong ties to the Chinese and Vietnamese communities. The findings highlight the importance of this growing group of older workers.

Sarcoidosis in first- and second-generation immigrants: a cohort study of all adults 18 years of age and older in Sweden.

BACKGROUND: There is a lack of studies on sarcoidosis among immigrants, which is of interest as there may be genetic and environmental characteristics affecting immigrants from certain countries. We aimed to study hazard ratios (HRs) of sarcoidosis in first- and second-generation immigrants, comparing them with native Swedes in the total adult Swedish population. METHODS: We conducted a nationwide study of individuals ≥18 y of age. Sarcoidosis was defined as at least two registered diagnoses in the National Patient Register between 1 January 1998 and 31 December 2018. Cox regression analysis was used to estimate HRs with 99% confidence intervals (CIs) of first registration of sarcoidosis in first- and second-generation immigrants compared with native Swedes. The Cox regression models were stratified by sex and adjusted for age, comorbidities and sociodemographic characteristics. RESULTS: In total, 6 175 251 were included in the first-generation study, with 12 617 cases of sarcoidosis, and 4 585 529 in the second-generation study, with 12 126 cases. The overall sarcoidosis risk was lower in foreign-born men (fully adjusted HR 0.63 [99% CI 0.57 to 0.69]) but not in foreign-born women (fully adjusted HR 0.98 [99% CI 0.90 to 1.06]). The overall risk was slightly lower in second-generation immigrants (HR 0.82 [99% CI 0.78 to 0.88]). Women from Asia exhibited a higher risk (HR 1.25 [99% CI 1.02 to 1.53)], while a potential trend was observed among women from Africa (HR 1.47 [99% CI 0.99 to 2.19]). CONCLUSIONS: Sarcoidosis risk was lower in foreign-born men but not in women and also lower in second-generation immigrants.

The Role of Sensory Impairment in Cognitive Health Appraisal: A Study of Older Korean Americans Living in Subsidized Senior Housing.

OBJECTIVES: We examined how the association between cognitive performance and cognitive health appraisal would be moderated by vision and/or hearing impairment. METHODS: Data were collected from 315 older Korean-American residents in subsidized senior housing in Los Angeles (M age = 79.4 years). Linear regression models examined the direct and interactive effects of cognitive performance, vision impairment, and hearing impairment on cognitive health appraisal. RESULTS: Negative appraisal of cognitive health was associated with lower cognitive performance and poorer ratings for vision and hearing. Moreover, we found a significant interaction between cognitive performance and hearing impairment (ß = .13, p < .05), as well as a three-way interaction among cognitive performance, vision impairment, and hearing impairment (ß = .12, p < .05). DISCUSSION: The association between objective and subjective measures of cognition was weakened when hearing was impaired. Such a pattern was further evident when both vision and hearing were impaired.

Honour, acculturation and well-being: Evidence from the UK and Canada.

Adopting a social psychological approach, across three studies (N = 927) in two western immigrant-receiving societies (UK and Canada), we examined the role of honour in acculturation variables (i.e., immigrants' heritage and mainstream cultural orientation and well-being), controlling for some of the commonly studied predictors of immigrant adaptation. We assessed honour as concern (Studies 1 and 2) and as a desired attribute for men and women (Study 3) and studied well-being in terms of acculturative stress (Study 1) and subjective evaluation of one's life (Studies 1 and 3). We examined our questions among groups of immigrants originating from honour (Studies 1 and 2) and dignity cultural groups (Study 1) and from first- and second-generation immigrants (Study 3). Overall, despite some significant associations at the bivariate level between honour and acculturation outcomes, findings provided mixed support for the claim that honour (measured as concerns and cultural codes) plays a significant role in immigrant acculturation above and beyond commonly studied predictors of immigrant adaptation.