A systematic review and meta-analysis of predictors and outcomes of community treatment orders in Australia and New Zealand

OBJECTIVES

Australia and New Zealand have some of the highest rates of compulsory community treatment order use worldwide. There are also concerns that people from culturally and linguistically diverse backgrounds may have higher rates of community treatment orders. We therefore assessed the health service, clinical and psychosocial outcomes of compulsory community treatment and explored if culturally and linguistically diverse, indigenous status or other factors predicted community treatment orders.

METHODS

We searched the following databases from inception to January 2020: PubMed/Medline, Embase, CINAHL and PsycINFO. We included any study conducted in Australia or New Zealand that compared people on community treatment orders for severe mental illness with controls receiving voluntary psychiatric treatment. Two reviewers independently extracted data, assessing study quality using Joanna Briggs Institute scales.

RESULTS

A total of 31 publications from 12 studies met inclusion criteria, of which 24 publications could be included in a meta-analysis. Only one was from New Zealand. People who were male, single and not engaged in work, study or home duties were significantly more likely to be subject to a community treatment order. In addition, those from a culturally and linguistically diverse or migrant background were nearly 40% more likely to be on an order. Indigenous status was not associated with community treatment order use in Australia and there were no New Zealand data. Community treatment orders did not reduce readmission rates or bed-days at 12-month follow-up. There was evidence of increased benefit in the longer-term but only after a minimum of 2 years of use. Finally, people on community treatment orders had a lower mortality rate, possibly related to increased community contacts.

CONCLUSION

People from culturally and linguistically diverse or migrant backgrounds are more likely to be placed on a community treatment order. However, the evidence for effectiveness remains inconclusive and limited to orders of at least 2 years' duration. The restrictive nature of community treatment orders may not be outweighed by the inconclusive evidence for beneficial outcomes.

Mindfulness and social-emotional skills in Latino pre-adolescents in the U.S.: The mediating role of executive function

Latino youth are the largest and the fastest growing ethnic minority group in the U.S., and social-emotional skills are critical to their ability to cope with acculturative stress, perceived racial/ethnic discrimination and cultural value conflicts. Despite the significant challenges faced by Latino youth in the U.S., a paucity of research has examined the social-emotional skills of Latino pre-adolescents specifically. Recent research suggests that mindfulness may be closely linked to youth social-emotional skills, and executive function may serve as a mediating mechanism, but such associations have not been examined prior to this study. Using a cross-sectional survey among a sample of Latino youth in fifth-sixth grades in northern New Jersey (N = 97, M_age  = 11, 54% male), this study examines the association between their mindfulness and their social-emotional skills, and tests the role of executive function in this relationship. Among the sampled Latino youth, mindfulness is positively associated with executive function, which is positively associated with social-emotional skills. Additionally, being male and being older both have marginally significant negative effect on social-emotional skills. Our results suggest that mindfulness, the awareness of and intentional focus on one's present thoughts and emotions with self-compassion, may benefit Latino pre-adolescents' executive function, which in turn may exhibit as improved social-emotional skills. This preliminary evidence and the differences based on gender and age therein warrant further investigation with larger samples among Latino youth. Future research and service implications are discussed.

Engaging ethnic minority communities through performance and arts: health education in Cambodian forest villages

Background

In Siem Pang, northeastern Cambodia, malaria transmission persists in remote forested areas populated by ethnic minorities. Engaging affected communities in health education campaigns is challenging due to language, access and literacy constraints. During 2018, a newly established medical research station conducted a health education programme in local villages harnessing traditional songs, arts and crafts, along with theatre, comedy and health talks and quizzes. Health education topics were proposed by community leaders and focused on maternal and child health and malaria. This article describes a process evaluation of these activities, the community's response and whether this was an appropriate form of health education in this context.

Methods

In-depth interviews were conducted with community members, leaders and performers. Interviews were audio-recorded, transcribed and translated to English for thematic analysis.

Results

In total, 65 interviews were conducted; 20 of these were follow-up interviews with respondents interviewed prior to the performances. Respondents were able to recall the key health messages about malaria, antenatal care and infant vaccination. They also showed good awareness of malaria transmission and prevention and described how they enjoyed the events and appreciated the efforts of the project team.

Conclusions

In isolated communities in Cambodia, a health education programme harnessing performance and arts engaged the whole community and its messages were readily recalled and prompted reflection.

Advance Care Planning in Older Adults with CKD: Patient, Care Partner, and Clinician Perspectives

BACKGROUND

Older patients with advanced CKD are at high risk for serious complications and death, yet few discuss advance care planning (ACP) with their kidney clinicians. Examining barriers and facilitators to ACP among such patients might help identify patient-centered opportunities for improvement.

METHODS

In semistructured interviews in March through August 2019 with purposively sampled patients (aged ≥70 years, CKD stages 4-5, nondialysis), care partners, and clinicians at clinics in across the United States, participants described discussions, factors contributing to ACP completion or avoidance, and perceived value of ACP. We used thematic analysis to analyze data.

RESULTS

We conducted 68 semistructured interviews with 23 patients, 19 care partners, and 26 clinicians. Only seven of 26 (27%) clinicians routinely discussed ACP. About half of the patients had documented ACP, mostly outside the health care system. We found divergent ACP definitions and perspectives; kidney clinicians largely defined ACP as completion of formal documentation, whereas patients viewed it more holistically, wanting discussions about goals, prognosis, and disease trajectory. Clinicians avoided ACP with patients from minority groups, perceiving cultural or religious barriers. Four themes and subthemes informing variation in decisions to discuss ACP and approaches emerged: (1) role ambiguity and responsibility for ACP, (2) questioning the value of ACP, (3) confronting institutional barriers (time, training, reimbursement, and the electronic medical record, EMR), and (4) consequences of avoiding ACP (disparities in ACP access and overconfidence that patients' wishes are known).

CONCLUSIONS

Patients, care partners, and clinicians hold discordant views about the responsibility for discussing ACP and the scope for it. This presents critical barriers to the process, leaving ACP insufficiently discussed with older adults with advanced CKD.

CCOUC Ethnic Minority Health Project: A Case Study for Health EDRM Initiatives to Improve Disaster Preparedness in a Rural Chinese Population

Disasters disproportionately impact poor and marginalised populations due to greater vulnerability induced by various risk determinants, such as compromised living conditions, language barriers, and limited resources for disaster risk management. Health Emergency and Disaster Risk Management (Health EDRM) emphasises a people- and community-centred approach for building stronger capacities in communities and countries since community members are often the first responders to health emergencies and should be central to effective risk management. A key action for promoting community disaster preparedness is the provision of Health EDRM education interventions. The Ethnic Minority Health Project (EHMP) has provided community-based Health EDRM education interventions in 16 ethnic minority-based villages in remote areas of China since 2009. It aims to enhance community disaster preparedness and resilience by improving health-risk literacy and self-help capacity at the individual and household levels. This case study outlines the first EHMP project in an ethnic minority-based community (Ma’an Qiao Village) in Sichuan Province, China. It highlights the key elements for planning and managing such a project and is a good demonstration of an effective Health EDRM workforce development project in rural communities. This report concludes with five recommendations for setting up a sustainable and effective Health EDRM education intervention in similar contexts.

Genetic mutations in patients with nonsyndromic hearing impairment of minority and Han Chinese ethnicities in Qinghai, China

Objective

Mutations in GJB2, SLC26A4, and mitochondrial (mt)DNA 12S rRNA genes are the main cause of nonsyndromic hearing impairment. The present study analyzed these mutations in ethnic minority and Han Chinese patients with nonsyndromic hearing impairment from Qinghai, China.

Methods

The SNPscan assay was used to analyze mutation spectra and frequencies in the two patient groups.

Results

GJB2 mutations were detected in 9.5% (20/210) of minority patients and 20.88% (48/230) of Han Chinese patients. The most common Han Chinese GJB2 variants were c.235delC and c.299_300delAT, whereas c.235delC and c.109G > A were the most prevalent in minority patients. SLC26A4 mutations were detected in 5.71% (12/210) of minority patients and 14.35% (33/230) of Han Chinese patients, and mtDNA 12S rRNA mutations were detected in 4.28% (9/210) of minority patients and 9.13% (21/230) of Han Chinese patients.

Conclusions

These data indicate that the mutation frequencies of three deafness-associated genes were significantly higher in Han Chinese patients than in minority patients. Moreover, the GJB2 mutation spectrum was shown to differ between these two patient groups.

Twenty seven years of treating survivors of torture and organized violence - associations between torture, gender and ethnic minority status among refugees referred for treatment of PTSD

Background: Victims of torture and organized violence are among the most vulnerable refugees. The nature of torture promotes shame, secrecy and silencing of the survivors, and there is a need for studies to provide a testimony to the experiences of survivors. Objective: To contribute to the global knowledge base by exploring the nature and frequency of different types of torture as reported by survivors and to explore potential associations between basic sociodemographic variables and the likelihood of reporting different kinds of torture and of attending treatment for PTSD. Method: This study is based on archival data from 27 years of clinical practice treating survivors of torture and organized violence (N = 1249) in a specialist outpatient clinic. Data was coded from patient files by two research assistants. Statistical analysis included independent samples t-tests, Pearson Chi Square tests and regression. Results: The study found strong associations between gender of survivors and the reporting of different kinds of torture, most strongly with respect to sexual torture. Furthermore, the study found significant differences between survivors belonging to an ethnic minority and survivors who belonged to the majority populations within their countries of origin with regards to the extent of the torture, they report being subjected to. Patients who received treatment reported more torture experiences than those who did not. Conclusions: Findings from the present study document the experiences of different torture methods as reported by survivors, and suggest that belonging to an ethnic minority population is associated with an increased risk of being subjected to more severe torture, which has implications for both research and interventions aimed at treating survivors of torture.

The Cultural and Methodological Factors Challenging the Success of the Community-Based Participatory Research Approach When Designing a Study on Adolescents Sexuality in Traditional Society

Youth growing up in traditional cultures are split between the messages that they receive on sexuality from their families and those they receive via the internet depicting values of Western culture. The Palestinian-Israeli community, a national, ethnic, and linguistic minority, is an example of this situation. The purpose of this community-based participatory research study is to describe the challenges and lessons learned about launching a community advisory board (CAB) in studies on the taboo topic of adolescent sexuality. Using content analysis, we identified two necessary conditions to convene a CAB on adolescent sexuality in a traditional community: (a) an insider academic researcher, fluent in the native language, able to discuss the linguistic difficulties of sexual terminology and (c) the recruitment of motivated, community activists who were knowledgeable on the topic. The mostly traditional society of Palestinian-Israelis shuns discussions on sexuality; but with these two conditions, the study was a success.

Identity Multiplicity in an Ethnic and Religious Minority in Latvia: Old Believer Youth

The paper explores the relationship between the religious identity and the ethnic and national identities of Old Believer youth in Latvia. This case is of particular interest in providing an in-depth insight into the intersection of ethnicity, nationality and religion, as the Old Believers are an ethnic and religious minority living in Latvia. Applying the concepts of multiple identities, this article explores the role of religion played in the integration of identity among young people belonging to the Old Believer religious community: their self-understanding as a composition of intersecting identities that influence each other; the manifestations of the intersection of various identities; the relationship of identity integration to religion. The analysis is based on the findings of ethnographic research conducted in the Old Believer youth group in Daugavpils (Latvia) within a framework of the international project "Cultural Heritage and Identities of Europe's Future", funded from the European Union's Horizon 2020 Research and Innovation Program under Grant Agreement No. 770464. The author has highlighted that today's rapid changes are leading to identity crisis: an individual faces difficulty in shaping and maintaining a stable identity, since economic life is becoming increasingly unpredictable and communities are becoming fragmented. The identity of Latvian Old Believer youth forms and develops in a local cultural context, and is affected by the social change. The qualitative data collected during the fieldwork provided a useful resource for an analysis of belonging, the crucial factor in the formation of identity for Old Believer youth. As the voices of young people in this study reveal, three types of belonging characterize Old Believer youth: their ethnicity, which interacts with national belonging in a complex way; the local belonging, which is stronger than the global one; the European belonging, which conflicts with national belonging and ethnicity.

A perspective on health inequalities in BAME communities and how to improve access to primary care

This article takes a look at access to healthcare for Black, Asian and minority ethnic (BAME) communities. Past research has shown that patients from ethnic minority backgrounds have faced inequality when accessing healthcare services. This article explores some of these reasons with a focus on primary care, including (but not limited to) language, culture, population diversity and institutional attitudes. The current reality for ethnic minority patients within our healthcare system is one which is substandard. New policies and processes should be created to tackle these issues, with ongoing quality research to further explore and monitor outcomes. With primary care being the front door to healthcare services, it must be geared to meet the needs of the whole population consistently and competently.

Health-related quality of life among survivors in minority area 2 years after Jiuzhaigou earthquake: A cross-sectional study

To investigate the health-related quality of life (HRQoL) and related factors, the symptoms of posttraumatic stress disorder (PTSD) among earthquake survivors in minority area 2 years after Jiuzhaigou earthquake.Two years after the Jiuzhaigou earthquake, a cross-sectional survey was conducted by a multi-stage sampling approach. HRQoL was measured by the short form 12 (SF-12), PTSD was measured by the PTSD Check List-Civilian Version (PCL-C), and social support was measured by the Multidimensional Scale of Perceived Social Support. Descriptive statistics, t-tests, ANOVA and multiple linear regression analysis were used for data analysis.Of the 561 participants, the mean scores on the physical component summary (PCS) and mental component summary (MCS) were 46.36 ± 12.79 and 55.03 ± 8.73, and 5.73% reported the symptoms of PTSD. Lower PCS and MCS after an earthquake were associated with elderly age, physical illness, and low level of social support (P < .05). Meanwhile, PTSD was significantly associated with MCS.These findings showed that physical disease and psychological symptoms can adversely affect the HRQoL of survivors. Moreover, providing higher social support to survivors should be considered as a way to improve the HRQoL outcomes of survivors.

The relationship between ingroup identity and Paranoid ideation among people from African and African Caribbean backgrounds

OBJECTIVES

People from ethnic minority groups experience higher rates of paranoid delusions compared with people from ethnic majority groups. Identifying with social groups has been shown to protect against mental health symptoms; however, no studies have investigated the relationship between social identification and paranoia in ethnic minority populations. Here, we investigated the association between British identification and paranoia in a sample of people from African and African Caribbean backgrounds living in the United Kingdom. We also assessed the role of potential mediating (self-esteem and locus of control) and moderating (contact with White British people) factors.

DESIGN

Cross-sectional quantitative survey design.

METHODS

We recruited 335 people from African and African Caribbean backgrounds who completed online self-report measures of identification with Great Britain, self-esteem, locus of control, positive and negative contact with White British people, and paranoia.

RESULTS

A parallel moderated mediation model indicated that British identification was associated with lower paranoia when participants experienced primarily positive contact with White British people. British identification was associated with higher paranoia when participants had primarily negative contact with White British people. Both effects were mediated by changes in locus of control, but self-esteem was not implicated in either pathway.

CONCLUSIONS

Identification with the majority culture is associated both positively and negatively with paranoid beliefs depending on the types of social interactions people experience. The findings have implications for preventative social prescribing initiatives and for understanding the causes of the high rates of psychosis in ethnic minority populations.

PRACTITIONER POINTS

People from African and African Caribbean backgrounds experience high rates of paranoia, which may stem from social causes such as lack of belonging and negative social experiences. Among people from African backgrounds living in the UK, British identification is associated with lower paranoia when people's social experiences with White British people are positive and higher paranoia when their social experiences with White British people are negative. It is recommended that social interventions designed to reduce paranoia in vulnerable groups foster positive social contact and community belonging, which should enhance feelings of personal control. Understanding the complex interplay between social identity and social contact in the development of paranoia may help therapists and researchers better understand the phenomenology and risk factors of paranoid symptomology.

Language of Administration as a Border: Wild Food Plants Used by Setos and Russians in Pechorsky District of Pskov Oblast, NW Russia

Socio-economic changes impact local ethnobotanical knowledge as much as the ecological ones. During an ethnobotanical field study in 2018-2019, we interviewed 25 Setos and 38 Russians in the Pechorsky District of Pskov Oblast to document changes in wild plant use within the last 70 years according to the current and remembered practices. Of the 71 botanical taxa reported, the most popular were Vaccinium vitis-idaea, Vaccinium oxycoccos, Vaccinium myrtillus, Betula spp., and Rumex acetosa. The obtained data was compared with that of 37 Setos and 35 Estonians interviewed at the same time on the other side of the border. Our data revealed a substantial level of homogeneity within the plants used by three or more people with 30 of 56 plants overlapping across all four groups. However, Seto groups are ethnobotanically closer to the dominant ethnic groups immediately surrounding them than they are to Setos across the border. Further study of minor ethnic groups in a post-Soviet context is needed, paying attention to knowledge transmission patterns.

Perceptions of Violent National-Political Protest among Arabs Living in Israel: A Pilot Study

This pilot study examines the perceptions of Arabs living in Israel (ALI) regarding violent national-political protests (VNPP). ALI, exposed to VNPP by organizations of their own ethnic minority, are trapped in a political and cultural conflict between their state and their nation. Qualitative analysis of semi-structured interviews with 15 Muslim ALI identified four possible groups presenting four types of VNPP perceptions: (a) justifiers, who regard VNPP as a legitimate means of protecting the Palestinians and who profess Palestinian identity; (b) opponents, who strongly condemn VNPP and who profess Israeli identity; (c) those understanding but disagreeing with VNPP, professing a dual Palestinian-Israeli identity; and (d) the ambivalents, representing people with internal conflicts and mixed feelings regarding the Palestinian VNPP and their own identity. The study contributes to the understanding of how a group of ALI perceives the Palestinian VNPP, and implies that this population consists of different groups, each with its own unique identity.

Contribution of pulmonary diseases to COVID-19 mortality in a diverse urban community of New York

We examined the relative contribution of pulmonary diseases (chronic obstructive pulmonary disease, asthma and sleep apnea) to mortality risks associated with Coronavirus Disease (COVID-19) independent of other medical conditions, health risks, and sociodemographic factors. Data were derived from a large US-based case series of patients with COVID-19, captured from a quaternary academic health network covering New York City and Long Island. From March 2 to May 24, 2020, 11,512 patients who were hospitalized were tested for COVID-19, with 4,446 (38.62%) receiving a positive diagnosis for COVID-19. Among those who tested positive, 959 (21.57%) died of COVID-19-related complications at the hospital. Multivariate-adjusted Cox proportional hazards modeling showed mortality risks were strongly associated with greater age (HR = 1.05; 95% CI: 1.04-1.05), ethnic minority (Asians, Non-Hispanic blacks, and Hispanics) (HR = 1.26; 95% CI, 1.10-1.44), low household income (HR = 1.29; 95% CI: 1.11, 1.49), and male sex (HR = 0.85; 95% CI: 0.74, 0.97). Higher mortality risks were also associated with a history of COPD (HR = 1.27; 95% CI: 1.02-1.58), obesity (HR = 1.19; 95% CI: 1.04-1.37), and peripheral artery disease (HR = 1.33; 95% CI: 1.05-1.69). Findings indicate patients with COPD had the highest odds of COVID-19 mortality compared with patients with pre-existing metabolic conditions, such as obesity, diabetes and hypertension. Sociodemographic factors including increased age, male sex, low household income, ethnic minority status were also independently associated with greater mortality risks.

Latinx Sexual Minority Men's Behavioral, Psychosocial, and Medical Experiences during COVID-19: Differences across Immigration Statuses

Latinx sexual minority men (LSMM) are at the intersection of two communities disproportionately impacted by COVID-19. To develop and deploy appropriate resources to support LSMM, it is important to understand the behavioral, psychosocial, and medical experiences of this population during COVID-19, as well as for LSMM of different immigration statuses. The current study uses the Pandemic Stress Index (PSI) to describe LSMM's self-reported behavioral, psychosocial, and medical experiences during COVID-19. Logistic and linear regressions compared experiences during COVID-19 among LSMM across different immigration statuses (recent, established, and US-born as the reference group). LSMM's responses to the PSI indicated they experienced anxiety (64.4%), depression (59.0%), alcohol/substance use (27.6%), as well as loneliness (50.1%) and sleep problems (60.4%). Overall, over half reported personal financial loss, the odds of which were 2.75 times greater among LSMM who were recent immigrants compared to US-born LSMM (OR = 2.75, 95% CI: 1.30, 5.82). Nearly 8% reported being diagnosed with COVID-19, with the odds four and a half times greater among established immigrants compared to US-born LSMM (OR = 4.52, 95% CI: 1.60, 12.81). The findings have implications for tailored support resources and public health interventions to reach LSMM in general and LSMM with immigration histories.

Change in incidence rates for psychosis in different ethnic groups in south London: findings from the Clinical Record Interactive Search-First Episode Psychosis (CRIS-FEP) study

BACKGROUND

A higher incidence of psychotic disorders has been consistently reported among black and other minority ethnic groups, particularly in northern Europe. It is unclear whether these rates have changed over time.

METHODS

We identified all individuals with a first episode psychosis who presented to adult mental health services between 1 May 2010 and 30 April 2012 and who were resident in London boroughs of Lambeth and Southwark. We estimated age-and-gender standardised incidence rates overall and by ethnic group, then compared our findings to those reported in the Aetiology and Ethnicity of Schizophrenia and Other Psychoses (ÆSOP) study that we carried out in the same catchment area around 10 years earlier.

RESULTS

From 9109 clinical records we identified 558 patients with first episode psychosis. Compared with ÆSOP, the overall incidence rates of psychotic disorder in southeast London have increased from 49.4 (95% confidence interval (CI) 43.6-55.3) to 63.1 (95% CI 57.3-69.0) per 100 000 person-years at risk. However, the overall incidence rate ratios (IRR) were reduced in some ethnic groups: for example, IRR (95% CI) for the black Caribbean group reduced from 6.7 (5.4-8.3) to 2.8 (2.1-3.6) and the 'mixed' group from 2.7 (1.8-4.2) to 1.4 (0.9-2.1). In the black African group, there was a negligible difference from 4.1 (3.2-5.3) to 3.5 (2.8-4.5).

CONCLUSIONS

We found that incidence rates of psychosis have increased over time, and the IRR varied by the ethnic group. Future studies are needed to investigate more changes over time and determinants of change.

Measurement Invariance of the Multidimensional Scale of Perceived Social Support Among Chinese and South Asian Ethnic Minority Adolescents in Hong Kong

Seven hundred adolescents (Chinese = 50%; South Asian ethnic minority = 50%) with mean age of 15.3 years (SD = 1.53). Multigroup confirmatory factor analysis was performed to assess measurement invariance of the MSPSS scale across Chinese and South Asian ethnic minority samples. Results show that the original three-factor structure of the MSPSS was supported in both samples. Measurement invariance was supported in terms of configural, metric, and partial scalar invariance. Given partial scalar invariance was achieved, the latent mean differences were compared across samples. Chinese adolescents had higher levels of all three types of social support when compared with their South Asian ethnic minority counterparts. The present study attempts to assess the measurement invariance of the MSPSS across ethnic groups in Asian society, which sheds light on future research that involves perceived social support among adolescents in Chinese culture contexts.

Association Between Social Support and Job Satisfaction Among Mainland Chinese Ethnic Minority Kindergarten Teachers: The Mediation of Self-Efficacy and Work Engagement

Grounded on the social exchange theory (SET), social cognitive theory (SCT), and self-determination theory (SDT), this study aims to explore the mediating role of self-efficacy (SE) and work engagement (WE) on the effect of social support (SS) on job satisfaction (JS) among Chinese ethnic minority kindergarten teachers (KTs). The results show that: (1) SS has a directly significant effect on JS; (2) WE mediates the relationship between SS and JS; and (3) SE mediates the relationship between SS and WE. Although the mediation of SE on the relationship between SS and JS is not found, the posited multiple mediations of SE and WE on the relationship between SS and JS are totally accepted. The results reveal that SS mainland Chinese ethnic minority KTs received can not only have a direct effect on JS but also have an indirect impact through the one-path mediating role of WE and the chain mediating role of SE and WE. The results suggest that governments, supervisors, and sponsors should work together to provide ethnic minority KTs with more prioritized SS from both cultural psychology and financial material and opportunities for facilitating professional knowledge and skills in order to enhance their SE, inspire their WE, and eventually accumulate their JS.

Eating disorders in New Zealand: Implications for Māori and health service delivery

OBJECTIVE

Lifetime prevalence rates in Te Rau Hinengaro (The New Zealand Mental Health Survey) suggest eating disorders are at least as common in the Māori population as the non-Māori population, yet little is known at a population level about those accessing specialist mental health treatment for eating disorders in New Zealand. The aim of this study was to describe the population undergoing specialist mental health treatment for eating disorders and compare Māori and non-Māori clinical characteristics and service use.

METHOD

This study uses the Programme for the Integration of Mental Health Data data set, managed by the New Zealand Ministry of Health to describe the characteristics of people with eating disorders and their use of specialist mental health services from 2009 to 2016.

RESULTS

There were 3,835 individuals with a diagnosed eating disorder who had contact with specialist mental health services in this time period, 7% of whom were Māori. Within the cohort, Māori had a higher prevalence for a bulimia nervosa diagnosis, fewer diagnosed with anorexia nervosa, and a higher prevalence of other psychiatric comorbidity than non-Māori.

DISCUSSION

There is discrepancy between the proportion of service users accessing specialist mental health services who are Māori and the assessed crude prevalence of eating disorders for Māori in national estimates. Once Māori are in specialist services; however, their use of services is comparable to non-Māori. Further research is needed to highlight the experiences of those Māori with eating disorders and address barriers to accessing services for Māori with eating disorders.

Acceptance of outgroup members in schools: Developmental trends and roles of perceived norm of prejudice and teacher support

BACKGROUND

Schools around the world are increasingly diverse in ethnicity. Given the importance of peer acceptance in children's well-being and development, it is a pressing concern for educators to promote intergroup acceptance in schools.

AIMS

First, to examine the developmental trends of acceptance of outgroup members in both the ethnic minority and majority students. Second, to investigate how outgroup acceptance is subject to the interplay between perceived norm of prejudice, a risk factor in the macrosystem, and teacher support, a protective factor in the microsystem.

SAMPLE

The participants were 3,723 students (ethnic majority: 61%; boys: 51.9%; mean age: 13.7) at Grade 2, 5, 8, and 11 from 24 schools in Hong Kong.

METHODS

The students were asked to complete a battery of questionnaires regarding their willingness to accept outgroup members in schools, perceived societal norm of prejudice against ethnic minority group, and teacher support they received in schools.

RESULTS

It was found that ethnic minority students accepted outgroup members more than ethnic majority students accepted them. The difference was primarily driven by the low outgroup acceptance of ethnic majority students in Grades 2 and 5. The results of multi-level analysis revealed that outgroup acceptance was associated negatively with perceived norm of prejudice but positively with teacher support. The negative association between outgroup acceptance and perceived norm of prejudice was attenuated in schools with supportive culture.

CONCLUSIONS

The results point to the need of early intervention and the importance of cultivating school culture with strong social emotional support.

Health literacy as a predictor of emergency department visits and self-rated health among Chinese immigrants: findings from an Australian survey

OBJECTIVES

Our objectives were to examine health literacy among first-generation Chinese immigrants living in Australia, identifying health literacy domains associated with emergency department (ED) visits and self-rated health (SRH).

METHODS

Chinese immigrants (n = 362, mean age = 59) were recruited from communities across New South Wales and surveyed for health literacy, ED visits in the past 12 months, and SRH using the Health Literacy Questionnaire (simplified Chinese version).

RESULTS

More than 70% of participants experienced health literacy difficulties. Health literacy was significantly lower among the following participants: older, migration at older age, recent immigrants, and those without university level education or proficient English. ED visits were independently associated with the health literacy domains lacking 'social support for health' (OR: 1.80; p = .031) and 'ability to appraise health information' (OR: 2.22; p = .005). Poor SRH was associated with the health literacy domains 'insufficient health information' (OR: 1.81; p = .025), 'inactively managing health' (OR: 1.72; p = .048), and 'lacking ability to appraise health information' (OR: 1.70; p = .048).

CONCLUSIONS

Inadequate health literacy was identified in the majority of first-generation Chinese immigrants and it had significantly association with higher prevalence of ED use and poorer SRH.

PRACTICE IMPLICATIONS

Early screening and support for health literacy is critical in Chinese immigrants.

Exploring health services accessibility by indigenous women in Asia and identifying actions to improve it: a scoping review

Objectives: The aim of this scoping review was to uncover and summarize what is known in the literature about the experiences of Indigenous women in Asia regarding access to health services. Design: The study was informed by the scoping review methodology proposed by Arksey and O'Malley [2005. "Scoping Studies: Towards a Methodological Framework." International Journal of Social Research Methodology 8 (1): 19-32. doi:10.1080/1364557032000119616]. A comprehensive search of the databases for peer-reviewed studies and grey literature was conducted between January 2000 and December 2016. The data of selected papers and abstracts were analysed by three independent researchers through a protocol of data charting, descriptive numerical summary, and thematic analysis. Results: Sixteen articles and two abstracts met the inclusion criteria for this scoping review. These 18 peer-reviewed documents consisted of eight qualitative studies, seven quantitative studies, and three mixed-method studies, which included the peer-reviewed poster and oral presentation abstracts from international conferences. The findings were sorted and grouped under the following themes: health care access for Indigenous women in Asia, facilitators to accessing healthcare services, barriers to accessing healthcare services, and cultural contexts impacting health and access. Conclusion: There is limited information about the experiences, facilitators, barriers, and cultural contexts faced by Indigenous women in Asia related to health services accessibility, and even less information related to improving health services accessibility and health outcomes. This scoping review in particular highlights the dearth of literature relating to Indigenous women's postpartum health and access to postnatal supports and services. Generally, it indicates that Indigenous women in Asia are more vulnerable to poor health in comparison to non-Indigenous women, and continue to face challenges and barriers in accessing quality and equitable health services. The barriers identified in this review are useful in explaining why inequities in health and access to health care for Indigenous women living in Asia continue to exist. Recommendations for future research directions are described.

Transferring a Community-Based Participatory Research Project to Promote Physical Activity Among Socially Disadvantaged Women-Experiences From 15 Years of BIG

Introduction: Community-based participatory research (CBPR) is an effective approach to health promotion, especially in relation to socially disadvantaged groups. However, the long-term implementation of CPBR-based projects on a broad scale is often challenging, and research regarding the sustainable transfer of participatory research is lacking. This limits the scaling-up and public health impact of CBPR. Therefore, this study examines the mechanisms utilized to transfer and sustain the BIG project, a multifaceted CBPR project aimed at promoting physical activity among women in difficult life situations.

Materials and Methods: Borrowing from the RE-AIM framework, we analyzed project documentation and conducted a reflection workshop to investigate methods of transferring BIG to new sites as well as strategies from researchers to support project implementation and the maintenance of program activities at those sites. Moreover, we analyzed the reasons for discontinuing program activities at some former BIG sites and the costs involved in transferring BIG.

Results: Since its establishment in 2005, BIG was transferred to and implemented at 17 sites. As of the winter of 2019, the program activities were maintained at eight sites. The average duration of sites that continue to offer program activities was more than 9 years. Discontinued sites maintained project activities for an average of 4 years. According to the study findings, the extent of scientific support, the provision of seed funding, and the local project coordinator, the person managing the project at the site, all have a significant impact on the sustainability of the transfer. A patchwork of funding agencies was needed to finance scientific support and seed funding in BIG. The transfer of BIG projects accrued annual costs of approximately EUR20,000 per site; however, long-term project implementation resulted in a decline in the annual transfer costs of BIG.

Discussion and Conclusion: The sustainable transfer of CBPR is challenging but possible, and increased support of research and seed funding can facilitate long-term transfer. Nevertheless, other factors in the implementation setting are beyond scientific control. With scarce financial resources, researchers need to carefully balance the efforts of the sustainability and transfer of CBPR projects. To address this issue, there is a need for further research into the interrelationship of the sustainability and transfer of CBPR projects as well as increased long-term funding.

Tobacco and Alcohol Use Among Ethnic Minorities in Vietnam

This study investigates the prevalence of tobacco and alcohol uses and associated factors among 12 ethnic minorities in Vietnam in 2019. A cross-sectional survey was conducted among 5172 people aged ≥15 years. The prevalence of smoking and drinking was 19.7% and 29.9%, respectively, and significantly higher among men than women. These numbers were heterogeneous across ethnic minorities. Smoking prevalence was high among Ba Na (25.9%), Cham An Giang (22.3%), Khmer (23.5%), La Hu (26.3%), Ta Oi (30.7%), and Bru Van Kieu (29.6%) ethnicities whereas that of Gie Trieng and Mnong ethnicities was low (3.7% and 9.5%, respectively). Drinking prevalence ranged from 1.4% in Cham An Giang ethnicity to 68.6% in Ba Na ethnicity. A wide ethnic disparity on tobacco and alcohol use could be explained by the ethnic variation of lifestyles, social norms, and cultural features. Our findings suggest the need to develop ethnic-specific interventions to mitigate the smoking and drinking prevalence.

Self-reported non-communicable diseases and associated socio-demographic status among ethnic minority populations in Vietnam, 2019

The aim of this study was to report the prevalence of self-reported non-communicable diseases among ethnic minority populations in Vietnam and related factors. A total of 5033 individuals aged 15 years and older who belonged to ethnic minority populations from 12 provinces in Vietnam completed a household survey. The overall prevalence of self-reported non-communicable diseases was 12.4% (95% CI: 11.5%–13.4%). Cardiovascular diseases were the most prevalent, followed by diabetes. Ethnicity was shown to have an independently significant correlation to having any non-communicable diseases. Older people, near-poor and non-poor people had significantly higher odds of having non-communicable diseases as compared to younger and poor people.

Association of immigration background with kidney graft function in a publicly funded health system: a nationwide retrospective cohort study in Italy

The impact of immigration background on kidney graft function (eGFR) is unknown. Italy has a publicly funded health system with universal coverage. Since immigration from non-European Union (EU) countries beyond Eastern Europe is a recent and extensive phenomenon, Italy is a rather unique setting for studying the effect of immigration status as a socioeconomic and cultural condition. We retrospectively identified all adult deceased donor kidney transplant recipients (KTRs) in Italy (2010-2015) and followed them until death, dialysis or 5-years post-transplantation; 6346 were EU-born, 161 Eastern European-born, and 490 non-European-born. We examined changes in eGFR after 1-year post-transplant using multivariable-adjusted joint longitudinal survival random-intercept Cox regression. Compared to EU-born KTRs, in non-European-born KTRs the adjusted average yearly eGFR decline was -0.96 ml/min/year (95% confidence interval: -1.48 to -0.45; P < 0.001), whereas it was similar in Eastern European-born KTRs [+0.02 ml/min/year (-0.77 to +0.81; P = 0.96)]. Adjusted 5-year transplant survival did not statistically differ between non-European-born, Eastern European-born, and EU-born. In those surviving beyond 1-year, it was 91.8% in EU-born (87.1-96.8), 92.5% in Eastern European-born (86.1-99.4), and 89.3% in non-European-born KTRs (83.0-96.0). This study provides evidence that among EU KTRs, non-European immigration background is associated with eGFR decline.

Depression among ethnic minority elderly in the Central Highlands, Vietnam

This cross-sectional study is to examine the prevalence of depression and associated factors among 110 ethnic minority elderly in Kon Tum city, Vietnam. Depression was assessed using 30-items Geriatric Depression Scale. Multivariate linear regression analysis was employed to identify factors associated with depression. The prevalence of depression among participants was 25.5%. All were classified as mild depression level. Depression was significantly associated with age, gender, educational level, chronic diseases, stressful life events in the past 12 months, and family history of depression. These risk factors can help formulate effective public health programs to improve mental health among ethnic minority elderly.

Exploring parent-child agreement on reports of exposure to community violence: Utilizing a latent profile approach

Exposure to community violence (ECV) has a number of implications for children including poor mental health functioning, impaired cognition, memory, learning, and school performance (Edlynn et al, 2008 Am. J. Orthopsychiat., 78, 249-258; Gardner et al., 1996, J. Consult. Clin. Psychol., 64, 602-609). Discrepancies in child and parent reports of the child's ECV may exacerbate these adverse effects (Hill & Jones, 1997 J. Natl Med. Assoc., 89, 270-276). This study aimed to categorize dyads based on the agreement in reports of ECV. Furthermore, this study aimed to identify ethnic differences within these groups in addition to mental health issues. Four profiles, based on average exposure to violence, emerged: Low exposure (LE), moderate exposure, high exposure, and severe exposure. Ethnic differences among these profiles indicate ethnic minorities are less likely to belong to the LE profile and more likely to represent the other profiles. There were differences among profiles based on mental health functioning.

Integrating Culturally Competent Advance Care Planning for Korean Immigrants: An Integrative Review

AIMS

This review aims to explore the extant literature on the current utilization of ACP in Kisin order to obtain a comprehensive understanding of their health disparities and to determineevidence-based best practices to integrate culturally-competent ACP for EOL care of KIs.

DESIGN

A systematic integrative review of the literature Data Sources:  Four electronic databases including PubMed, the Cumulative Index of Nursing and Allied Health Literature, the Cochrane Library, and Embase.

METHOD

The detailed search strategy for databases implicated a combination of MeSHkeywords and associated terms, which can be found in Table A.Results: Three themes emerged in relation to fundamental components in the integration of culturally-competent ACP for EOL of KIs: (1) cultural characteristics of KIs; (2) disparities in ethnic-oriented ACP and EOL care resources in KIs; and (3) KIs' perspectives on ACP.

CONCLUSION

The findings of this review indicate that culturally-competent ACP resources for KIsare presently quite insufficient. It is determined that much future research is needed on howculturally-competent ACP can best augment the quality of EOL care for KIs, and on howspecific interventions can effectively implement ACP in community settings. Impact: Such ongoing research dedicated to the development of feasible culturally competent practice guidelines is anticipated to markedly reduce health disparities and promote ACP in KIs. The recommendations in this review may support Korean primary HCPs, Korean health care center administrators, Korean health maintenance organizations (HMOs), Korean advance care nurse practitioners in hospice and palliative care, and nurse researchers in their work.

Social prevalence of knowledge about ectopic pregnancy - tip of the 'health inequalities' iceberg?

We aimed to assess the social and demographic factors determining the level of awareness of the signs and symptoms of ectopic pregnancy (EP) in an East London female population and determine if awareness was related to adverse outcomes. This was a prospective, observational study using a structured questionnaire to assess awareness of EP. A retrospective analysis of a database of EP patients was used to assess the association between adverse clinical outcomes and knowledge about EP. A younger age (<20 years) (p = .024), higher education (p = .008), higher income (p = .002), professional (p = .008), white ethnicity (p= <.00001), single (p = .037) and an awareness of the media (p = .030) were statistically significantly related to a higher knowledge. A significant difference was seen between the white and all other ethnicities in the amount of blood loss (p = .033). The relative risks (RRs 1.169) of having >500 ml of blood loss were higher in the ethnic minorities. RR of >500 ml of blood loss if Asian compared to white is 1.1034 and if black compared to white is 1.1201. Blacks are more likely than whites and Asians to have blood loss >1000 ml (p = .019). An ethnic minority, a lower education level, the older age groups, those with a lower income and with non-professional careers are linked to a lower level of knowledge about EP. Ethnic minority communities have a higher risk of adverse clinical outcomes.Impact StatementWhat is already known on this subject? Research has identified demographic and social factors which prove that victims of health inequalities are usually the poor and the marginalised.What the results of this study add? To-date, our study is the only one to establish that the level of knowledge about ectopic pregnancy (EP) is influenced by demographic and socioeconomic factors and that lower levels of knowledge are significantly associated with adverse clinical outcomes. Our findings show that ethnic minority women are more likely to suffer morbidity from EP than their Caucasian counterparts. We have also established that women of poorer backgrounds, women with lesser levels of education and in non-professional jobs are least likely to be aware of signs and symptoms and consequences of EP.What the implications are of these findings for clinical practice and/or further research? The health service has a responsibility to identify these populations and target them for interventions to correct these health inequalities. We propose a multifaceted plan to increase the level of knowledge of these identified sections of the local community.

Interventions to promote access to eye care for non-Indigenous, non-dominant ethnic groups in high-income countries: a scoping review protocol

INTRODUCTION

For many people, settling in a new country is associated with a new identity as an 'ethnic minority', one that can remain through future generations. People who are culturally distinct from the dominant population group may experience a variety of barriers to accessing healthcare, including linguistic and cultural barriers in communication, navigation of an unfamiliar health system and unconscious or overt discrimination. Here, we outline the protocol of a scoping review to identify, describe and summarise interventions aimed at improving access to eye care for non-Indigenous, non-dominant ethnic groups residing in high-income countries.

METHODS AND ANALYSIS

We will search MEDLINE, Embase and Global Health from their inception to July 2019. We will include studies of any design that describe an intervention to promote access to eye care for non-Indigenous, non-dominant ethnic groups. Two authors will independently review titles, abstracts and full-text articles for inclusion. Reference lists from all included articles will also be searched. In cases of disagreement between initial reviewers, a third author will help resolve the conflict. For each included article, we will extract data about the target population, details of the intervention delivered and the effectiveness of or feedback from the intervention. Overall findings will be summarised with descriptive statistics and thematic analysis.

ETHICS AND DISSEMINATION

This review will summarise existing literature and as such ethics approval is not required. We will publish the review in an open-access, peer-reviewed journal, and draft appropriate summaries for dissemination to the wider community. This wider community could include clinicians, policymakers, health service managers and organisations that work with non-dominant ethnic groups. Our findings will also feed into the ongoing Lancet Global Health Commission on Global Eye Health.

Prevalence and Correlates of Sexting Behaviors in a Provincially Representative Sample of Adolescents

OBJECTIVES

To examine the prevalence and correlates of sending and receiving sexts (i.e., sexually explicit images) in a provincially representative sample of adolescents in Canada.

METHODS

Data from the 2014 Ontario Child Health Study, a provincial survey of households with children in Ontario, which includes a sample of 2,537 adolescents aged 14 to 17 years (mean age = 15.42, male = 51.6%) were used to address the research objectives.

RESULTS

The past 12 months prevalence of sending and receiving sexts was 14.4% and 27.0%, respectively. In unadjusted logistic regression analyses, non-White adolescents and those living in low-income households were less likely to send or receive sexts compared to White and non-low-income adolescents. Adolescents who disclosed their sexual and/or gender minority identities were 3 to 4 times more likely to send and receive sexts than youth who had not disclosed these identities. Higher levels of mental health problems generally observed among adolescents who sent or received sexts. In fully adjusted models, low income and ethnic minority status were associated with reduced odds of sending and receiving sexts, while sexual and/or gender minority disclosure status was associated with increased odds. Social anxiety was associated with reduced odds of sending and receiving sexts, while conduct disorder was associated with elevated odds.

CONCLUSION

The prevalence of sexting behavior was higher among adolescents who disclosed their sexual or gender minority identities. Sexting behaviors were associated with higher levels of mental health problems. Identifying vulnerable populations and the potential mental health ramifications associated with sexting behavior is vital to mitigating negative sequelae.

Sense of Filial Obligation and Caregiving Burdens Among Chinese Immigrants in the United States

BACKGROUND/OBJECTIVES

Focusing on Chinese immigrants, this study examined (1) whether filial obligation, the core social norm in the Chinese culture, is related to caregiving burdens; and (2) whether level of acculturation of the caregivers moderates the above relationships.

DESIGN

Cross-sectional.

SETTING

Chicago, Illinois.

PARTICIPANTS

A purposive sample of 393 Chinese adult immigrants who were primary caregivers of parents aged 60 years or older.

MEASURES

Sense of filial obligation was captured by felt responsibility toward parents in six domains (respect, make happy, care, greet, obey, and provide financial support). Caregiving burdens were measured by the Caregiver Burden Inventory. Acculturation was measured by 12 questions about respondents' language preference in different settings and ethnicity of individuals they interact with.

RESULTS

A stronger sense of filial obligation was significantly associated with lower levels of developmental (β = -.15), emotional (β = -.18), social (β = -.20), and physical (β = -.10) burdens. For subjective burdens (developmental, social burdens), such a protective effect of filial obligation was stronger among caregivers with lower acculturation levels. For more objective burdens (time-dependent, physical burdens), stronger filial obligation was actually associated with greater burdens among caregivers with higher acculturation levels.

CONCLUSION

Programs focusing on celebrating the cultural heritage of immigrants and improving the relationship between the parents and children may be helpful to reduce caregiving burdens. Intervention programs that help Chinese immigrant caregivers to find the most appropriate way to balance traditional and new social norms are important to provide successful care to aging Chinese immigrants. J Am Geriatr Soc 67:S564-S570, 2019.

Effectiveness of Culturally Tailored Interventions for Chronic Illnesses among Ethnic Minorities

Culturally tailored interventions have been applied to provide benefits to ethnic minorities' care; however, the effectiveness of these interventions for chronic conditions is mixed. This systematic review of systematic reviews critically evaluates recent evidence of the effects that culturally tailored interventions have on health care outcomes among ethnic minorities with chronic conditions. It synthesizes results of eight English-language systematic reviews published between 2010 and 2018 and identifies four health care outcomes common to the reviews: disease knowledge, objective clinical outcomes, satisfaction, and access. Our findings suggest that culturally tailored interventions can contribute to the improvement of ethnic minorities' health care outcomes and especially improve patients' satisfaction with care. However, results overall are mixed. Further studies to better understand the value of culturally tailored interventions for ethnic minorities' care are needed.

Ethnic Bullying Victimization in Italy: The Role of Acculturation Orientation for Ethnic Minority Adolescents With Differing Citizenship Statuses

This study examines the role of acculturation orientation toward home and host countries in ethnic bullying victimization, by considering citizenship status and taking into account social withdrawal. Within a larger school project with middle and high school students, we analyzed data on 252 adolescents from immigrant backgrounds: 71 born abroad without Italian citizenship (Males = 71.4%; mean age = 13.98, SD = 1.7); 96 born in Italy to immigrant parents and without Italian citizenship (Males = 58.3%; mean age = 13.26, SD = 1.6); and 85 Italian citizens born in Italy with an immigrant parent (Males = 54.7%; mean age = 13.12, SD = 1.5). At the univariate level we found that the group of adolescents born abroad with foreign parents showed significantly higher levels of ethnic victimization compared to the group of adolescents born in Italy with an Italian parent. The latter also reported a significantly higher mean in Acculturation Orientation toward their Host Country (i.e., Italy) compared to the other two groups. Looking at the processes working within each group, we found differences in the patterns of association between acculturation orientation and ethnic bullying victimization. Specifically, we found a significant and positive association between acculturation orientation toward the home country and ethnic victimization in the two groups of adolescents born in Italy, while acculturation orientation toward the host country seems to be a protective factor only for adolescents with Italian citizenship. Acculturation orientation does not play any role in ethnic victimization for the first generation of immigrants, while for this group we found a stronger positive effect of Social Withdrawal. Citizenship status appears to be a good indicator of belonging to an ethnic minority group with a background of immigration: it seems to catch specific processes in ethnic bullying victimization.

Epidemiology characteristics of ethnic minority colorectal cancer in Yunnan in Southwestern China

BACKGROUND

Colorectal cancer (CRC) is one of the world's deadliest cancers, and its mortality rate has been on the rise in China. Yunnan is a region with a higher concentration of ethnic minorities. CRC affects many people from ethnic minority groups, which differ from Han in terms of their age and gender compositions.

METHODS

We collected samples from 1,016 cases of CRC patients along with their case files at Yunnan Provincial Cancer Hospital from the period between January 2013 and December 2018.

RESULTS

In total, 7.1% (n=72) of all lung cancer cases diagnosed from 2013 to 2018 in Yunnan Provincial Cancer Hospital occurred in patients 40 years old or younger, 44% (n=447) were 40 to 60 years old, and 48.9% (n=497) were 60 years old or above. The composition ratio of CRC patients in the different age groups differed significantly and enhanced significantly with age, with a statistical significance of P<0.05. A total of 33.6% (n=38) of 113 minority patients and 16.8% (n=152) of 903 Han patients reported a history of smoking, and 23.0% (n=26) of 113 minority patients and 14.6% (n=132) of Han patients had a history of drinking. Long-term smoking and drinking are significantly associated with the incidence of CRC, and this was more significant among ethnic minorities (P<0.05).

CONCLUSIONS

The high incidence of CRC in Yunnan is strongly related to patients' lifestyles, and diet should be a core focus of efforts to prevent and treat CRC. Early screening and regular check for common tumor markers can also help to reduce the incidence of CRC and provide a basis for improvements in CRC treatment and prognosis in Yunnan.

The Use of Dietary Supplements Among African and Caribbean Women Living in the UK: A Cross-Sectional Study

Previous studies have shown that the use of dietary supplements is associated with the prevention of birth defects, negative pregnancy outcomes and cardiovascular diseases. However, there might be some ethnic disparities in supplement usage suggesting that women who could benefit from it are not frequent users. This study aimed to characterise the use of dietary supplement among Black African and Black Caribbean women living in the United Kingdom (UK). Furthermore, it evaluated possible associations between the use of dietary supplements and health and diet awareness. A total of 262 women self-ascribed as Black African and Black Caribbean living in the UK completed a comprehensive questionnaire on socio-demographic factors, diet, use of supplements and cultural factors. The main outcome variable was the regular use of any type of dietary supplement. Use of vitamin D and/or calcium was also explored. A stepwise logistic regression analysis was applied to identify predictors of regular use of dietary supplements. A total of 33.2% of women reported regular use of any dietary supplements and 16.8% reported use of vitamin D and/or calcium. There were no significant ethnic differences in the use of dietary supplements. Reporting use of the back of food packaging label (odds ratio (OR) 2.21; 95% CI 1.07–4.55); a self-rated healthy diet (OR 2.86; 95% CI 1.19–6.91) and having cardiovascular disease (CVD), hypertension and/or high cholesterol (OR 3.81; 95% CI 1.53–9.49) increased the likelihood of using any dietary supplement. However, having poorer awareness decreased the likelihood (OR 0.94; 95% CI 0.88–0.99) of using any dietary supplement. For the use of vitamin D and/or calcium supplements, the main predictor was having CVD, hypertension and/or high cholesterol (OR 4.43; 95% CI 1.90–10.35). The prevalence of dietary supplement use was low among African and Caribbean women. Thus, awareness of potential benefits of some dietary supplements (e.g., vitamin D) among the Black population should be promoted.

Challenges of healthcare professionals in providing care to South Asian ethnic minority patients in Hong Kong: A qualitative study

Ethnic minorities across the globe encounter disparities in healthcare. While a great deal of research has been conducted on the experiences of these patients, studies focusing on the perspectives of healthcare professionals are limited, particularly in the context of Asia. This study explores the perceptions of and challenges faced by Hong Kong healthcare professionals in the provision of culturally appropriate care to South Asian ethnic minority patients. Taking a qualitative approach, interviews were conducted with 22 healthcare professionals. Two main themes were identified: 'lack of support' at the healthcare system level and 'dysfunctional relationship with South Asian ethnic minority patients' at the interpersonal level. Challenges at the healthcare system level include information outreach, cultural competency, utilisation of available resources and time and workload, whereas challenges at the interpersonal level include patient-provider interaction, patient-provider perceptions of illness and care and patient-provider sociocultural discordance. Intercultural care was found to be influenced by both the healthcare system and interpersonal characteristics. The study highlights the need for healthcare professional education and training in cultural competency, in order to improve the provision of intercultural care. Identifying the challenges faced by healthcare professionals and the implications of these challenges for the provision of healthcare to South Asian ethnic minority patients will help practitioners, policy makers and care provider agencies to improve quality of care and health outcomes for culturally diverse patients.

School-Based Sedentary Behavior, Physical Activity, and Health-Related Outcomes among Hispanic Children in the United States: A Cross-Sectional Study

The main purpose of this study was to examine the relationships between school-based sedentary behavior, physical activity, and health-related outcomes, including cardiorespiratory fitness, weight status, and health-related quality of life (HRQOL) among Hispanic children. The participants were 374 children (192 boys, 182 girls; M_age = 9.64) recruited from four elementary schools from 3rd grade through to 5th grade. Sedentary behavior and physical activity behaviors (light physical activity [LPA] and moderate-to-vigorous physical activity (MVPA)) during school were measured by accelerometers. Cardiorespiratory fitness and weight status were measured using the FITNESSGRAM^®, while HRQOL was measured using the PedsQL 4.0^TM Spanish version, a validated questionnaire. Sedentary behavior was negatively correlated with cardiorespiratory fitness and HRQOL but positively associated with weight status. MVPA was positively correlated with cardiorespiratory fitness and HRQOL, but negatively associated with weight status and sedentary behavior. Multiple regressions demonstrated that sedentary behavior significantly predicted cardiorespiratory fitness and weight status, whereas MVPA significantly predicted HRQOL. With the current public health priority aiming to reduce health disparities in minority populations, the findings of this study provide important insights. Educators, health care providers, or other professionals working with Hispanic children are encouraged to focus on reducing sedentary behavior and promoting physical activity to improve their health-related outcomes.

Gene-environment Interaction on the Risk of Type 2 Diabetes Among Ethnic Minority Populations Living in Europe and North America: A Systematic Review

BACKGROUND

The body of evidence on gene-environment interaction (GEI) related to type 2 diabetes (T2D) has grown in the recent years. However, most studies on GEI have sought to explain variation within individuals of European ancestry and results among ethnic minority groups are inconclusive.

OBJECTIVE

To investigate any interaction between a gene and an environmental factor in relation to T2D among ethnic minority groups living in Europe and North America.

METHODS

We systematically searched Medline and EMBASE databases for the published literature in English up to 25th March 2019. The screening, data extraction and quality assessment were performed by reviewers independently.

RESULTS

1068 studies identified through our search, of which nine cohorts of six studies evaluating several different GEIs were included. The mean follow-up time in the included studies ranged from 5 to 25.7 years. Most studies were relatively small scale and few provided replication data. All studies included in the review included ethnic minorities from North America (Native-Americans, African- Americans, and Aboriginal Canadian), none of the studies in Europe assessed GEI in relation to T2D incident in ethnic minorities. The only significant GEI among ethnic minorities was HNF1A rs137853240 and smoking on T2D incident among Native-Canadians (Pinteraction = 0.006).

CONCLUSION

There is a need for more studies on GEI among ethnicities, broadening the spectrum of ethnic minority groups being investigated, performing more discovery using genome-wide approaches, larger sample sizes for these studies by collaborating efforts such as the InterConnect approach, and developing a more standardized method of reporting GEI studies are discussed.

Efficacy of compulsory community treatment and use in minority ethnic populations: A statewide cohort study

BACKGROUND

There is conflicting and equivocal evidence for the efficacy of compulsory community treatment within Australia and overseas, but no study from Queensland. In addition, although people from Indigenous or culturally and linguistically diverse backgrounds are over-represented in compulsory admissions to hospital, little is known about whether this also applies to compulsory community treatment.

AIMS

We initially investigated whether people from Indigenous or culturally and linguistically diverse backgrounds in terms of country of birth, or preferred language, were more likely to be on compulsory community treatment using statewide databases from Queensland. We then assessed the impact of compulsory community treatment on health service use over the following 12 months. Compulsory community treatment included both community treatment orders and forensic orders.

METHODS

Cases and controls from administrative health data were matched on age, sex, diagnosis and time of hospital discharge (the index date). Multivariate analyses were used to examine potential predictors of compulsory community treatment, as well as impact on bed-days, time to readmission or contacts with public mental health services in the subsequent year.

RESULTS

We identified 7432 cases and controls from January 2013 to February 2017 (total n = 14,864). Compulsory community treatment was more likely in Indigenous Queenslanders (adjusted odds ratio = 1.45; 95% confidence interval = [1.28, 1.65]) subjects coming from a culturally and linguistically diverse background (adjusted odds ratio = 1.54; 95% confidence interval = [1.37, 1.72]), or those who had a preferred language other than English (adjusted odds ratio = 1.66; 95% confidence interval = [1.30, 2.11]). While community contacts were significantly greater in patients on compulsory community treatment, there was no difference in bed-days while time to readmission was shorter. Restricting the analyses to just community treatment orders did not alter these results.

CONCLUSION

In common with other coercive treatments, Indigenous Australians and people from culturally and linguistically diverse backgrounds are more likely to be placed on compulsory community treatment. The evidence for effectiveness remains inconclusive.

Health system strengthening in post-conflict ethnic regions of Northeastern Myanmar: a qualitative study

Civil wars, political conflicts, ethnic issues and stagnant social development have resulted in fragile health systems in Northeastern Myanmar. The healthcare provision continues to be fragile and inefficient, with prevalent health inequity. Limited service point, poor financial protection mechanism and gender-based inequity restrain the population's access to healthcare services, not to mention local authority's lacking participation in the making, implementation and evaluation of health policies. The issuance of the National Health Plan (NHP) 2017-2021 brought huge potential for the ethnic health organizations to strengthen the health system in ethnic regions. The present study aims to audit the local health systems and their performance in Northeastern Myanmar ethnic region through qualitative data collected by 26 semi-structured interviews and seven focus group discussions with key informants including health officials, policymakers, international donors, ethnic authority/government officials, local clinic managers/staff and health workers, non-governmental organizations, private outlets, etc. The findings indicated that challenges exist within each pillar of the health system. To achieve universal health coverage in the ethnic regions, health system alignment and decentralization is needed. Health system strengthening could serve as both an urgent need and also a way of peace building.

Experience of Culturally-Tailored Diabetes Interventions for Ethnic Minorities: A Qualitative Systematic Review

This qualitative systematic review synthesizes recent qualitative studies of culturally tailored interventions to better understand the experiences that individuals who are members of ethnic minorities have when undergoing type 2 diabetes treatment in the United States. Such interventions have been shown to be effective among ethnic minority populations; however, no qualitative synthesis has reported on recent findings from studies of these interventions. This systematic review identified seven relevant qualitative studies from five electronic databases-CINAHL, PsycINFO, PubMed, Ovid, and Web of Science-published from 2009 to 2019, and used a thematic synthesis review methodology. Methodological rigor was assessed for an appraisal of study quality. Five themes were identified as experiences of culturally tailored diabetes interventions: culturally appropriate healthy lifestyle behaviors, knowledge about diabetes care, emotional supports, access to the healthcare system, and family involvement. The findings of this review can be utilized as resources for improving diabetes care for ethnic minorities.

Measuring Acculturation of Pakistani Women: A Psychometric Evaluation of Urdu Version of the Short Acculturation Scale

OBJECTIVES

The purpose of the study was to translate and validate the psychometric properties of the Short Acculturation Scale-Urdu version (SAS-U) for Pakistani women in Hong Kong.

METHODS

This is a methodological study, and a convenience sample of 263 Pakistani women was recruited to participate in the study. The SAS was translated from English to Urdu using forward and backward translation and reviewed by an expert panel for semantic equivalence and content validity. Face validity was done by five bilingual Pakistani women. Construct validity was established by confirmatory factor analysis (CFA). Convergent validity was examined by the bivariate correlation of proxy indicators such as language preference, with the overall and subscales of SAS-U. Reliability was established by internal consistency and test-retest reliability. IBM SPSS Statistics for Windows version 22.0 and LISREL version 8.80 were used for data analysis.

RESULTS

The translated SAS-U had good content validity and face validity. CFA revealed that the second-order model with three first-order factors and the results was supported by the following indices: root mean square error of approximation = 0.055, standardized root mean square residual = 0.031, χ2/df = 1.80, nonnormed fit index = 0.99, and comparative goodness-of-fit index = 1.00. Language preference correlated significantly with the overall and subscales of SAS-U (r > 0.6, P < 0.01). SAS-U demonstrated high internal consistency (Cronbach's alpha = 0.96) and acceptable test-retest reliability (weighted kappa = 0.68-0.93).

CONCLUSIONS

The results provide support for the psychometric properties of the SAS-U - it is a reliable and valid instrument for measuring levels of acculturation among Pakistani women in Hong Kong.

A Mixed-Method Study Examining Cancer Screening Uptake among South Asian Ethnic Minorities in Hong Kong

Objective:

Utilization of cancer screening is an effective means of cancer prevention. However, South Asian ethnic minorities in Western countries are reported to face barriers in cancer screening utilization, resulting in a low screening uptake by these individuals. The purpose of this mixed-method study is to assess the uptake rate of cancer screening among South Asian ethnic minorities in the Chinese Society of Hong Kong and to examine the factors affecting their participation in cancer screening.

Methods:

This study utilized a sequential mixed-method design, involving two phases. Following the implementation of a self-report survey among South Asian participants via an author-developed questionnaire with 1547 participants in Phase 1, a focus group interview was conducted with 34 participants in Phase 2 to assess the barriers to screening utilization. Convenience sampling was adopted to recruit participants at South Asian community centers in Phase 1, whereas purposive sampling was used for recruiting participants in Phase 2.

Results:

The findings revealed a low (<40%) uptake rate of cancer screening among the participants. Health illiteracy, language barrier, limited access to health information and screening services, and cultural issues were the major barriers to their cancer screening utilization.

Conclusions:

Our findings provided valuable information for both policymakers and health professionals to better understand the needs of ethnic minorities in Hong Kong. As cancer death rates can be lowered by early detection and primary preventive measures, health professionals should focus on the development of culture-specific interventions. Similarly, training the community health workers can strengthen the primary care system in enhancing knowledge on cancer, its prevention, and access to cancer screening services among local ethnic minorities.

What factors hinder ethnic minority women in rural China from getting antenatal care? A retrospective data analysis

BACKGROUND

Mother-to-child transmission (MTCT) is one of the main transmission routes of HIV, and the probability of MTCT can be dramatically reduced with comprehensive interventions. In southwest and western regions in China, the level of development in rural areas is relatively backwards and retains some original features, which also increases the difficulty of controlling infectious diseases. The Liangshan Prefecture started the prevention of MTCT programme in 2009. However, the implementation of the programme is not ideal, and the coverage of HIV testing is still low. Many Yi (local major ethnicity) women did not take antenatal care (ANC) and just gave birth to their babies at home for a variety of reasons.

METHODS

Women with pregnancy history in the last 5 years were recruited from two townships based on cluster sampling. Face-to-face interviews were conducted to collect data. Descriptive analysis was performed to describe demographic characteristics, history of pregnancy and ANC uptake, knowledge of and attitudes towards ANC. Multivariable analysis was used to identify factors associated with uptake of ANC.

RESULTS

Among 538 women who completed the questionnaires, 77.9% knew that ANC was necessary during and after pregnancy. However, only 24.2% actually accessed ANC. Almost all women (94.6%) expressed their willingness to receive ANC for pregnancy but barriers towards actual uptake of ANC existed including shyness, lack of independence and unavoidable cost. Multivariate analysis showed that no experience of living outside of Zhaojue for more than 6 months, higher number of births, not knowing the necessity of ANC during pregnancy and not knowing the government's promotion policies for ANC were associated with lack of ANC uptake.

CONCLUSION

Although ethnic minority women in rural Liangshan expressed strong intention to use ANC, actual uptake of ANC was low. Knowledge of ANC and HIV prevention for MTCT should be improved among this population, and efforts should be made to help them overcome barriers to accessing ANC.

Trends and Racial Disparities of Palliative Care Use among Hospitalized Patients with ESKD on Dialysis

BACKGROUND

Study findings show that although palliative care decreases symptom burden, it is still underused in patients with ESKD. Little is known about disparity in use of palliative care services in such patients in the inpatient setting.

METHODS

To investigate the use of palliative care consultation in patients with ESKD in the inpatient setting, we conducted a retrospective cohort study using the National Inpatient Sample from 2006 to 2014 to identify admitted patients with ESKD requiring maintenance dialysis. We compared palliative care use among minority groups (black, Hispanic, and Asian) and white patients, adjusting for patient and hospital variables.

RESULTS

We identified 5,230,865 hospitalizations of such patients from 2006 through 2014, of which 76,659 (1.5%) involved palliative care. The palliative care referral rate increased significantly, from 0.24% in 2006 to 2.70% in 2014 (P<0.01). Black and Hispanic patients were significantly less likely than white patients to receive palliative care services (adjusted odds ratio [aOR], 0.72; 95% confidence interval [95% CI], 0.61 to 0.84, P<0.01 for blacks and aOR, 0.46; 95% CI, 0.30 to 0.68, P<0.01 for Hispanics). These disparities spanned across all hospital subtypes, including those with higher proportions of minorities. Minority patients with lower socioeconomic status (lower level of income and nonprivate health insurance) were also less likely to receive palliative care.

CONCLUSIONS

Despite a clear increase during the study period in provision of palliative care for inpatients with ESKD, significant racial disparities occurred and persisted across all hospital subtypes. Further investigation into causes of racial and ethnic disparities is necessary to improve access to palliative care services for the vulnerable ESKD population.

Changes in cardiovascular health and physical fitness in ethnic youth with intellectual disabilities participating in a park-based afterschool programme for two years

BACKGROUND

Youth with intellectual disabilities are more likely to be an unhealthy weight and less physically active than youth without intellectual disability.

OBJECTIVE

The effects of Fit2Play, a park-based afterschool programme on cardiovascular/fitness health outcomes among youth with intellectual disability, were prospectively assessed.

METHODS

Youth ages 6 to 22 with intellectual disability who participated in Fit2Play for either one or two school years between 2010 and 2016 (N = 297, mean age 14.1 years, 70% Hispanic, 20% non-Hispanic black, 72% male) were examined via a fitness battery at the beginning/end of the school year(s). Effects of length of Fit2Play participation on body mass index (BMI) %ile, skinfold thicknesses, systolic/diastolic blood pressure (SBP/DBP) %iles, fitness tests, and health and wellness knowledge) were evaluated via two-level repeated measures analysis adjusted for child gender, age, ethnicity and area-level poverty.

RESULTS

Adjusted models showed that up to two years of Fit2Play participation was significantly associated with improved BMI %ile, skinfold thicknesses, SPB/DBP %iles and PACER scores (p < 0.05 for all). One and two years of programme participation was associated with a 6% [95% CI: 0.92, 0.96] and 10% [95% CI: 0.87, 0.93] reduction in SBP%ile, respectively (p < 0.001), and a 36% [95% CI: 1.28, 1.45] and 57% [95% CI: 1.44, 1.70] increase in PACER score laps, respectively, compared to baseline.

CONCLUSIONS

Results here suggest that park-based, structured afterschool programmes with a focus on health and wellness can be a rich resource for this nation by offering both exclusive and immersion programmes for children with intellectual disability to foster cardiovascular health in all youth.

Depression in carers of people with dementia from a minority ethnic background: Systematic review and meta-analysis of randomised controlled trials of psychosocial interventions

OBJECTIVES

Systematic review and meta-analysis to determine the effectiveness of interventions in reducing depressive symptoms in ethnic minority carers of people with dementia.

METHODS

We systematically searched EMBASE, CINAHL, MEDLINE, PsycINFO, PsycARTICLES, Applied Social Sciences Index and Abstracts (ASSIA), The Cochrane Central Register of Controlled Trials (CENTRAL), and Sociological Abstracts and Social Policy and Practices databases from 1990 to 2015, supplemented by a grey literature search, hand searches of bibliographies, and contacting authors. Study quality was assessed independently by two researchers using The Effective Public Health Practice Project Quality Assessment Tool, with an inter-rater reliability of Cohen's kappa of 0.72 (95% CI, 0.42-1.01). Narrative synthesis and meta-analysis were used to assess intervention effectiveness. Meta-regression was used to assess whether factors such as intervention type, peer support, and ethnicity accounted for hetereogeneity.

RESULTS

Thirteen studies were eligible for inclusion, with 1076 participants in control groups and 980 participants in intervention groups; 12 studies provided estimates for meta-analysis. All studies were from the United States. Interventions were associated with an overall mean reduction in depression in caregivers (SMD -0.17 (95% CI, -0.29 to -0.05; P = 0.005). Meta-regression did not indicate any potential sources of heterogeneity, although narrative synthesis suggested that interventions developed with the target ethnic minority group's preferred mode of engagement in mind alongside cultural adaptations may have enhanced effectiveness.

CONCLUSIONS

Psychosocial interventions for depression in ethnic minority carers of people with dementia are effective and could be enhanced through cultural adaptations. High-quality studies targeting minority ethnic groups outside of the United States are needed.