Examining recovery and mental health service satisfaction among young immigrant Muslim women with mental distress in Quebec.

OBJECTIVE: The overall aim of this study was to understand the experiences and perspectives of immigrant Muslim women in Quebec living with mental illness, who have recently used formal mental health services such as an accredited therapist, psychologist, or clinician. Specific objectives included (i) eliciting and examining their self-identified barriers and facilitators to recovery; (ii) exploring links between religion and mental health; and (iii) self-reported satisfaction with mental health services received. METHODS: We adopted a qualitative approach, facilitating the prioritization of participant perspectives. This involved semi-structured interviews with 20 women who (i) identified as Muslim; (ii) had used mental health services in the last three years; and (iii) were 18 + years of age. Interviews were transcribed and analyzed using thematic analysis techniques. RESULTS: Three prominent themes emerged from the analysis. These themes were (i) stigma and misunderstandings in families (especially parents) and sometimes in the ethno-religious community, both acting as barriers to health service utilization and recovery; (ii) frustrating clinical experiences within formal mental health care settings, in particular a perceived lack of cultural and religious competence, which negatively affected service utilization and the development of a therapeutic alliance; and (iii) deeply-held religious beliefs, practices and trust in God imparting a rhythm, purpose and meaning, which were strong facilitators to recovery. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: These findings suggest that recovery from mental illness can be advanced by a three-pronged approach in this population. First, anti-stigma mental health literacy interventions could be held in collaboration with Muslim community groups. Second, there is a need for further religious and cultural competence interventions, resources and trainings for mental health professionals working with Muslims. Third, self-care resources should be developed that harness aspects of religious practices that can give structure, meaning, purpose and hope. All this could ultimately foster recovery in this population.

Mexican-origin women's individual and collective strategies to access and share health-promoting resources in the context of exclusionary immigration and immigrant policies.

BACKGROUND: A growing literature has documented the social, economic, and health impacts of exclusionary immigration and immigrant policies in the early 21st century for Latiné communities in the US, pointing to immigration and immigrant policies as forms of structural racism that affect individual, family, and community health and well-being. Furthermore, the past decade has seen an increase in bi-partisan exclusionary immigration and immigrant policies. Immigration enforcement has been a major topic during the 2024 Presidential election cycle, portending an augmentation of exclusionary policies towards immigrants. Within this context, scholars have called for research that highlights the ways in which Latiné communities navigate exclusionary immigration and immigrant policies, and implications for health. This study examines ways in which Mexican-origin women in a midwestern northern border community navigate restrictive immigration and immigrant policies to access health-promoting resources and care for their well-being. METHODS: We conducted a grounded theory analysis drawing on interviews with 48 Mexican-origin women in Detroit, Michigan, who identified as being in the first, 1.5, or second immigrant generation. Interviews were conducted in English or Spanish, depending on participants' preferences, and were conducted at community-based organizations or other locations convenient to participants in 2013-2014. RESULTS: Women reported encountering an interconnected web of institutional processes that used racializing markers to infer legal status and eligibility to access health-promoting resources. Our findings highlight women's use of both individual and collective action to navigate exclusionary policies and processes, working to: (1) maintain access to health-promoting resources; (2) limit labeling and stigmatization; and (3) mitigate adverse impacts of immigrant policing on health and well-being. The strategies women engaged were shaped by both the immigration processes and structures they confronted, and the resources to which they had access to within their social network. CONCLUSIONS: Our findings suggest a complex interplay of immigration-related policies and processes, social networks, and health-relevant resources. They highlight the importance of inclusive policies to promote health for immigrant communities. These findings illuminate women's agency in the context of structural violence facing immigrant women and are particularly salient in the face of anti-immigrant rhetoric and exclusionary immigration and immigrant policies.

Religion, Geography, and Risky Sexual Behaviors Among International Immigrants Living in China: Cross-Sectional Study.

Background: Behavioral differences exist between countries, regions, and religions. With rapid development in recent decades, an increasing number of international immigrants from different regions with different religions have settled in China. The degrees to which sexual behaviors-particularly risky sexual behaviors-differ by religion and geographical areas are not known. Objective: We aim to estimate the associations of religion and geographical areas with sexual behaviors of international immigrants and provide evidence for promoting the sexual health of international immigrants. Methods: A cross-sectional study was conducted via the internet with a snowball sampling method among international immigrants in China. In our study, risky sexual behaviors included having multiple sexual partners and engaging in unprotected sex. Descriptive analysis was used to analyze the basic characteristics of international immigrants as well as their sexual behaviors, religious affiliations, and geographical regions of origin. Multivariate binary logistic regression analyses with multiplicative and additive interactions were used to identify aspects of religion and geography that were associated with risky sexual behaviors among international immigrants. Results: A total of 1433 international immigrants were included in the study. South Americans and nonreligious immigrants were more likely to engage in risky sexual behaviors, and Asian and Buddhist immigrants were less likely to engage in risky sexual behaviors. The majority of the Muslims had sexually transmitted infection and HIV testing experiences; however, Muslims had a low willingness to do these tests in the future. The multivariate analysis showed that Muslim (adjusted odds ratio [AOR] 0.453, 95% CI 0.228-0.897), Hindu (AOR 0.280, 95% CI 0.082-0.961), and Buddhist (AOR 0.097, 95% CI 0.012-0.811) immigrants were less likely to report engaging in unprotected sexual behaviors. Buddhist immigrants (AOR 0.292, 95% CI 0.086-0.990) were also less likely to have multiple sexual partners. With regard to geography, compared to Asians, South Americans (AOR 2.642, 95% CI 1.034-6.755), Europeans (AOR 2.310, 95% CI 1.022-5.221), and North Africans (AOR 3.524, 95% CI 1.104-11.248) had a higher probability of having multiple sexual partners. Conclusions: The rates of risky sexual behaviors among international immigrants living in China differed depending on their religions and geographical areas of origin. South Americans and nonreligious immigrants were more likely to engage in risky sexual behaviors. It is necessary to promote measures, including HIV self-testing, pre-exposure prophylaxis implementation, and targeted sexual health education, among international immigrants in China.

Pathway Programs That Support Students From Immigrant Backgrounds in Becoming Physicians.

Pathways programs are critical to promoting access and success for careers in healthcare for students from immigrant backgrounds. Three cases are presented that demonstrate the successful elements of pathways programs. Excellence in pediatrics requires the inclusion of talent from immigrant communities. Community capacity building and systems level change can be achieved through coliberatory practice of mutual action, investment, and benefit. Navigation, mentorship, and structural support for educational, social, and monetary capital are key components of pathways programs.

Immigrant and Refugee Health Curricula in US-Based Medical Training: A Scoping Review to Inform Integration Into Pediatric Residency Programs.

OBJECTIVE: Despite increases in the US foreign-born population, medical education opportunities in immigrant and refugee health (IRH) remain limited. We summarize findings for published IRH curricula and offer recommendations for integrating IRH into pediatric residency programs. METHODS: We performed a literature review of articles describing the design, implementation, or assessment of IRH curricula for US-based undergraduate and graduate medical trainees. RESULTS: The literature review identified 36 articles from 21 institutions describing 37 unique curricula. Three curricula included pediatric residency programs. Commonly taught topics included cultural humility, interpreter use, and immigration status as a social determinant of health. Immigrant-focused training experiences existed at continuity clinics, clinics for refugees or asylum seekers, and dedicated electives/rotations. Curricula were most frequently described as stand-alone electives/rotations. CONCLUSIONS: IRH curricula provide opportunities to develop skills in clinical care, advocacy, and community partnerships with immigrant populations. Pediatric residency programs should align the IRH curriculum with existing learning priorities, support and hire faculty with expertise in IRH, and partner with community organizations with expertise. Programs can also consider how to best support learners interested in careers focusing on immigrant populations. Further work is needed to establish competencies and validated tools measuring trainee satisfaction and clinical competency for IRH curricula.

The Intergenerational Effects From Structural Racism Cost Our Society Greatly.

Structural racism is historically rooted, and has been a foundation for United States immigration policy. This injustice has intergenerational effects that cost society greatly - with impacts on social cohesion, individual and collective health, and well-being, and ultimately our ability to function as a civil society. Limited pathways to citizenship and major restrictions to resources that promote integration have adverse consequences for immigrants and, their families. Research shows that children experience toxic stress that negatively impacts their long-term health and development from heightened immigration enforcement, regardless of any personal impact. In embracing the next generation of children, we will not succeed unless we support sound integration policies that promote the health and well-being of immigrant families across this nation. We must recognize how intricately our fates and our health are tied to each other; we all depend on immigrants being well. We must advance new a social contract, one that counters the 'othering' of immigrants" and recognizes that we must invest in the health and well-being of all families.

Reimagining Social and Emotional Supports in Schools for Immigrant Students: A Contextual and Structural Approach.

Immigrant students and families experience disproportionate exposure to trauma, immigration-related stress, structural inequities, and poor access to mental health and social services which can lead to mental health inequities. Immigrant students and their families also have many strengths that can buffer potential negative mental health outcomes. Schools, which address social and emotional development in addition to academic achievement, are critical institutions that can play a unique role in enhancing the strengths and responding to the needs of immigrant students and families. In this review, we adapt the Behavioral Model for Vulnerable Populations to acknowledge the contextual and macro-level factors (e.g., relevant policies, environmental influences, and structural factors) and the predisposing, enabling, and need factors that immigrant students and families experience and impact access to school mental health and social services. We discuss school-based interventions that show efficacy for improving mental health outcomes and focus on addressing acculturative stress among immigrant students. We also discuss models to address social determinants of health need among immigrant students and families within schools, including the community schools model applied to immigrant students and families. We conclude this review by providing recommendations and strategies for pediatricians and schools to transform school-based supports for immigrant students and families and promote equitable outcomes. Our recommendations include incorporating multi-level school supports for addressing mental health, social need, and acculturative stress among immigrant students, along with reinforcing the strengths of immigrant students, and promoting school collaborations with pediatricians, school-based health centers, and trusted community partners.

Supporting Sexual and Reproductive Health for Immigrant Families Across the Lifespan.

The ability to exercise autonomy in achieving reproductive health goals necessitates access to contraceptive and reproductive health information and medical care. Finding trusted, comprehensive, consistent and affordable reproductive care is particularly challenging for immigrants living in the United States, especially for those without legal immigration status and for those who prefer a language other than English. In immigrant communities, sexual and reproductive health (SRH) knowledge, contraceptive choice, and family planning are influenced by many factors including tension between traditional and adopted cultural norms, limited English proficiency, restricted health care access, and structural racism. The family-centered model and longitudinal nature of relationships in pediatric primary care pose a unique opportunity to support immigrant families across the lifespan in obtaining SRH information and achieving reproductive health goals. Here, we present the unique vulnerabilities faced by immigrants seeking SRH services in the United States including both the upstream and downstream health effects of immigration status on family health. We then describe four time points across the lifespan where pediatricians can support SRH, including examples of existing SRH programming designed or adapted for immigrant families. Finally, we discuss opportunities to advance research, policy, education, and clinical care related to SRH equity for immigrant families.

School-Based Behavioral Health Programming for Newcomer Youth: A Scoping Review.

OBJECTIVE: Newcomer youth experience health disparities in accessing behavioral health services. School-based mental health programming is proposed a potential solution to address these disparities. The present study uses a scoping review methodology to examine the state-of-the-art of the evidence base for school-based mental health programming for newcomer youth. Studies were categorized into a tiered typology using the framework established by the National Center for School Mental Health. METHODS: Several databases were examined as well as the results of one scoping and two systemic recent reviews. RESULTS: A total of 37 studies were included in the present analysis, over half from the last decade. Most studies were conducted in the United States and Europe, and most programs were focused on mental health promotion and wellness (Tier 1) or were multi-tiered. Programming for younger children, especially those in early childhood settings, were underrepresented. CONCLUSIONS: While the literature is promising regarding programming for newcomer youth, particularly the advent of complex multi-tiered programming, many gaps still remain. For example, most programs do not provide information on how programming was adapted for different groups of newcomers with different cultural and contextual needs. Tier 1 programs lack theoretical foundations or theories of change in the design of programming. Further, more research is needed for a group with rising numbers across high- and middle-income countries, particularly for programming targeting early and middle childhood.

Somos Esenciales, We are Essential: Our Mental Health is Essential. Research for, by and of the Latinx Community in the Mission District during the Pandemic.

We are Latinx immigrants and children of Latinx immigrants. We provided emergency volunteer services at the Mission Food Bank during the pandemic to provide food assistance to low-income families in the Mission District and the city of San Francisco. In March 2021, we were invited to lead a research project that we call "We are Essential". Here we share our process and a few of our findings on the mental health of San Francisco's Latinx community during the pandemic, with a focus on our children and youth. A full report of our findings will be published in 2024.

Beyond the diagnosis of drug-resistant Tuberculosis in Norway: patients' experiences before, during and after treatment.

BACKGROUND: This study aims to explore the varied experiences of patients with drug-resistant tuberculosis in Norway. The study emphasizes challenges and implications of being diagnosed with drug-resistant tuberculosis, including the impact on psychosocial health during the diagnosis, disease, treatment, isolation and recovery phases. Norway is a low endemic country of tuberculosis. Most patients are immigrants, and some of them have recently arrived in the country. Patients undergoing treatment for drug-resistant tuberculosis endure prolonged and demanding treatment that could affect their psychosocial health. METHODS: This qualitative study conducted 16 in-depth interviews with individuals aged 18 years and above who were diagnosed with drug-resistant tuberculosis. All participants completed the treatment between 2008 and 2020. Fourteen participants were immigrants, and eight of them had resided in Norway for less than four years before diagnosis. Data analysis followed the six-phase reflexive thematic analysis framework, focusing on identifying patterns in participants' experiences, thoughts, expectations and attitudes. RESULTS: The narratives of the participants highlighted the complexities of navigating the diagnosis of drug-resistant tuberculosis, treatment, side effects and life after treatment. Immigrants encountered additional challenges, including language barriers and adapting to new social environments. All participants reported experiencing physical health issues that additionally affected their mental health and social activity. Several participants had a delayed or prolonged diagnosis that complicated their disease trajectory. Participants with suspected or confirmed contagious pulmonary tuberculosis underwent hospital isolation for periods ranging from weeks to six months. The participants reported mental health issues, social isolation and stigma, however few were offered follow-up by a psychologist. Many participants had persistent problems at the time of the interviews. Three main themes emerged from the analysis: Delayed and prolonged diagnosis; Psychosocial impact of isolation during treatment; The life after tuberculosis. CONCLUSION: This study highlights the enduring impact of drug-resistant tuberculosis on patients and the significance of timely diagnosis, psychosocial support and post-treatment follow-up. The participants universally faced serious implications of the disease, including stigma and isolation. Participants who experienced delayed diagnosis, reflected on missed early intervention opportunities. We recommend further research in low endemic countries to evaluate the international and local recommendations on psychosocial support.

Supporting Underserved Communities for Health Care: US Immigrants' Experiences with Social Support.

Background: Social support is associated with improved clinical outcomes but is understudied among US immigrants. We examined two types of social support, perceived health provider support and community support, and characterized perceptions of social support among US immigrants compared with nonimmigrants. Methods: We conducted cross-sectional data analysis on self-reported data from Health Information National Trends Survey 5, Cycle 2. Population-level estimates were obtained using jack-knife replicate weights. Results: Immigrant status was not associated with perceived health care provider support or community support. However, compared with nonimmigrants, US immigrants were more likely to report rarely (adjusted odds ratio [aOR]=3.07) or never (aOR=3.18) having access to emotional support. Conclusions: Further research that incorporates nuanced factors (eg, time since arrival) that may influence social support in diverse US immigrant groups is needed to determine the impact of social support on health outcomes in an underserved and often overlooked population.