Barriers to accessing preventive health care among African-born individuals in King County, Washington: A qualitative study involving key informants.

Studies of African immigrant health in the U.S. have traditionally focused on infectious diseases. However, the rising burden of non-communicable diseases (NCDs) indicates the increasing importance of general preventive health care. As part of a series of community health events designed for African-born individuals in King County, Washington, we administered key informant interviews (KIIs) with 16 health event participants, medical professionals, and community leaders to identify barriers and facilitators to use of preventive health care among African-born individuals. We used descriptive thematic analysis to organize barriers according to the socio-ecological model. Within the individual domain, KII participants identified lack of knowledge and awareness of preventive health benefits as barriers to engagement in care. Within the interpersonal domain, language and cultural differences frequently complicated relationships with health care providers. Within the societal and policy domains, healthcare costs, lack of insurance, and structural racism were also reported as major barriers. Participants identified community outreach with culturally competent and respectful providers as key elements of interventions to improve uptake. In conclusion, African immigrant communities face several barriers, ranging from individual to policy levels, to accessing health services, resulting in substantial unmet need for chronic disease prevention and treatment. Community-centered and -led care may help facilitate uptake and engagement in care.

Positive and negative behavioural intentions towards immigrants: A question of ethnic categorisation or worldview conflict?

Anti-immigrant attitudes are often explained in terms of ethnic boundaries in which a categorical distinction between the ethnic ingroup and immigrant outgroup is made. However, these attitudes might also result from contrasting cultural worldviews. We examined the importance of ethnic categorisation and perceived cultural worldview difference in explaining behavioural intentions towards immigrants. Using an experimental survey design with a national sample of ethnic Dutch respondents (N = 832), we studied two positive and two negative behavioural intentions towards either immigrants with a contrasting cultural worldview or co-ethnics with such as worldview. Our findings indicate similar behavioural intentions towards both target groups. Furthermore, except for "the intention to learn" there were no differences in behavioural intentions towards both target groups for respondents with lower and higher authoritarian dispositions. Overall, this pattern of findings is theoretically most in line with a worldview conflict perspective rather than an ethnic boundary perspective.

Exploring Factors Associated with Physical Activity in Latino Immigrants.

Latinos are at increased risk for developing chronic conditions. Regular physical activity (PA) assists in protecting adults from developing type 2 diabetes, excess weight, and heart disease, making PA important for health promotion. This cross-sectional, descriptive investigation was conducted with adults 18 years of age and older in a predominately Latino community. Perceptions of factors which influenced PA were examined. Descriptive statistics and multiple regression analysis were performed. Immigrant Latino males engaged in PA significantly more often than female participants. In Latino participants, those who engaged in walking activities were more likely to engage in both vigorous (r = .341, p<.005) and moderate PA (r = .317, p <.001). Self-efficacy and acculturation were significant predictors of PA. Acculturation was associated with physical activity, even after adjusting for perceived stress. Findings highlight the continued importance of self-efficacy to foster health promotion in Latino communities.

Waiting times and treatment following cancer diagnosis: comparison between immigrants and the Norwegian host population.

Background: There are concerns about timely access to appropriate cancer treatment for the growing immigrant population in Norway. This study aims to compare waiting times between cancer diagnosis and start of cancer treatment, as well as treatment patterns between immigrants in Norway and the host population.Material and methods: We performed a nationwide, registry-based study with individual-level data, including 213,320 Norwegians and 8324 immigrants diagnosed with breast, colorectal, lung or prostate cancer in 1990-2014. Differences in time from diagnosis to treatment and in treatment patterns were described for the selected cancer sites. The Cox and logistic regressions were used to adjust for patient and tumour characteristics.Results: After adjustment for covariates, hazard ratios for time from diagnosis to treatment for non-Western immigrants compared to Norwegians were 0.88 (95% confidence interval (CI): 0.82-0.95) for breast cancer and 0.84 (95% CI: 0.75-0.95) for lung cancer, indicating longer waiting times. Treatment patterns in the four major cancer sites were similar among immigrants and the Norwegian host population, except for breast cancer, where women from East and South Asia received less breast-conserving surgery than the Norwegian host population (adjusted odds ratios 0.65 (95% CI: 0.46-0.93) for East Asians and 0.75 (95% CI: 0.50-1.13) for South Asians).Conclusions: The present study reports delayed treatment for lung and breast cancer among immigrants from non-Western countries in Norway. Systematic differences in cancer treatment were not detected. However, less breast-conserving surgery among breast cancer patients from Asia compared to Norwegians was observed.

Ethnic differences in the risk of caesarean section: a Danish population-based register study 2004-2015.

BACKGROUND: Studies have shown differences in the risk of caesarean section (CS) between ethnic minority groups. This could be a marker of unequal health care. The aim of this study was to investigate differences in the risk of CS between immigrants of various origins in Denmark, where all health care is free and easy to access, and Danish-born women. A further aim was to determine the possible influence of known risk factors for CS. METHODS: The design was a population-based register study using national Danish registers and included all live- and stillborn singleton deliveries by primiparous women in Denmark from 2004 to 2015. The total study population consisted of 298,086 births, including 25,198 births to women from the 19 largest immigrant groups in Denmark. Multinomial logistic regression analysis was used to estimate relative risk ratios (RRR) of emergency and planned CS, using vaginal delivery (VD) as reference, in immigrant women compared to Danish-born women. A number of known risk factors were included separately. RESULTS: Women from Turkey, the Philippines, Thailand, Somalia, Vietnam, Iran and Afghanistan had a statistically significant elevated risk ratio of emergency CS vs. VD compared to Danish-born women; adjusted RRR's ranging 1.15-2.19. The risk ratio of planned CS vs. VD was lower among the majority of immigrant groups, however higher among women from Poland, Thailand and Iran, when compared to Danish-born women. None of the studied explanatory variables affected the risk ratio of planned CS vs. VD, whereas maternal height contributed with varying strength to the risk ratio of emergency CS vs. VD for all immigrant groups. CONCLUSION: Substantial variations in CS risks by maternal country of birth were documented. Some of the disparities in emergency CS seem to be explained by maternal height.

Healthy immigrant effect by immigrant category in Canada.

BACKGROUND: Medical screening plays a role in explaining the healthy immigrant effect (HIE) among immigrants newly landed in Canada. The 2002 Immigration and Refugee Protection Act (IRPA) modernized immigration selection by exempting certain immigrant categories (e.g., refugees and certain family-class immigrants) from inadmissibility on health grounds. This study examines the HIE in the IRPA era by sex, with a focus on those categories affected by the IRPA. DATA AND METHODS: The linked Canadian Community Health Survey (CCHS)-Longitudinal Immigration Database (IMDB) was used to compare sex-specific age-standardized proportions of four health measures between Canadian-born and immigrants aged 20 to 65, overall and by duration since landing. Immigrants who landed within three years of the surveys from 2007 to 2014 were examined by sex and immigrant category. Logistic regression was used to further compare the HIE in the same immigrant sub-groups to the Canadian-born, controlling for age and selected confounders. RESULTS: This study found the HIE in most selected measures for immigrants overall, as well as for those recent immigrants arriving under the IRPA, including the family class. Among refugees, the HIE was observed only in less severe chronic conditions; this was especially the case among females. As expected, a strong HIE was observed among economic-class principal applicants. These health advantages persisted even after adjustment for socioeconomic and health factors. For self-rated health, the advantage existed for some groups only after full adjustment. DISCUSSION: This study is a first look at the healthy immigrant effect under the 2002 Immigration and Refugee Protection Act by immigration category. Results corroborate the existing literature on the presence of the HIE among immigrants: the HIE was found to be much weaker among refugees.

Multidimensional measure of immigrant integration.

The successful integration of immigrants into a host country's society, economy, and polity has become a major issue for policymakers in recent decades. Scientific progress in the study of immigrant integration has been hampered by the lack of a common measure of integration, which would allow for the accumulation of knowledge through comparison across studies, countries, and time. To address this fundamental problem, we propose the Immigration Policy Lab (IPL) Integration Index as a pragmatic and multidimensional measure of immigrant integration. The measure, both in the 12-item short form (IPL-12) and the 24-item long form (IPL-24), captures six dimensions of integration: psychological, economic, political, social, linguistic, and navigational. The measure can be used across countries, over time, and across different immigrant groups and can be administered through short questionnaires available in different modes. We report on four surveys we conducted to evaluate the empirical performance of our measure. The tests reveal that the measure distinguishes among immigrant groups with different expected levels of integration and also correlates with well-established predictors of integration.

[Tuberculosis among asylum seekers].

Global migration is increasing, including migration from tuberculosis (TB) high-incidence countries to TB low-incidence countries as Denmark. Asylum seekers are at increased risk of having TB, and screening for TB is potentially highly relevant in Europe. However, there is a large variation in the ways screening is carried out and in the yield of the different screening programmes. There is a need of more quality data on how effectively to target the screening among asylum seekers, considering both the TB incidence in the country of origin and the risk factors along the migration route.

Demographic predictors of active tuberculosis in people migrating to British Columbia, Canada: a retrospective cohort study.

BACKGROUND: Canadian tuberculosis (TB) guidelines recommend targeting postlanding screening for and treatment of latent tuberculosis infection (LTBI) in people migrating to Canada who are at increased risk for TB reactivation. Our objectives were to calculate robust longitudinal estimates of TB incidence in a cohort of people migrating to British Columbia, Canada, over a 29-year period, and to identify groups at highest risk of developing TB based on demographic characteristics at time of landing. METHODS: We included all individuals (n = 1 080 908) who became permanent residents of Canada between Jan. 1, 1985, and Dec. 31, 2012, and were resident in BC at any time between 1985 and 2013. Multiple administrative databases were linked to the provincial TB registry. We used recursive partitioning models to identify populations with high TB yield. RESULTS: Active TB was diagnosed in 2814 individuals (incidence rate 24.2/100 000 person-years). Demographic factors (live-in caregiver, family, refugee immigration classes; higher TB incidence in country of birth; and older age) were strong predictors of TB incidence in BC, with elevated rates continuing many years after entry into the cohort. Recursive partitioning identified refugees 18-64 years of age from countries with a TB incidence greater than 224/100 000 population as a high-yield group, with 1% developing TB within the first 10 years. INTERPRETATION: These findings support recommendations in Canadian guidelines to target postlanding screening for and treatment of LTBI in adult refugees from high-incidence countries. Because high-yield populations can be identified at entry via demographic data, screening at this point may be practical and high-impact, particularly if the LTBI care cascade can be optimized.

Immigration Basics for Nurses.

The United States is known as a nation of immigrants and a land of promise that welcomes the needy, poor, and oppressed. Immigrants represent some of the most vulnerable in society. It is vital that nurses and other health care providers possess knowledge of social, economic, and political factors related to health care for immigrant populations. This article provides definitions of the various immigrant populations, addresses health needs within this group, and offers suggestions for nursing practice and advocacy.

Native-immigrant occupational segregation and worker health in the United States, 2004-2014.

Immigrant workers are a growing share of the U.S. labor force and are overrepresented in certain occupations. This much is well documented, yet few studies have examined the consequences of this division of labor between foreign-born and native-born workers. This research focuses on one of the consequences of occupational segregation-worker health. We merge data from the 2004-2014 National Health Interview Surveys with occupational-level data from the Occupational Information Network 20.1 database and the American Community Surveys to examine the relationship between occupational segregation and health. First, logistic regression models show that working in an occupation with a higher share of immigrants is associated with higher odds of poor physical and psychological health. This relationship is more pronounced among native-born workers than among foreign-born workers. Second, we propose two explanations for the association between occupational segregation and health: (1) workers with less human capital are typically sorted into culturally devalued occupations with a higher concentration of immigrants, and (2) occupations with a higher percentage of immigrants generally have relatively poor work environments. We find sorting variables play a major role, whereas the smaller contribution of occupational environments to the segregation-health link is partly because of the heterogeneous (i.e., both positive and negative) indirect effects of different exposure measures. With the sustained high levels of immigration to the United States, the implications of integrated or segregated experiences in the labor market and their impact on workers are important avenues for health policies and future research.

Risk of firearm injuries among children and youth of immigrant families.

BACKGROUND: Firearm injuries contribute to substantial morbidity and mortality. The immigrant paradox suggests that, despite being more socially disadvantaged, immigrants are less likely than nonimmigrants to have poor outcomes. We tested the association of immigrant characteristics with firearm injuries among children and youth. METHODS: We conducted a population-based cohort study involving residents of Ontario aged 24 years and younger from 2008-2012 using health and administrative databases. We estimated rate ratios of unintentional and assault-related firearm injuries by immigrant status using Poisson regression models with Generalized Estimating Equations. RESULTS: We included 15 866 954 nonimmigrant and 4 551 291 immigrant person-years in our analysis. Nonimmigrant males had 1032 unintentional (12.4 per 100 000, 95% confidence interval [CI] 11.7-13.2) and 304 assault-related (3.6 per 100 000, 95% CI 3.2-4.0) firearm injuries. Immigrant males had 148 unintentional (7.2 per 100 000, 95% CI 6.1-8.5) and 113 assault-related (5.5 per 100 000, 95% CI 4.5-6.6) firearm injuries. Compared with nonimmigrants, immigrants had a lower rate of unintentional firearm injury (adjusted rate ratio 0.5, 95% CI 0.4-0.6) but a similar rate of assault-related firearm injury. Among immigrants, refugees had a 43% higher risk of assault-related firearm injury compared with nonrefugees (adjusted rate ratio 1.4, 95% CI 1.0-2.0). Immigrants from Central America and Africa accounted for 68% of immigrants with assault-related firearm injuries. INTERPRETATION: Compared with nonimmigrants, immigrant children and youth had a lower risk of unintentional firearm injury, although the risk of assault-related firearm injury was higher among refugees and immigrants from Central America and Africa. The results suggest that prevention strategies for firearm safety should target nonimmigrant youth as well as these newly identified high-risk immigrant populations.

Os fluxos migratórios mistos e os entraves à proteção aos refugiados / Mixed migration flows and the obstacles to the refugees protection / Los flujos migratorios mixtos y las barreras a la protección de los refugiados

Resumo O artigo discute o fenômeno dos fluxos migratórios mistos, considerando seus impactos sobre o reconhecimento das solicitações de refúgio, seu enquadramento jurídico nos países de passagem e destino e, especialmente, a proteção aos refugiados. Os Estados Nacionais, invariavelmente, tratam as migrações internacionais de forma generalista, desconsiderando os elementos específicos e individuais que as motivaram. Isso faz com que muitos solicitantes de refúgio, que utilizam os mesmos mecanismos e rotas dos denominados migrantes voluntários, sejam prejudicados no acesso ao direito de reconhecimento de seus pedidos. Tal realidade tem influenciado os debates sobre os fluxos migratórios na academia e nos órgãos protetivos e de promoção de ações voltadas aos refugiados, como é o caso do Alto Comissariado das Nações Unidas para Refugiados (Acnur) e do sistema americano desenvolvido após a Declaração de Cartagena. O presente texto pretende analisar, com base nos documentos de organismos internacionais e nos debates realizados na academia, o que são fluxos mistos e a forma como as questões relativas ao tema têm sido debatidas no âmbito internacional, apresentando boas práticas e soluções que permitam assegurar aos refugiados a proteção a que fazem jus.(AU)

Abstract The paper discusses mixed migration flows considering its impacts on the requests of refugee status recognition, its legal framework in the transit and destination countries and, specially, the protection to refugees. The National States have, invariably, been treating international migration in a general way, disregarding specific and individuals elements that have motivated them. The consequence of this modus operandi is that many refugee applicants, who use the same mechanisms and routes as the so-called voluntary migrants, have disadvantages in the access to the right of recognition of their requests. Such reality have affected the debates on migratory flows in both the academy and in the refugee protection and advocacy bodies, such is the case of UNHCR and the American System developed after the Cartagena Declaration. Accordingly, based on documents from the international organizations and in the debates carried out in the Academia, the paper will analyze the mixed flows and the way these questions concerning the topic have been debated in the international arena, presenting good practices and solutions that can assure to the refugees the protection to which they are entitled.

Resumen El artículo discute el fenómeno de los flujos migratorios mixtos, considerandos sus impactos sobre el reconocimiento de las solicitudes de refugio, los marcos legales de los países de tránsito y destino y, especialmente, la protección a los refugiados. Los Estados Nacionales, invariablemente, tratan a la migración internacional de manera general, sin tener en cuenta los elementos específicos e individuales que las motivaron. Esto lleva a que muchos solicitantes de refugio, que utilizan los mismos mecanismos y rutas de los llamados migrantes voluntarios, tengan obstáculos en el acceso al derecho de reconocimiento de sus solicitudes de refugio. Esta realidad ha afectado los debates sobre flujos migratorios tanto en la academia como en los órganos de protección y de promoción de las acciones dirigidas a los refugiados, como es el caso de ACNUR y del sistema americano desarrollado después de la Declaración de Cartagena. En este sentido, el artículo busca analizar, con base en los documentos de las organizaciones internacionales y en las discusiones de la academia, qué son los flujos mixtos y cuál es la forma como las cuestiones relativas a este tema han sido debatidas en ámbito internacional, presentando las mejores prácticas y las soluciones que pueden garantizar la protección a que los refugiados tienen derecho.

[Documents make a difference: the case of Brazilian domestic workers in Massachusetts, USA]. / Documento faz diferença: o caso das trabalhadoras domésticas brasileiras em Massachusetts, Estados Unidos.

Brazilian immigrants in the United States experience various social, labor, and health challenges. This study aimed to analyze the profile of female Brazilian domestic workers in Massachusetts, USA, through a description of their working conditions and self-rated health. This was a cross-sectional study of 198 domestic workers in Massachusetts, recruited with "snowball" sampling. The instrument addressed participants' demographic characteristics, work conditions, and self-rated health. Data were analyzed with SPSS 21.0. Among the interviewees, 95.5% were women, 62.1% were 30 to 49 years of age, and 55.6% were undocumented. Documented and undocumented participants showed statistically significant differences in demographics, work conditions, and health. Irregular immigrant status appears to have a negative impact on domestic workers' living and health conditions.

Tooth brushing among 11- to 15-year-olds in Denmark: combined effect of social class and migration status.

OBJECTIVE: Regular tooth brushing in adolescence predicts stable tooth brushing habits later in life. Differences in tooth brushing habits by ethnic background and socioeconomic position have been suggested. We investigated migration status and social class in relation to infrequent tooth brushing both separately and combined. METHODS: The study population was 11-15 year-olds chosen from a clustered random sample of schools. Univariate and multivariate logistic regression analyses estimated the separate and combined effects of migration status and social class on less than twice daily tooth brushing. RESULTS: 10,607 respondents: a response rate of 88.3%. Boys of lower social class had higher odds ratio (OR) of infrequent tooth brushing than girls: 1.98 (95% confidence interval 1.62-2.41) vs 1.80 (1.53-2.24). Immigrants and descendants had higher odds compared to adolescents of Danish origin: immigrant boys OR 1.39 (1.05-1.89), girls OR 1.92 (1.47-2.50); descendant boys OR 2.53 (1.97-3.27), girls OR 2.56 (2.02-3.35). Analyses of the combined effect of social class and migration status showed that the social gradient in tooth brushing habits observed among ethnic Danes cannot be found among groups of immigrants and descendants. CONCLUSION: The study shows that both non-Danish origin and low social class increases the risk of infrequent tooth brushing among school-aged children. The study calls for in depth analyses of the processes which influence young people's tooth brushing habits. Further, there is a need to strengthen the promotion of appropriate tooth brushing habits of minority and low social class youths.

Diferencias en los hallazgos clínicos en dos grupos de población inmigrante afecta de tuberculosis / Differences in clinical features of two immigrant populations with tuberculosis

Se realizó un estudio descriptivo para identificar posibles diferencias en la presentación clínica de la tuberculosis entre 2 grupos de población inmigrante. Se incluyeron 94 pacientes visitados en urgencias y que fueron diagnosticados de tuberculosis activa en el periodo 2006-12. Cuarenta y nueve pacientes era originarios de Asia Central (A) y 45 de Latinoamérica (LA). La edad media (años [DE]) fue de 35,3 (13) años en los procedentes de A por 33,9 (10) en los de LA. Existía un predominio de varones en asiáticos (40/49 vs. 25/45; p = 0,006). Los pacientes procedentes de LA tenían mayor porcentaje de tuberculosis pulmonar. Los pacientes de A vivían en condiciones de hacinamiento con mayor frecuencia. Los pacientes de LA tenían más antecedentes de seropositividad para el VIH. La mayoría recibió tratamiento cuádruple. Dos pacientes latinoamericanos eran resistentes a isoniazida

A study was performed to assess differences in the clinical presentation of tuberculosis between two groups of immigrants. Ninety-four patients seen in the emergency room for newly diagnosed tuberculosis between 2006 and 2012 were included. Forty-nine patients were from Asian countries and 45 from Latin America. Mean age [years (SD)] was 35.3 (13) in Asian patients and 33.9 (10) in Latin American patients. Asian subjects were predominantly male (40/49 vs 25/45; P=0.006). Patients from Latin American countries had a higher rate of pulmonary tuberculosis. A higher percentage of Asian patients lived in overcrowded conditions, whereas HIV infection was more frequent among Latin Americans. Most patients were treated with a quadruple regimen. Resistance to isoniazid was documented in two patients from Latin America

Percepções de mulheres imigrantes acerca das dificuldades de acesso e da qualidade do atendimento de saúde em portugal / Perceptions of immigrants women about difficulties of access and quality of health care in Portugal

Avaliar as percepções de mulheres imigrantes (brasileiras e oriundas de países africanos de língua portuguesa), residentes em Portugal, acerca das facilidades/dificuldades de acesso aos serviços de saúde bem como as suas considerações acerca da qualidade do atendimento em saúde recebido. Métodos: Investigação original de caráter qualitativo. O estudo foi realizado em Portugal, no ano de 2008, por investigadores brasileiros e portugueses, com ajuda de Organizações Não-governamentais que atendem imigrantes. Participaram no estudo 35 mulheres, sendo 15 brasileiras e 20 africanas. Destas últimas, nove são de Cabo Verde, seis de Angola, quatro de São Tomé e Príncipe e uma da Guiné. Os dados/informações utilizados no estudo foram produzidos a partir da realização de grupos focais e, posteriormente, analisados através da análise de conteúdos. Os grupos foram formados de acordo com a origem das participantes, pois a intenção foi constituir grupos heterogêneos em relação a outras características sociodemográficas, por exemplo, diferentes faixas etárias, profissão, número de filhos (e sem filhos), experiências migratórias diversificadas, entre outros aspectos diferenciadores. Resultados e Conclusões: De modo geral, foi possível observar manifestações de insatisfação relacionadas com o atendimento de imigrantes e, a partir disso, aponta-se a necessidade de mudanças que envolvem a capacitação dos profissionais da área da saúde na direção de melhorar a qualidade dos serviços prestados, bem como estimular a participação dessas utentes nos programas de saúde de modo a se promover melhores condições de saúde aos imigrantes.

To evaluate the perceptions of immigrant women (Brazilians and Africans from African Portugue se-speaking countries) residing in Portugal, about the facilities/difficulties about access to health services as well as their considerations about the quality of health care. Type of study: Original qualitative research. Methods: The study was conducted in Portugal, in 2008, by Brazilian and Portuguese researchers, who had help from Non-Governmental Organizations. Participants were 35 women, 15 Brazilian and 20 African, nine from Cape Verde, six from Angola, four from Sao Tome and Principe and Guinea. The data/information used in the research was produced with focus groups and subsequently analysed by content analysis. The groups were formed according to the origin of the participants, because we tried to establish working teams heterogeneous, with other suicide mographic characteristics: different age, occupation, number of children (and childless), experiments migration varied among other things differentiators. Results and Conclusions: In general, we observed manifestations of dissatisfaction related to the care of Immi grants and, from that, it points to the need for changes involving the training of health professionals towards improving the quality of services provided and to encourage the participation of these users in health programs in order to promote better health.