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Aidoo-Frimpong G, Turner D, Collins RL, Ajiboye W, Agbemenu K, Nelson LE. WhatsApp-propriate? Exploring "WhatsApp" as a Tool for Research Among Ghanaian Immigrants in the United States. J Racial Ethn Health Disparities 2024; 11:1956-1963. [PMID: 37285049 PMCID: PMC10246539 DOI: 10.1007/s40615-023-01664-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/19/2023] [Accepted: 05/24/2023] [Indexed: 06/08/2023]
Abstract
African immigrants remain underrepresented in research due to challenges in recruitment. Mobile instant messaging applications, such as WhatsApp, present novel, and cost-effective opportunities for conducting health research across geographic and temporal distances, potentially mitigating the challenges of maintaining contact and engagement in research with migrant populations. Moreover, WhatsApp has been found to be commonly used by African immigrant communities. However, little is known about the acceptability and use of WhatsApp as a tool for health research among African immigrants in the US. In this study, we examine the acceptability and feasibility of WhatsApp as a tool for research among Ghanaian immigrants- a subset of the African immigrant population group. We used WhatsApp to recruit 40 participants for a qualitative interview about their use of the mobile messaging application. Three distinct themes related to the acceptability and feasibility of WhatsApp emerged from the interviews: (1) preference for using WhatsApp as a medium of communication; (2) positive perception of WhatsApp; and (3) preference for using WhatsApp for research. The findings indicate that for African immigrants in the US, WhatsApp is a preferred method for recruiting and collecting data. It remains a promising strategy to utilize in future research involving this population.
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Affiliation(s)
- Gloria Aidoo-Frimpong
- Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, New Haven, CT, USA.
| | - DeAnne Turner
- College of Nursing, University of South Florida, Tampa, FL, USA
| | - R Lorraine Collins
- School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Wale Ajiboye
- MAP Center for Urban Health Solution, Unity Health Toronto - St Michael's Hospital, Ontario, Canada
| | - Kafuli Agbemenu
- School of Nursing, University at Buffalo, State University of New York, Buffalo, NY, USA
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Chen T, Borondy-Jenkins F, Zovich B, Block SJ, Moraras K, Chan A, Cohen C. Existing knowledge, myths, and perceptions about hepatitis B and liver cancer within highly impacted immigrant communities. J Virus Erad 2024; 10:100379. [PMID: 38983869 PMCID: PMC11231744 DOI: 10.1016/j.jve.2024.100379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 06/11/2024] [Indexed: 07/11/2024] Open
Abstract
Background Immigrant groups from Southeast Asia, the Pacific Islands, sub-Saharan Africa, and the Caribbean bear the heaviest burden of chronic hepatitis B and primary liver cancer in the United States. Educational campaigns to increase knowledge about these diseases and their connection are necessary to promote protective health behaviors within these communities, to ultimately reduce the burden of disease, lessen stigma, and eliminate health disparities. Objectives This project sought to engage groups within highly impacted communities to identify existing gaps in hepatitis B- and liver cancer-related knowledge, in order to inform future health education programming that will aim to reduce stigma and promote liver cancer prevention and early detection behaviors within and across groups. Methods Fifteen focus groups and two key informant interviews were conducted virtually with participants from Micronesian, Chinese, Hmong, Nigerian, Ghanaian, Vietnamese, Korean, Somali, Ethiopian, Filipino, Haitian, and Francophone West African communities. Qualitative data were analyzed using thematic coding. Results There are large gaps in knowledge and awareness of hepatitis B and liver cancer, and the link between these two diseases among Asian, Pacific Islander, African and Haitian immigrant communities. This limited knowledge and misinformation, exacerbated by stigma, hinder these groups' utilization of hepatitis B and liver cancer diagnostic and preventative healthcare services. Conclusion To reduce hepatitis B and liver cancer health disparities within heavily burdened groups, health education needs to be community-informed, culturally sensitive, and actionable. Study results can guide the development of culturally and linguistically appropriate education programs that focus on the link between hepatitis B and liver cancer and the need for vaccination and routine screening, and that are responsive to the knowledge gaps and misperceptions of diverse communities. The results also provide valuable insights for healthcare providers to improve the knowledge gaps of the diverse patient populations that they serve.
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Affiliation(s)
- Thomas Chen
- Department of Internal Medicine, The Mount Sinai Hospital, 1 Gustave L. Levy Place, New York, 10029, New York, United States
| | - Fiona Borondy-Jenkins
- Hepatitis B Foundation, 3805 Old Easton Road, Doylestown, 18902, Pennsylvania, United States
| | - Beatrice Zovich
- Hepatitis B Foundation, 3805 Old Easton Road, Doylestown, 18902, Pennsylvania, United States
| | - Suzanne J Block
- Johns Hopkins University, Bloomberg School of Public Health, 615 N Wolfe St., Baltimore, 21205, Maryland, United States
| | - Kate Moraras
- Hepatitis B Foundation, 3805 Old Easton Road, Doylestown, 18902, Pennsylvania, United States
| | - Alice Chan
- Hepatitis B Foundation, 3805 Old Easton Road, Doylestown, 18902, Pennsylvania, United States
| | - Chari Cohen
- Hepatitis B Foundation, 3805 Old Easton Road, Doylestown, 18902, Pennsylvania, United States
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Yu YL. Disparities by Race/Ethnicity and Immigration Status in Perceived Importance of and Access to Culturally Competent Health Care in the United States. J Racial Ethn Health Disparities 2024; 11:1829-1841. [PMID: 37314687 DOI: 10.1007/s40615-023-01655-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/17/2023] [Accepted: 05/24/2023] [Indexed: 06/15/2023]
Abstract
While cultural competence has been proposed as an important framework for enhancing health care equity, how members of different racial/ethnic groups consider the importance of cultural competence and their access to culturally competent health care are insufficiently understood. Despite continuously increasing immigrants into the US, it is unclear how immigration status intersects with race/ethnicity to shape individuals' perception of and access to culturally competent care in the US health care system. To fill this research gap, this study examined how the intersection of race/ethnicity and immigration status is associated with people's perception of and access to culturally competent health care and among immigrants, whether their length of stay matters, using data from the 2017 National Health Interview Survey. The results show that while racial and ethnic minority members reported greater importance of culturally competent care than non-Hispanic whites, Asian, black and other-race immigrants reported even greater importance than their US-born counterparts. Additionally, although racial/ethnic minorities reported greater limited access to culturally competent care than their white peers, this gap in access was observed primarily among US-born racial/ethnic minorities. Shorter length of residence (fewer than 15 years) was associated with greater perceived importance than residence of at least 15 years among immigrants, but access to culturally competent care did not differ by length of residence. The findings speak to racial/ethnic minorities' greater desire for culturally competent care and their unmet needs.
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Affiliation(s)
- Yan-Liang Yu
- Department of Sociology and Criminology, Howard University, 2419 6th St. NW Bldg. 23, Washington, DC, 20059, USA.
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Koku EF, Johnson-Yengbeh N, Muhr A. Addressing COVID-19 Vaccine Hesitancy and Uptake Among African Immigrants: Lessons from a Community-Based Outreach Program. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01947-9. [PMID: 38443740 DOI: 10.1007/s40615-024-01947-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/07/2024] [Accepted: 02/13/2024] [Indexed: 03/07/2024]
Abstract
In 2021, the African Cultural Alliance of North America (ACANA) implemented a community-based vaccine education and outreach program to decrease hesitancy and increase COVID-19 vaccine uptake among African immigrants in Philadelphia. The program had three components: (1) tailored messaging on the benefits of vaccines by trusted community health navigators in familiar languages/dialects, (2) use of educational/tabling events, and (3) establishment of a vaccine clinic in community settings. Using secondary data analysis, in-depth interviews, focus group discussions and a self-administered survey, we explored (i) the impact and effectiveness of the outreach program and extent of vaccine uptake, (ii) African immigrants' beliefs about the COVID-19 pandemic and the vaccine, and (iii) barriers and facilitators of vaccine knowledge, uptake, and hesitancy. Our analysis showed that ACANA's outreach program was effective in addressing several cultural, logistic, and systematic barriers to vaccine uptake. The program distributed 2000 educational/informational flyers, reached 3000 community members via social media campaigns, and an additional 2320 through other person-to-person outreach events. The program was effective and resulted in the vaccination of 1265 community members over the course of the outreach. The impact of this outreach underscores the critical role of community-based organizations in addressing COVID-19 vaccine hesitancy and increasing vaccine uptake in underserved and minority communities. The paper concludes with suggestions and recommendations for using community-based outreach programs to increase COVID-19 vaccine uptake and decrease hesitancy.
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Affiliation(s)
- Emmanuel F Koku
- Department of Sociology, Drexel University, 3201 Arch Street, Room 288, Philadelphia, PA, 19104, USA.
| | - Nettie Johnson-Yengbeh
- Health Department, African Cultural Alliance of North America (ACANA), 5530 Chester Ave, Philadelphia, PA, 19143, USA
| | - Ava Muhr
- Health Department, African Cultural Alliance of North America (ACANA), 5530 Chester Ave, Philadelphia, PA, 19143, USA
- School of Social and Political Science, University of Edinburgh, 15a George Square, EH8 9LD, Edinburgh, UK
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Portela-Pino I, Brea-Castro M, Portela-Pino C, Pino-Juste M. Health literacy and pandemic coping in Leisure Time Monitors. Glob Health Promot 2024; 31:15-24. [PMID: 37609824 DOI: 10.1177/17579759231191501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
INTRODUCTION Health literacy allows us to make appropriate decisions about our self-care and to use health services appropriately, therefore, it conditions people's health. OBJECTIVES The aim of this study was to describe the level of health literacy of leisure time monitors and the influence of self-perception of health in times of pandemic. STUDY DESIGN We used a cross-sectional observational design with non-probabilistic purposive sampling among leisure time monitors in the Autonomous Community of Galicia (Spain). METHOD For this purpose, the HLS-EU-Q47 questionnaire measuring health literacy and a questionnaire measuring perception of COVID-19 were used. RESULTS The results verify that the monitors consider that the pandemic affects their daily life, that it will be a situation that will last for a long time, and they are very worried. The low level of health literacy of the leisure time monitors is also confirmed. CONCLUSIONS Therefore, it seems urgent to evaluate the existing training programme and to include health education contents in this programme, given the involvement of leisure time monitors in the training of children and adolescents.
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Affiliation(s)
- Iago Portela-Pino
- Department of Health Sciences, Faculty of Health Sciences, Isabel I University, Burgos, Spain
- Research Group on Education, Physical Activity and Health (GIES10), Galicia Sur Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - Millán Brea-Castro
- Research Group on Education, Physical Activity and Health (GIES10), Galicia Sur Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
- Department of Psychoeducational Analysis and Intervention, Faculty of Education, University of Vigo, Ourense, Spain
| | - Clara Portela-Pino
- Internal Medicine Service, Complejo Hospitalario Universitario de Vigo, Galicia Sur Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - Margarita Pino-Juste
- Research Group on Education, Physical Activity and Health (GIES10), Galicia Sur Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
- Department of Didactics, School Organization and Research Methods, Faculty of Education and Sport Sciences, University of Vigo, Spain
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Arizpe A, Navarro S, Ochoa-Dominguez CY, Rodriguez C, Kim SE, Farias AJ. Nativity differences in socioeconomic barriers and healthcare delays among cancer survivors in the All of Us cohort. Cancer Causes Control 2024; 35:203-214. [PMID: 37679534 PMCID: PMC10787892 DOI: 10.1007/s10552-023-01782-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 08/21/2023] [Indexed: 09/09/2023]
Abstract
PURPOSE We aimed to assess whether nativity differences in socioeconomic (SES) barriers and health literacy were associated with healthcare delays among US cancer survivors. METHODS "All of Us" survey data were analyzed among adult participants ever diagnosed with cancer. A binary measure of healthcare delay (1+ delays versus no delays) was created. Health literacy was assessed using the Brief Health Literacy Screen. A composite measure of SES barriers (education, employment, housing, income, and insurance statuses) was created as 0, 1, 2, or 3+. Multivariable logistic regression model tested the associations of (1) SES barriers and health literacy with healthcare delays, and (2) whether nativity modified this relationship. RESULTS Median participant age was 64 years (n = 10,020), with 8% foreign-born and 18% ethnic minorities. Compared to survivors with no SES barriers, those with 3+ had higher likelihood of experiencing healthcare delays (OR 2.18, 95% CI 1.84, 2.58). For every additional barrier, the odds of healthcare delays were greater among foreign-born (1.72, 1.43, 2.08) than US-born (1.27, 1.21, 1.34). For every 1-unit increase in health literacy among US-born, the odds of healthcare delay decreased by 9% (0.91, 0.89, 0.94). CONCLUSION We found that SES barriers to healthcare delays have a greater impact among foreign-born than US-born cancer survivors. Higher health literacy may mitigate healthcare delays among US cancer survivors. Healthcare providers, systems and policymakers should assess and address social determinants of health and promote health literacy as a way to minimize healthcare delays among both foreign- and US-born cancer survivors.
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Affiliation(s)
- Angel Arizpe
- Keck School of Medicine of the University of Southern California, 2001 N. Soto St., Suite 318B, Los Angeles, CA, 90032, USA
| | - Stephanie Navarro
- Keck School of Medicine of the University of Southern California, 2001 N. Soto St., Suite 318B, Los Angeles, CA, 90032, USA
| | | | | | - Sue E Kim
- Keck School of Medicine of the University of Southern California, 2001 N. Soto St., Suite 318B, Los Angeles, CA, 90032, USA
| | - Albert J Farias
- Keck School of Medicine of the University of Southern California, 2001 N. Soto St., Suite 318B, Los Angeles, CA, 90032, USA.
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Pham D, Lin A, Rosenthal H, Milanaik R. ADHD Diagnosis in Children of Non-US-Born Parents: A Cross-Sectional Analysis. J Atten Disord 2024; 28:3-13. [PMID: 37694890 DOI: 10.1177/10870547231197242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
OBJECTIVE(S) To assess the likelihood of ADHD diagnosis in children of non-US-born caregivers relative to children of US-born caregivers. METHOD Cross-sectional analysis of a combined 2016 to 2019 National Survey of Children's Health dataset (n = 109,881) was performed to identify associations between caregiver's birth outside the U.S. and child's ADHD diagnosis. Logistic regression models adjusted for potential sociodemographic confounders. RESULTS Children with one or two non-US-born caregivers were less likely to be diagnosed with ADHD (aOR = 0.58, p < .001; aOR = 0.59, p < .001, respectively). Likelihood of a diagnosis increased as non-US-born caregivers spent more time in the US. After a diagnosis, children of two non-US-born caregivers were less likely to be treated with medication. CONCLUSION The lower likelihood of ADHD diagnosis in children with non-US-born caregivers may reflect an increasing need for public health education to raise awareness about ADHD among this population and the development of culturally sensitive ADHD identification methodologies.
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Affiliation(s)
- Duy Pham
- Steven and Alexandra Cohen Children's Medical Center of New York, Lake Success, USA
| | - Allison Lin
- Steven and Alexandra Cohen Children's Medical Center of New York, Lake Success, USA
| | - Hannah Rosenthal
- Steven and Alexandra Cohen Children's Medical Center of New York, Lake Success, USA
| | - Ruth Milanaik
- Steven and Alexandra Cohen Children's Medical Center of New York, Lake Success, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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McMahon B, Cohen C, Brown Jr RS, El-Serag H, Ioannou GN, Lok AS, Roberts LR, Singal AG, Block T. Opportunities to address gaps in early detection and improve outcomes of liver cancer. JNCI Cancer Spectr 2023; 7:pkad034. [PMID: 37144952 PMCID: PMC10212536 DOI: 10.1093/jncics/pkad034] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/10/2023] [Indexed: 05/06/2023] Open
Abstract
Death rates from primary liver cancer (hepatocellular carcinoma [HCC]) have continued to rise in the United States over the recent decades despite the availability of an increasing range of treatment modalities, including new systemic therapies. Prognosis is strongly associated with tumor stage at diagnosis; however, most cases of HCC are diagnosed beyond an early stage. This lack of early detection has contributed to low survival rates. Professional society guidelines recommend semiannual ultrasound-based HCC screening for at-risk populations, yet HCC surveillance continues to be underused in clinical practice. On April 28, 2022, the Hepatitis B Foundation convened a workshop to discuss the most pressing challenges and barriers to early HCC detection and the need to better leverage existing and emerging tools and technologies that could improve HCC screening and early detection. In this commentary, we summarize technical, patient-level, provider-level, and system-level challenges and opportunities to improve processes and outcomes across the HCC screening continuum. We highlight promising approaches to HCC risk stratification and screening, including new biomarkers, advanced imaging incorporating artificial intelligence, and algorithms for risk stratification. Workshop participants emphasized that action to improve early detection and reduce HCC mortality is urgently needed, noting concern that many of the challenges we face today are the same or similar to those faced a decade ago and that HCC mortality rates have not meaningfully improved. Increasing the uptake of HCC screening was identified as a short-term priority while developing and validating better screening tests and risk-appropriate surveillance strategies.
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Affiliation(s)
- Brian McMahon
- Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | | | - Robert S Brown Jr
- Department of Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY, USA
| | - Hashem El-Serag
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - George N Ioannou
- Department of Medicine, Division of Gastroenterology, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Anna S Lok
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Lewis R Roberts
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Amit G Singal
- Department of Internal Medicine, Division of Digestive and Liver Diseases, UT Southwestern, Dallas, TX, USA
| | - Timothy Block
- Baruch S. Blumberg Institute and Hepatitis B Foundation, Doylestown, PA, USA
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Cerezo A, Ching S, Ramirez A. Healthcare Access and Health-Related Cultural Norms in a Community Sample of Black and Latinx Sexual Minority Gender Expansive Women. JOURNAL OF HOMOSEXUALITY 2023; 70:782-805. [PMID: 34842502 DOI: 10.1080/00918369.2021.1999123] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Major strides have been made in understanding the impact of intersectionality in everyday life. However, there is a significant gap in the research literature on how individuals with multiple minority statuses must uniquely interact and navigate health services. We carried out an exploratory qualitative study with twenty sexual minority gender expansive women of Latinx and African American descent to explore participants' access to health services and the impact of cultural factors on their health decisions and behaviors. Participants described long-term challenges with accessing health services that were primarily tied to income and discriminatory treatment on the part of health providers. Participants also shared regular discouragement from family members to engage with U.S./Western medicine and health traditions. Together, participants' early life experiences and the continued messages from family members, influenced their health behaviors (e.g., delaying care). Implications for future research and health services are discussed.
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Affiliation(s)
- Alison Cerezo
- Department of Counseling, Clinical and School Psychology, University of California Santa Barbara, Santa Barbara, California, USA
| | - Sesame Ching
- Department of Counseling, San Francisco State University, San Francisco, California, USA
| | - Amaranta Ramirez
- Department of Counseling, Clinical and School Psychology, University of California Santa Barbara, Santa Barbara, California, USA
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Almoussa M, Mattei J. Cardiovascular health and risk factors in African refugees and immigrants in the United States: a narrative review. ETHNICITY & HEALTH 2023; 28:399-412. [PMID: 35306946 DOI: 10.1080/13557858.2022.2052712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVES Refugees and immigrants often experience challenges pre- and post-settlement that expose them to risk factors of cardiovascular disease (CVD). Literature on CVD among the growing population of African refugees and immigrants in the United States (US) is scant. This narrative review aimed to evaluate existing studies reporting on CVD and its risk factors among African refugees and immigrants in the US, and to recognize limitations in the current research, policy, and healthcare for adequate CVD-related care for African refugees and immigrants. DESIGN Articles on African refugee and/or immigrant health were searched on PubMed using multiple key search terms. Studies conducted between 1995 and 2020 and reporting on CVD-related measures in individuals from African countries of origin were included. Six articles were found discussing refugee health only and seven articles discussed refugee and immigrant health together. RESULTS Overall, the studies showed the varying prevalence of CVD risk factors, mostly depending on the country of origin. Worsening cardiometabolic health with longer residency in the US was generally reported. Refugee-only studies relied mostly on medical records data, while refugee and immigrant studies used both medical records and primary data collection. Limitations in data pertain to the geographical representation of both African countries (predominantly from Somalia despite migrants arriving from diverse African countries) and of regions of settling in the US (predominantly the north/northeast), scarce longitudinal studies, and lack of distinction between refugees and immigrants. Multiple social and structural barriers to cardiovascular health were identified, mostly related to cultural and linguistic challenges and to inadequate or complex health insurance and healthcare systems. CONCLUSION The cardiovascular health of African refugees and immigrants remains understudied and underserved. Further research and interventions to alleviate barriers and improve cardiovascular health in African refugees and immigrants in the US should be developed using culturally appropriate, accessible, flexible, and multifaceted strategies.
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Affiliation(s)
- Maya Almoussa
- Department of Molecular and Cellular Biology, Harvard College Faculty of Arts and Sciences, Cambridge, MA, USA
| | - Josiemer Mattei
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Karodeh YR, Wingate LT, Drame I, Talbert PY, Dike A, Sin S. Predictors of Academic Success in a Nontraditional Doctor of Pharmacy Degree Program at a Historically Black College and University. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2022; 86:ajpe8600. [PMID: 34716132 PMCID: PMC10159406 DOI: 10.5688/ajpe8600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 10/18/2021] [Indexed: 05/06/2023]
Abstract
Objective. Rapid changes in the current US health care system, especially in the fields of pharmacy and pharmaceutical sciences, require practicing pharmacists to acquire new knowledge and skills. Despite the growth of opportunities for pharmacists within new spaces such as nanotechnology, informatics, and pharmacogenomics, those without a Doctor of Pharmacy (PharmD) degree could be eliminated from consideration by employers who seek new graduates with more contemporary training and skills. The purpose of this study was to determine what associations exist between student success within a nontraditional Doctor of Pharmacy (NTDP) program and certain demographic factors.Methods. This quantitative longitudinal study was designed to determine which factors predict academic success among NTDP students entering the College of Pharmacy at Howard University. Academic success was measured by cumulative graduating grade point average (GPA). Data from four cohorts of students were used to develop multivariate linear regression models with several predictors including age, region of residence, citizenship status, previous pharmacy work background, and ethnicity.Results. The study sample included 81 students whose mean cumulative GPA was 3.44. A foreign-born African heritage was predictive of a GPA that was significantly higher in comparison to African Americans after adjusting for other factors.Conclusion. Findings showed that international students had a higher cumulative GPA in comparison to African American students in the NTDP program.
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Affiliation(s)
| | | | - Imbi Drame
- Howard University, College of Pharmacy, Washington, DC
| | - Patricia Y Talbert
- Howard University, College of Nursing and Allied Health Sciences, Washington, DC
| | - Ashley Dike
- Howard University, College of Pharmacy, Washington, DC
| | - Sophia Sin
- Howard University, College of Pharmacy, Washington, DC
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Longanga Diese E, Baker E, Akpan I, Acharya R, Raines-Milenkov A, Felini M, Hussain A. Health information-seeking behavior among Congolese refugees. PLoS One 2022; 17:e0273650. [PMID: 36084096 PMCID: PMC9462811 DOI: 10.1371/journal.pone.0273650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/12/2022] [Indexed: 11/19/2022] Open
Abstract
Background The purpose of this cross-sectional study was to determine the extent to which Congolese refugees seek health information, to identify and assess the resources used while exercising Health Information-Seeking Behavior (HISB), and to identify individual determinants that affect their HISB. Methodology Building Bridges program participants who resided in Texas between 2017–2020, reported country of origin as Democratic Republic of Congo, and responded to HISB questions were included in this study. Four HISB questions asked about frequency seeking health information, preferred source and perceived trustworthiness of source, and frequency worrying about their health. Associations between HISB and sociodemographic factors (age, gender, education years, years in US, proficiency speaking English, marital status) were tested using Pearson chi-square or Fisher’s exact tests (α≤0.05). Results Most participants (59%) reported seeking health information sometimes. Less than half (44%) of participants identified doctors as their preferred source of health information, Twenty-five percent relied on family, friends, and community leaders, and 23% used media sources. Doctors were identified as the most trustworthy source (71%), family and friends were the second highest trusted source (25%), whereas media sources were the least trusted (4%). Sociodemographic factors age (p = .02), gender (p < .01), and education years (p < .01) were the only significant predictors of preferred information sources. Conversely, those residing in US <5 years were more likely to seek health information more frequently (p = .01). The majority of participants did not worry about their health, and it was not significantly associated with source or frequency of seeking health information. Conclusions The high trust in doctors represents an opportunity for healthcare professionals to educate and address individual barriers contributing to refugees’ underutilization of preventive care services such as routine immunizations and preventive health screenings.
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Affiliation(s)
- Elvis Longanga Diese
- Department of Pediatrics and Women’s Health, University of North Texas Health Science Center, Fort Worth, TX, United States of America
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX, United States of America
- * E-mail:
| | - Eva Baker
- Department of Pediatrics and Women’s Health, University of North Texas Health Science Center, Fort Worth, TX, United States of America
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX, United States of America
| | - Idara Akpan
- Department of Pediatrics and Women’s Health, University of North Texas Health Science Center, Fort Worth, TX, United States of America
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX, United States of America
| | - Rushil Acharya
- Department of Pediatrics and Women’s Health, University of North Texas Health Science Center, Fort Worth, TX, United States of America
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX, United States of America
| | - Amy Raines-Milenkov
- Department of Pediatrics and Women’s Health, University of North Texas Health Science Center, Fort Worth, TX, United States of America
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX, United States of America
| | - Martha Felini
- Department of Pediatrics and Women’s Health, University of North Texas Health Science Center, Fort Worth, TX, United States of America
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX, United States of America
| | - Arbaz Hussain
- Department of Pediatrics and Women’s Health, University of North Texas Health Science Center, Fort Worth, TX, United States of America
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX, United States of America
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13
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Racial disparities in pediatric malignant glioma management: current state of affairs in the United States. J Neurooncol 2022; 160:171-178. [PMID: 36074284 DOI: 10.1007/s11060-022-04130-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 09/03/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND The diagnosis of malignant glioma confers a poor prognosis in the pediatric population. In the adult demographic, racial disparities exist with respect to access to care and survival. Yet to date no efforts have been made to characterize racial disparities in the care of malignant pediatric gliomas. Correspondingly, the aim of this study was to understand if racial disparities exist in the setting of malignant pediatric gliomas. METHODS All pediatric malignant gliomas patients with known race status (White, Black, Other) in the US National Cancer Database (NCDB) between the years 2005-2016 were retrospectively reviewed. Demographic, socioeconomic and clinical data were then abstracted and analyzed by comparison and regression techniques. RESULTS A total of 1803 pediatric malignant glioma cases were identified, with 48% female and a median age of 8 years old. Brainstem locations were reported in 48% of cases. Socioeconomically, there were statistically significant differences with respect to insurance status, yearly income, household education level and metropolitan residences between the racial groups (all P < 0.01). With respect to treatment, there was statistical difference in the proportion of patients treated with surgical resection (White 43% vs Black 34% vs Other 37%, P = 0.02). There were no differences between race groups for radiation therapy (P = 0.73) or chemotherapy (P = 0.12). The odds of surgical resection were significantly less in the Black group compared to the White group (OR 0.69, P < 0.01), although there was no difference in overall survival between the two groups in those treated with (P = 0.44) or without (P = 0.27) surgical resection. Primary associations of surgical resection in the Black group were brainstem location (P < 0.05) and lower yearly household income quartiles (P < 0.05). CONCLUSIONS Racial disparities exist amongst the management of pediatric malignant gliomas, with undefined impact on survival and quality of life. In this perspective, we identified associations between Black patients and access to surgical treatment. Understanding that there are many elements to patient care, including quality of life, should encourage all clinicians and carers to consider racial disparities appropriately when managing malignant pediatric glioma patients.
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14
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Pinchas-Mizrachi R, Velan B. The Effects of Sociocultural Transitioning on Accessibility to Healthcare: The Case of Haredi Jews Who Leave Their Communities. CONTEMPORARY JEWRY 2022; 42:139-156. [PMID: 35496659 PMCID: PMC9040699 DOI: 10.1007/s12397-022-09433-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/11/2022] [Indexed: 11/29/2022]
Abstract
Minority groups and immigrants encounter complex issues when attempting to access healthcare. This study examines factors affecting access to healthcare by a group of individuals in Israel who decided to leave their Haredi Jewish communities. We conducted 23 semi-structured interviews with individuals disaffiliating from Haredi communities in Israel in order to identify hurdles encountered during the process of seeking healthcare. We focused on specific steps in this process, including recognizing the need for help, deciding to actually turn to the health system, interaction with the system, and behavior after referring to the health system. We identified approximately 20 factors which can be either barriers or catalysts affecting healthcare access at the various stages. These were then traced to religious upbringing, hurdles of sociocultural transition, and unique characteristics of individuals reshaping their lives. The findings can be instrumental in designing culturally adapted health programs for individuals leaving the Haredi community. Moreover, the methodology that we are proposing can serve other investigations studying access to healthcare among various groups undergoing sociocultural transitions.
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Affiliation(s)
- Ronit Pinchas-Mizrachi
- The Israel Academic College in Ramat Gan, Ramat Gan, Israel
- Jerusalem College of Technology, Jerusalem, Israel
| | - Baruch Velan
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
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15
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Barlow P, Mohan G, Nolan A. Utilisation of healthcare by immigrant adults relative to the host population: Evidence from Ireland. J Migr Health 2022; 5:100076. [PMID: 35005673 PMCID: PMC8715328 DOI: 10.1016/j.jmh.2021.100076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 11/17/2021] [Accepted: 11/17/2021] [Indexed: 12/02/2022] Open
Abstract
Non-UK migrants in Ireland were less likely to visit a GP than those local-born. Non-UK migrants in Ireland were less likely to attend a consultant. Different migrant groups had different patterns of healthcare use. Healthcare use by immigrants is context specific.
Objective While there is a broad consensus that barriers to access in the utilisation of healthcare exist for immigrants in the US, European evidence exploring this issue paints a mixed picture, with studies from a variety of European jurisdictions presenting different conclusions. In this context, Ireland, a European country with substantial private involvement in healthcare delivery, and, a largely young immigrant population, provides an opportunity to investigate the healthcare utilisation of immigrants compared to natives in a European country with mixed private-public healthcare provision. Design The healthcare utilisation patterns of immigrants (defined as residents with a foreign country of birth) and native-born participants were analysed from a nationally representative health survey of 6,326 adults, carried out in Ireland in 2016. An array of socio-economic and health information was collected such that regression analysis on healthcare consultations accounted for confounding factors. Results Non-native residents of Ireland born outside the UK were less likely to have attended a General Practitioner (Odds ratio (OR): 0.62 [95% Confidence Interval (CI): 0.51–0.74]; p<0.001) or consultant doctor (OR: 0.60 [95% CI: 0.47–0.76]; p<0.001) in the previous year, relative to Irish-born individuals. UK-born residents of Ireland displayed similar utilisation patterns to those of the native population in terms of GP visitation, but a higher likelihood of having attended a consultant (OR: 1.44 [95% CI: 1.14–1.816]; p = 0.004). Conclusions Lower use of healthcare by those born outside Ireland and the UK relative to the native Irish population may be due to different approaches to healthcare utilisation or obstacles to healthcare utilisation. The findings suggest that the utilisation of healthcare by immigrants merits continued policy attention to respond to the needs of these key groups in society and facilitate integration.
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Affiliation(s)
- Peter Barlow
- Economic and Social Research Institute, Dublin, Ireland
| | - Gretta Mohan
- Economic and Social Research Institute, Dublin, Ireland.,Department of Economics, Trinity College, Dublin, Ireland
| | - Anne Nolan
- Economic and Social Research Institute, Dublin, Ireland.,Department of Economics, Trinity College, Dublin, Ireland.,The Irish Longitudinal Study on Ageing, Trinity College, Dublin, Ireland
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16
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Daniel NA, Hassan SA, Mohamed F, Sheikh N, Basualdo G, Schwartz R, Gebreselassie BT, Beyene YK, Gabreselassie L, Bayru K, Tadesse B, Libneh HA, Shidane M, Benalfew S, Ali A, Rao D, Kerani RP, Patel RC. Harambee! 2.0: The Impact of HIV-Related and Intersectional Stigmas on HIV Testing Behaviors Among African Immigrant Communities in Seattle, Washington. AIDS Behav 2022; 26:149-164. [PMID: 34368910 PMCID: PMC8349708 DOI: 10.1007/s10461-021-03396-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2021] [Indexed: 02/07/2023]
Abstract
African immigrants are disproportionately affected by HIV compared to U.S.-born individuals, and early HIV testing is the key challenge in ending the HIV epidemic in these communities. HIV-related stigma appears to be the most significant barrier to testing for HIV among African communities in King County, WA. In this formative study, we conducted thirty key informant interviews and five focus group discussions (n = total 72 participants) with Ethiopian, Somali, and Eritrean people living with HIV, health professionals, religious and other community leaders, and lay community members in King County to better understand HIV-related and intersectional stigmas' impact on HIV testing behaviors. We used inductive coding and thematic analysis. Participants from all communities reported similar themes for HIV-related and intersectional stigmas' influences on HIV testing behaviors. Misconceptions or poor messaging, e.g., regarding treatability of HIV, as well as normative or religious/moral beliefs around pre/extramarital sex contributed to HIV-related stigma. Intersecting identities such as immigrant status, race/ethnicity, and having a non-English language preference, all intermingle to further influence access to the U.S. healthcare system, including for HIV testing. These findings can be used to inform future research on community-led approaches to addressing early HIV testing amongst African immigrant communities.
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Affiliation(s)
| | - Shukri A Hassan
- Department of Medicine, UW, 325 9th Ave, Seattle, WA, 98105, USA
| | - Farah Mohamed
- Department of Medicine, UW, 325 9th Ave, Seattle, WA, 98105, USA
- Somali Health Board, Tukwila, WA, USA
| | - Najma Sheikh
- Department of Global Health, UW, Seattle, WA, USA
| | | | - Rahel Schwartz
- Ethiopian Community in Seattle, Seattle, WA, USA
- Ethiopian Health Board, Seattle, WA, USA
| | | | | | | | | | | | | | | | | | - Ahmed Ali
- Somali Health Board, Tukwila, WA, USA
- Department of Global Health, UW, Seattle, WA, USA
| | - Deepa Rao
- Department of Global Health, UW, Seattle, WA, USA
| | - Roxanne P Kerani
- Department of Medicine, UW, 325 9th Ave, Seattle, WA, 98105, USA
| | - Rena C Patel
- Department of Medicine, UW, 325 9th Ave, Seattle, WA, 98105, USA.
- Department of Global Health, UW, Seattle, WA, USA.
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17
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Fuller H, Dubbala K, Obiri D, Mallare M, Advani S, De Souza S, Stoby K, King-Okoye M. Addressing Vaccine Hesitancy to Reduce Racial and Ethnic Disparities in COVID-19 Vaccination Uptake Across the UK and US. Front Public Health 2021; 9:789753. [PMID: 34950633 PMCID: PMC8688686 DOI: 10.3389/fpubh.2021.789753] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/02/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Harriett Fuller
- The Ethnicity and Covid-19 Research Consortium, International Research Group, Edinburgh, United Kingdom.,Faculty of Environment, School of Food Science and Nutrition, University of Leeds, Leeds, United Kingdom
| | - Keerthi Dubbala
- The Ethnicity and Covid-19 Research Consortium, International Research Group, Edinburgh, United Kingdom
| | - Dorotheah Obiri
- The Ethnicity and Covid-19 Research Consortium, International Research Group, Edinburgh, United Kingdom.,Department of Immunology, College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Meryll Mallare
- The Ethnicity and Covid-19 Research Consortium, International Research Group, Edinburgh, United Kingdom.,Nursing Studies, School of Health in Social Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Shailesh Advani
- The Ethnicity and Covid-19 Research Consortium, International Research Group, Edinburgh, United Kingdom.,Affiliate Faculty, Terasaki Institute of Biomedical Innovation, Los Angeles, CA, United States
| | - Sophie De Souza
- The Ethnicity and Covid-19 Research Consortium, International Research Group, Edinburgh, United Kingdom.,School of Population Health and Environmental Sciences, King's College University, London, United Kingdom
| | - Karlene Stoby
- The Ethnicity and Covid-19 Research Consortium, International Research Group, Edinburgh, United Kingdom
| | - Michelle King-Okoye
- The Ethnicity and Covid-19 Research Consortium, International Research Group, Edinburgh, United Kingdom.,Nursing Studies, School of Health in Social Science, University of Edinburgh, Edinburgh, United Kingdom
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18
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Hassan SA, Mohamed F, Sheikh N, Basualdo G, Daniel NA, Schwartz R, Gebreselassie BT, Beyene YK, Gabreselassie L, Bayru K, Tadesse B, Libneh HA, Shidane M, Benalfew S, Ali A, Rao D, Patel RC, Kerani RP. "They Wait until the Disease Has Taking over You and the Doctors Cannot Do Anything about It": Qualitative Insights from Harambee! 2.0. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12706. [PMID: 34886432 PMCID: PMC8657258 DOI: 10.3390/ijerph182312706] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/24/2021] [Accepted: 11/27/2021] [Indexed: 11/19/2022]
Abstract
African immigrants make up a large subgroup of Black/African-Americans in the US. However, because African immigrant groups are typically categorized as "Black," little is known about their preventative healthcare needs. Differences in culture, life and healthcare experiences between African immigrant populations and US-born people may influence preventive health care uptake. Thus, policymakers and healthcare providers lack information needed to make informed decisions around preventive care for African immigrants. This formative study was conducted among the largest East African immigrant communities in King County, WA. We recruited religious leaders, community leaders, health professionals, and lay community members to participate in thirty key informant interviews and five focus group discussions (n = 72 total), to better understand preventative healthcare attitudes in these communities. Through inductive coding and thematic analysis, we identified factors that impact preventative healthcare attitudes of the Somali, Ethiopian and Eritrean immigrant communities and deter them from accessing and utilizing healthcare. Cultural beliefs and attitudes around preventative healthcare, mistrust of westernized healthcare, religious beliefs/views, intersecting identities and shared immigrant experiences all influence how participants view preventative healthcare. Our results suggest that interventions that address these factors are needed to most effectively increase uptake of preventative healthcare in African immigrant communities.
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Affiliation(s)
- Shukri A. Hassan
- Department of Medicine, University of Washington, Seattle, WA 98104, USA; (R.C.P.); (R.P.K.)
| | - Farah Mohamed
- Department of Medicine, University of Washington, Seattle, WA 98104, USA; (R.C.P.); (R.P.K.)
- Somali Health Board, Tukwila, WA 98188, USA; (M.S.); (A.A.)
| | - Najma Sheikh
- Department of Global Health, University of Washington, Seattle, WA 98195, USA; (N.S.); (D.R.)
| | - Guiomar Basualdo
- Department of Anthropology, University of Washington, Seattle, WA 98195, USA;
| | - Nahom A. Daniel
- Department of Biology, University of Washington, Seattle, WA 98195, USA;
| | - Rahel Schwartz
- Ethiopian Community Center in Seattle, Seattle, WA 98118, USA; (R.S.); (B.T.); (H.A.L.); (S.B.)
- Ethiopian Health Board, Seattle, WA 98118, USA
| | | | - Yikealo K. Beyene
- Eritrean Health Board, Seattle, WA 98122, USA; (B.T.G.); (Y.K.B.); (L.G.); (K.B.)
| | - Luwam Gabreselassie
- Eritrean Health Board, Seattle, WA 98122, USA; (B.T.G.); (Y.K.B.); (L.G.); (K.B.)
| | - Kifleyesus Bayru
- Eritrean Health Board, Seattle, WA 98122, USA; (B.T.G.); (Y.K.B.); (L.G.); (K.B.)
| | - Bethel Tadesse
- Ethiopian Community Center in Seattle, Seattle, WA 98118, USA; (R.S.); (B.T.); (H.A.L.); (S.B.)
| | - Hirut Amsalu Libneh
- Ethiopian Community Center in Seattle, Seattle, WA 98118, USA; (R.S.); (B.T.); (H.A.L.); (S.B.)
| | | | - Sophia Benalfew
- Ethiopian Community Center in Seattle, Seattle, WA 98118, USA; (R.S.); (B.T.); (H.A.L.); (S.B.)
| | - Ahmed Ali
- Somali Health Board, Tukwila, WA 98188, USA; (M.S.); (A.A.)
- Department of Global Health, University of Washington, Seattle, WA 98195, USA; (N.S.); (D.R.)
| | - Deepa Rao
- Department of Global Health, University of Washington, Seattle, WA 98195, USA; (N.S.); (D.R.)
| | - Rena C. Patel
- Department of Medicine, University of Washington, Seattle, WA 98104, USA; (R.C.P.); (R.P.K.)
- Department of Global Health, University of Washington, Seattle, WA 98195, USA; (N.S.); (D.R.)
| | - Roxanne P. Kerani
- Department of Medicine, University of Washington, Seattle, WA 98104, USA; (R.C.P.); (R.P.K.)
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19
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Castro-Ramirez F, Al-Suwaidi M, Garcia P, Rankin O, Ricard JR, Nock MK. Racism and Poverty are Barriers to the Treatment of Youth Mental Health Concerns. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2021; 50:534-546. [PMID: 34339320 DOI: 10.1080/15374416.2021.1941058] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Traditional studies of treatment moderators have focused largely on psychological factors such as clinical severity. Racial and economic inequity exert large effects on youth mental health, on treatment efficacy, and on the likelihood of receiving treatment altogether. Yet, these factors are studied less often by clinical psychological scientists. METHOD We conducted a narrative review of literature on racial and economic inequities and their impact on youth mental health. RESULTS First, systemic problems such as racism and poverty increase the risk of developing complex health issues and decrease the likelihood of benefiting from treatment. Second, attitudinal barriers, such as mistrust associated with treatments provided by researchers and government agencies, decrease the likelihood that minoritized groups will engage with or benefit from evidence-based treatments. Third, minoritized and underserved communities are especially unlikely to receive evidence-based treatment. CONCLUSION Clinical psychological science has unique insights that can help address systemic inequities that can decrease treatment efficacy for youth mental health treatment. Psychological scientists can help eliminate disparities in accessing evidence-based treatment and help end violent policies in underserved minoritized communities by at the very least (1) building and supporting scalable community-based treatments as well as (2) publicly advocating for an end to violent policies that impose negative social costs.
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Affiliation(s)
| | | | | | | | | | - Matthew K Nock
- Department of Psychology, Harvard University.,Department of Psychiatry, Massachusetts General Hospital.,Mental Health Research Program, Franciscan Children's
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20
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Association Between HIV Testing and HIV-Related Risk Behaviors Among US and Non-US Born Black Individuals Living in the US: Results From the National Survey on HIV in the Black Community (NSHBC). J Immigr Minor Health 2021; 23:1152-1158. [PMID: 34269989 DOI: 10.1007/s10903-021-01244-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
Despite improvements in HIV prevention and treatment, Black individuals continue to be disproportionately affected by the HIV epidemic in the US. Using data from the National Survey on HIV in the Black Community, we examined the differences in demographic characteristics, risk behaviors, and HIV testing between US and non-US born Black adults. 868 individuals completed the survey and provided baseline data on sexual risk. Participants were grouped as US-born (N = 763) and non-US born (N = 101) based on self-reported place of birth. Amongst US-born participants, males were less likely to test for HIV, whereas those who reported a lifetime history of anal sex and sexually transmitted infections (STIs) were more likely to test for HIV. Non-US born participants who reported a single marital status were less likely to test for HIV, whereas those who reported a lifetime history of STIs were more likely to test for HIV. Some differences in predictors of HIV testing exist by place of birth. Understanding these differences is needed to develop HIV/AIDS prevention and treatment programs for US and non-US born Black individuals.
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21
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Kovaleva M, Jones A, Maxwell CA. Immigrants and dementia: Literature update. Geriatr Nurs 2021; 42:1218-1221. [PMID: 34090727 DOI: 10.1016/j.gerinurse.2021.04.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 04/20/2021] [Indexed: 11/25/2022]
Abstract
The population of immigrants in the U.S. is increasing with older immigrants experiencing age-related decline more rapidly than the U.S.-born white population. Immigrants have a higher prevalence and risk of dementia, including undiagnosed dementia. Older immigrants face unique obstacles in terms of their cognitive health, including language barriers, economic constraints, depressive symptoms, social isolation, low acculturation to the U.S., stigma related to dementia, and lacking education about dementia. Nurses, including advanced practice registered nurses, are well-positioned to enhance immigrants' access to accurate information about dementia and to promote immigrants' timely diagnosis and treatment of dementia symptoms. Several interventions have been developed specifically for immigrant caregivers. Immigrant families need interventions that provide education about dementia, offer resources for caregivers nationally and locally, and are targeted towards specific ethnic groups.
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Affiliation(s)
- Mariya Kovaleva
- Vanderbilt University School of Nursing, Center for Research Development and Scholarship, 461 21(st) Ave South, Room 421, Nashville, TN 37240, United States.
| | - Abigail Jones
- Vanderbilt University School of Nursing, Center for Research Development and Scholarship, 461 21(st) Ave South, Room 421, Nashville, TN 37240, United States
| | - Cathy A Maxwell
- Vanderbilt University School of Nursing, Center for Research Development and Scholarship, 461 21(st) Ave South, Room 421, Nashville, TN 37240, United States
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22
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Roberts DA, Abera S, Basualdo G, Kerani RP, Mohamed F, Schwartz R, Gebreselassie B, Ali A, Patel R. Barriers to accessing preventive health care among African-born individuals in King County, Washington: A qualitative study involving key informants. PLoS One 2021; 16:e0250800. [PMID: 33970923 PMCID: PMC8109781 DOI: 10.1371/journal.pone.0250800] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/13/2021] [Indexed: 11/19/2022] Open
Abstract
Studies of African immigrant health in the U.S. have traditionally focused on infectious diseases. However, the rising burden of non-communicable diseases (NCDs) indicates the increasing importance of general preventive health care. As part of a series of community health events designed for African-born individuals in King County, Washington, we administered key informant interviews (KIIs) with 16 health event participants, medical professionals, and community leaders to identify barriers and facilitators to use of preventive health care among African-born individuals. We used descriptive thematic analysis to organize barriers according to the socio-ecological model. Within the individual domain, KII participants identified lack of knowledge and awareness of preventive health benefits as barriers to engagement in care. Within the interpersonal domain, language and cultural differences frequently complicated relationships with health care providers. Within the societal and policy domains, healthcare costs, lack of insurance, and structural racism were also reported as major barriers. Participants identified community outreach with culturally competent and respectful providers as key elements of interventions to improve uptake. In conclusion, African immigrant communities face several barriers, ranging from individual to policy levels, to accessing health services, resulting in substantial unmet need for chronic disease prevention and treatment. Community-centered and -led care may help facilitate uptake and engagement in care.
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Affiliation(s)
- D. Allen Roberts
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Seifu Abera
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Guiomar Basualdo
- College of Arts and Sciences, University of Washington, Seattle, Washington, United States of America
| | - Roxanne P. Kerani
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- HIV/STD Program, Public Health – Seattle and King County, Seattle, Washington, United States of America
| | - Farah Mohamed
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Somali Health Board, Seattle, Washington, United States of America
| | - Rahel Schwartz
- Ethiopian Health Council, Ethiopian Community in Seattle, Seattle, Washington, United States of America
| | | | - Ahmed Ali
- Somali Health Board, Seattle, Washington, United States of America
| | - Rena Patel
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
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23
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"Was Test Designed for Africans?" Health Literacy and African Immigrants. J Racial Ethn Health Disparities 2021; 9:315-324. [PMID: 33428160 DOI: 10.1007/s40615-020-00959-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/29/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Immigrants experience barriers to accessing and utilizing health care. Language and cultural differences regarding health and healing impact use of health care. Limited health literacy is associated with decreased preventive health services and is reported among immigrant groups in the USA, but the health literacy of African immigrants is not known. OBJECTIVE Assess health literacy, its association with engagement in primary care and select sociodemographic variables, and the use of two health literacy measures with African immigrants. METHODS We conducted a community-based participatory research cross-sectional survey among African immigrants in Massachusetts. Participants completed the Newest Vital Sign, the Health Literacy Skills Instrument, acceptability questionnaires, and a Health Survey. We observed and recorded comments and questions as participants completed the surveys. KEY RESULTS Out of 75 participants, 60% have limited health literacy. Over 80% are connected to a health care system and comfortable speaking with their doctor/nurse. Education, English proficiency, country of origin, and access to health care are associated with health literacy. Participants found the measures easy to understand but difficult to answer. Observation data revealed unfamiliarity with nutrition labels, cooking measurements, and navigation of internet links, and the need for clarification of select items. CONCLUSIONS Most African immigrants in this study have limited health literacy despite English proficiency, college education, employment, and connection to a health system. Further research is needed to determine the value of aligning the measurement of health literacy with the cultural-linguistic identities of the population being assessed versus the need to understand their health literacy within the dominant culture.
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24
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Freeland C, Vader D, Cohen C, George B. A predictive model for hepatitis B infection among high-risk adults using a community-based sample in greater Philadelphia. J Viral Hepat 2020; 27:1319-1325. [PMID: 32702781 DOI: 10.1111/jvh.13365] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 12/13/2022]
Abstract
Liver cancer is the 3rd deadliest cancer worldwide, with 5-year survival rates of only 15%. In the United States, liver cancer incidence and death rates are increasing at a faster rate than any other cancer and are projected to continue to rise through at least 2030. A significant proportion of these liver cancer cases are due to hepatitis B virus (HBV). Community-based screening is a public health practice working to identify individuals who are living with HBV in underserved communities, particularly Asian American, Pacific Islander and African immigrant populations. This data set includes a total of 3019 individuals considered high risk for HBV tested at community-based testing events between 2008 and 2019. Descriptive results revealed HBV infection rate was 7.9% (N = 229), and 59% (N = 1704) had protective antibodies against HBV. To account for missingness in the data, multiple imputation was preformed and followed by logistic regression to create a predictive model. The results support an association between insurance status and HBV infection in the predictive model. Participant region of origin was also significantly related to HBV infection, and participants who immigrated from the Western Pacific and African World Organization designated regions had higher odds of infection compared to participants from the Americas. Results emphasize the need to continue to expand testing in high-risk populations for HBV.
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Affiliation(s)
| | - Daniel Vader
- Drexel University, Philadelphia, Pennsylvania, USA
| | - Chari Cohen
- Hepatitis B Foundation, Doylestown, Pennsylvania, USA
| | - Brandon George
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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25
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Moon H, Kim H, Rote SM, Haley WE, Sears JS. The Effects of Nativity Status on Well-Being Among Medicare Beneficiaries by Race/Ethnicity: A Multi-group Analysis. J Immigr Minor Health 2020; 23:755-763. [PMID: 32815082 DOI: 10.1007/s10903-020-01072-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Nativity status is related to stress, health and well-being, but the literature is scant concerning whether these effects differ by race/ethnicity for older adults. We examined direct and indirect effects of nativity status on stress, coping resources, health, and depression/anxiety for the three largest racial/ethnic groups [Non-Hispanic White (NHW), Non-Hispanic Black (NHB), and Hispanic] in the U.S. using the Transactional Model of Stress and Coping. We obtained the data from Round 1 of the National Health and Aging Trends Study (NHATS; U.S.-born Medicare beneficiaries = 4093, foreign-born Medicare beneficiaries = 382, N = 4475). We used the multi-group analysis function in structural equation modeling to examine similarities and differences in the stress coping processes for the three racial/ethnic groups. The results indicated there are multiple pathways from nativity status to depression or self-rated health. For all three groups, being foreign-born was directly associated with higher stress and indirectly associated with lower self-rated health via stress. Only for Hispanic older adults was being foreign-born directly associated with higher depression/anxiety. For NHWs, being foreign-born was indirectly associated with higher depression/anxiety via less coping resources. Nativity status may have similar effects on self-rated physical health but may exert very different effects on depression/anxiety, depending on race/ethnicity. Nativity status will require special attention for both assessment and management of depression/anxiety as well as self-rated health among older adults of all racial/ethnic backgrounds and especially for older Hispanics.
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Affiliation(s)
- Heehyul Moon
- Kent School of Social Work, University of Louisville, Louisville, KY, USA.
| | - Hyesook Kim
- College of Education, Daegu University, Gyeongsan-si, Gyeongsangbuk-do, Republic of Korea
| | - Sunshine M Rote
- Kent School of Social Work, University of Louisville, Louisville, KY, USA
| | - William E Haley
- School of Aging Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA
| | - Jeanelle S Sears
- College of Health and Human Services, Bowling Green State University, Bowling Green, OH, USA
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Pascoe M, Mahura O, Dean J. Health resources for South Africa: A scoping review. Health SA 2020; 25:1378. [PMID: 32832107 PMCID: PMC7433232 DOI: 10.4102/hsag.v25i0.1378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 06/07/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Healthcare is more effective when people are treated in their own language with respect for their culture. However, information about the availability and nature of health resources is fragmented and studies suggest few assessments, screening tools, or other health resources in many of South Africa's languages. AIM This scoping review identified health resources written in the eleven official languages of South Africa for health professionals to use for patient assessment and management. METH ODS Databases were searched and information about resources collated and analysed. RESULTS Two-hundred-and-fifty two unique resources were found (444 items, if different language versions of the same resource were counted separately). All official languages were represented. The most widely used (excluding English) were Afrikaans (118 resources), IsiXhosa (80) and IsiZulu (55). CONCLUSION Development of more health resources and critical evaluation of their validity and reliability remain important. This study contributes a preliminary database for South African health professionals, ultimately promoting improved service delivery.
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Affiliation(s)
- Michelle Pascoe
- Department of Health and Rehabilitation Sciences/Child Language Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Olebeng Mahura
- Department of Health and Rehabilitation Sciences/Child Language Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jessica Dean
- Department of Health and Rehabilitation Sciences/Child Language Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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A qualitative exploration of the experiences of undocumented African immigrant women in the health care delivery system. Nurs Outlook 2020; 68:242-251. [DOI: 10.1016/j.outlook.2019.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/01/2019] [Accepted: 08/03/2019] [Indexed: 11/17/2022]
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Parental Perceptions of Culturally Sensitive Care and Well-Child Visit Quality. Acad Pediatr 2020; 20:234-240. [PMID: 31857250 PMCID: PMC8177736 DOI: 10.1016/j.acap.2019.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 12/10/2019] [Accepted: 12/12/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Incorporating culturally sensitive care into well-child visits may help address pediatric preventive care disparities faced by racial and ethnic minorities, families with limited English proficiency, and immigrants. We explored parents' perspectives about the extent to which their children's pediatric care is culturally sensitive and potential associations between culturally sensitive care and well-child visit quality. METHODS We conducted cross-sectional surveys with parents attending a well-child visit for a child ages 3 to 48 months. To measure culturally sensitive care, we created a composite score by averaging 8 subscales from an adapted version of the Clinicians' Cultural Sensitivity Survey. We assessed well-child visit quality through the Promoting Healthy Development Survey. Multivariate linear regression was used to understand associations between demographic characteristics and parent-reported culturally sensitive care. We used multivariate logistic regression to examine associations between culturally sensitive care and well-child visit quality. RESULTS Two hundred twelve parents (71% of those approached) completed the survey. Parents born abroad, compared with those born in the United States, reported significantly higher culturally sensitive care scores (+0.21; confidence interval [CI]: 0.004, 0.43). Haitian parents reported significantly lower culturally sensitive care scores compared with non-Hispanic white parents (-0.49; CI: -0.89, -0.09). Parent-reported culturally sensitive care was significantly associated with higher odds of well-child visit quality including receipt of anticipatory guidance (adjusted odds ratio: 2.68; CI: 1.62, 4.62) and overall well-child visit quality (adjusted odds ratio: 2.54; CI: 1.59, 4.22). CONCLUSIONS Consistent with prior research of adult patients, this study demonstrates an association between parent-reported culturally sensitive care and well-child visit quality. Future research should explore best practices to integrating culturally sensitive care in pediatric preventive health care settings.
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Taylor TN, DeHovitz J, Hirshfield S. Intersectional Stigma and Multi-Level Barriers to HIV Testing Among Foreign-Born Black Men From the Caribbean. Front Public Health 2020; 7:373. [PMID: 31998675 PMCID: PMC6965168 DOI: 10.3389/fpubh.2019.00373] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 11/21/2019] [Indexed: 01/08/2023] Open
Abstract
Testing is the entry point into the HIV care continuum that includes linkage to and retention in prevention services, and adherence to prevention strategies, including repeat HIV testing. Despite US policy approaches to expand HIV testing to diverse clinical care and community settings, disparities in HIV testing among Black populations persist. Foreign-born (FB) Black persons from the Caribbean have higher annual rates of HIV diagnosis and a higher percentage of late-stage HIV diagnosis, compared with US-born Black persons; and most HIV infections among FB Blacks are among men. In this article, we provide an overview of HIV testing barriers among FB Black men who engage in HIV risk-taking behaviors (e.g., condomless sex with male and/or female partners of unknown HIV serostatus). Barriers to HIV testing for both FB and US-born Black men, include HIV stigma (anticipated, perceived, internalized), low perceived HIV risk, medical or government mistrust, and perceived low access to testing resources. We examine beliefs about masculinity and gender roles that may perpetuate heteronormative stereotypes associated with perceptions of low HIV risk and barriers to HIV testing. We also discuss the impact of recent immigration policies on accessing HIV testing and treatment services and how intersectional stigmas and structural forms of oppression, such as racism, prejudice against select immigrant groups, and homophobia that may further amplify barriers to HIV testing among FB Black men. Finally, we review comprehensive prevention approaches, and suggest innovative approaches, that may improve the uptake of HIV testing among FB Black men.
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Affiliation(s)
- Tonya N. Taylor
- SUNY Downstate Health Sciences University, Brooklyn, NY, United States
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Omenka OI, Watson DP, Hendrie HC. Understanding the healthcare experiences and needs of African immigrants in the United States: a scoping review. BMC Public Health 2020; 20:27. [PMID: 31914960 PMCID: PMC6950921 DOI: 10.1186/s12889-019-8127-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 12/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Africans immigrants in the United States are the least-studied immigrant group, despite the research and policy efforts to address health disparities within immigrant communities. Although their healthcare experiences and needs are unique, they are often included in the "black" category, along with other phenotypically-similar groups. This process makes utilizing research data to make critical healthcare decisions specifically targeting African immigrants, difficult. The purpose of this Scoping Review was to examine extant information about African immigrant health in the U.S., in order to develop lines of inquiry using the identified knowledge-gaps. METHODS Literature published in the English language between 1980 and 2016 were reviewed in five stages: (1) identification of the question and (b) relevant studies, (c) screening, (d) data extraction and synthesis, and (e) results. Databases used included EBSCO, ProQuest, PubMed, and Google Scholar (hand-search). The articles were reviewed according to title and abstract, and studies deemed relevant were reviewed as full-text articles. Data was extracted from the selected articles using the inductive approach, which was based on the comprehensive reading and interpretive analysis of the organically emerging themes. Finally, the results from the selected articles were presented in a narrative format. RESULTS Culture, religion, and spirituality were identified as intertwined key contributors to the healthcare experiences of African immigrants. In addition, lack of culturally-competent healthcare, distrust, and complexity, of the U.S. health system, and the exorbitant cost of care, were identified as major healthcare access barriers. CONCLUSION Knowledge about African immigrant health in the U.S. is scarce, with available literature mainly focusing on databases, which make it difficult to identify African immigrants. To our knowledge, this is the first Scoping Review pertaining to the healthcare experiences and needs of African immigrants in the U.S.
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Affiliation(s)
- Ogbonnaya I Omenka
- College of Pharmacy and Health Sciences, Butler University, 4600 Sunset Avenue, PHSB 404E, Indianapolis, IN, 46208, USA.
| | - Dennis P Watson
- Center for Dissemination and Implementation Science, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Hugh C Hendrie
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
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Adebayo CT, Walker K, Hawkins M, Olukotun O, Shaw L, Sahlstein Parcell E, Dressel A, Luft H, Mkandawire-Valhmu L. Race and Blackness: A Thematic Review of Communication Challenges Confronting the Black Community Within the U.S. Health Care System. J Transcult Nurs 2019; 31:397-405. [DOI: 10.1177/1043659619889111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Effective communication is integral to the patient–provider relationship. Yet, as a result of structural factors that ignore the unique health care needs of different populations of patients who identify as Black—both African American and African immigrants—are confronted with communication challenges during health care seeking encounters. Using cultural safety as a framework, in this article, we thematically review communication challenges specifically experienced by patients of African descent in the U.S. health care system. In our review, we focus on complications that might arise from discrimination, mistrust, health literacy, and impacts of culture and language barriers on health literacy. In conclusion, we offer recommendations for improving the health care experiences and potential health outcomes for this population, through nursing care and health care delivery.
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Affiliation(s)
| | | | - Maren Hawkins
- University of Wisconsin–Milwaukee, Milwaukee, WI, USA
| | - Oluwatoyin Olukotun
- University of Wisconsin–Milwaukee, Milwaukee, WI, USA
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Leslie Shaw
- University of Wisconsin–Milwaukee, Milwaukee, WI, USA
| | | | - Anne Dressel
- University of Wisconsin–Milwaukee, Milwaukee, WI, USA
| | - Heidi Luft
- University of Wisconsin–Milwaukee, Milwaukee, WI, USA
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Oliphant SM, Donaldson LP. A Community-Based Participatory Approach to Understanding HIV/AIDS in the Ethiopian Community. SOCIAL WORK IN PUBLIC HEALTH 2019; 34:557-569. [PMID: 31264535 DOI: 10.1080/19371918.2019.1635944] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The rate of HIV/AIDS in Washington, D.C remains at epidemic levels and is most prevalent in the black community, with foreign-born blacks accounting for an increasing proportion of HIV infections in the Washington DC area. The Ethiopian community is among the subgroups that are especially impacted by HIV/AIDS. Yet, seldom does research on the epidemiology of HIV/AIDS break data into diverse subgroups, accounting for the distinct needs based on cultural or ethnic differences. This paper reports on the qualitative findings from a community participatory action research study that involved interviewing 60 Ethiopian-immigrants and nine community-based providers about their attitudes toward HIV/AIDS, and to elicit their ideas about how to improve HIV/AIDS prevention, promotion, and treatment approaches targeting the Ethiopian community. Findings show that stigma remains the largest barrier to accessing HIV/AIDS treatment among Ethiopians in the Washington, D.C. area. Therefore, strategies to reduce HIV/AIDS must address stigmatizing beliefs and be met with cultural sensitivity when developing community prevention and treatment outreach programs designed to reduce HIV/AIDS among Ethiopians.
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Affiliation(s)
| | - Linda Plitt Donaldson
- National Catholic School of Social Service, Catholic University of America , Washington , DC , USA
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Garabiles MR, Harper Shehadeh M, Hall BJ. Cultural Adaptation of a Scalable World Health Organization E-Mental Health Program for Overseas Filipino Workers. JMIR Form Res 2019; 3:e11600. [PMID: 30924784 PMCID: PMC6460314 DOI: 10.2196/11600] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/26/2018] [Accepted: 01/24/2019] [Indexed: 12/12/2022] Open
Abstract
Background Electronic mental (e-mental) health interventions can address mental health needs of different populations. Cultural adaptation of these interventions is crucial to establish a better fit with the cultural group and to achieve better treatment outcomes. Objective This study aimed to describe the cultural adaptation of the World Health Organization’s e-mental health program Step-by-Step for overseas Filipino workers. We used a framework which posits that cultural adaptation should enhance (1) relevance, wherein the cultural group can relate with the content; (2) acceptability, where the cultural group will not find any element offensive; (3) comprehensibility, where the program is understandable; and (4) completeness, wherein the adapted version covers the same concepts and constructs as the original program. We aimed to have English and Filipino and male and female versions. Methods Overall, 3 experienced Filipino psychologists provided their perspectives on the program and how it might be adapted for overseas Filipino workers. We then adapted the program and obtained feedback from 28 overseas Filipino workers from diverse industries through focus group discussions. We conducted 7 and 9 focus group discussions with male and female participants, respectively. Per discussion, cognitive interviewing was used to probe for relevance, acceptability, comprehensibility, and completeness of illustrations and text. Participant feedback guided iterative program adaptations, which were again shown to participants for validation and improvement. Results Several issues were raised by participants about the generic version of Step-by-Step. There were elements deemed irrelevant, like unfitting characters, lack of Filipino values, and unsuitable problems and activities. There were unacceptable components that were stigmatizing, political, inappropriate to context or subgroups, and too feminine for male users. Some elements were incomprehensible, unclear, or complicated. To address these issues, we made key adaptations. To enhance relevance, we adapted the narrative to match the experiences of overseas Filipino workers, incorporated Filipino values, and illustrated familiar problems and activities. To increase acceptability, our main characters were changed to wise elders rather than health professionals (reducing mental health and help-seeking stigma), political or unacceptable content was removed, and the program was made suitable for overseas Filipino workers from different sectors. To increase comprehension, we used English and Filipino languages, simplified the text to ease interpretation of abstract terms, and ensured that text and illustrations matched. We also used Taglish (ie, merged English and Filipino) when participants deemed pure Filipino translations sounded odd or incomprehensible. Finally, we retained the core elements and concepts included in the original Step-by-Step program to maintain completeness. Conclusions This study showed the utility of a 4-point framework that focuses on acceptance, relevance, comprehensibility, and completeness in cultural adaptation. Moreover, we achieved a culturally appropriate adapted version of the Step-by-Step program for overseas Filipino workers. We discuss lessons learned in the process to guide future cultural adaptation projects of e-mental health interventions.
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Affiliation(s)
- Melissa R Garabiles
- Ateneo de Manila University, Manila, Philippines.,Global and Community Mental Health Research Group, The University of Macau, Macau, China
| | | | - Brian J Hall
- Global and Community Mental Health Research Group, The University of Macau, Macau, China.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Mourão S, Bernardes SF. What determines immigrant caregivers' adherence to health recommendations from child primary care services? A grounded theory approach. Prim Health Care Res Dev 2019; 20:e31. [PMID: 32799992 PMCID: PMC6476339 DOI: 10.1017/s1463423619000033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 10/24/2018] [Accepted: 01/03/2019] [Indexed: 11/10/2022] Open
Abstract
AIM To investigate the diversity and specificity of the determinants of immigrant caregivers' adherence to child primary care (CPC) health recommendations. BACKGROUND Immigrant caregiver's adherence to CPC health recommendations is of utmost importance to minimize their children's health-related vulnerabilities. Some research has been conducted on the determinants of immigrants' access to health services, but much less is known about the determinants of their adherence to health professionals' recommendations once they get there, especially in a primary health care context. This study contributes to bridge these gaps. METHODS Interviews and focus groups were conducted, with immigrant and non-immigrant caregivers living in Portugal (n=35), from heterogeneous socioeconomic backgrounds. Focus group and individual interview scripts were developed to explore caregivers' understanding and use of CPC services and, particularly, their adherence to CPC recommendations. A socio-demographic questionnaire was also administered. Qualitative data were analyzed using a grounded theory methodology. FINDINGS 'Adherence to CPC health recommendations' is a core and multidimensional concept. Several determinants were identified at individual, interpersonal, organizational and structural levels. Some determinants were highlighted both by immigrant and non-immigrant caregivers: valuing children's health, usefulness of recommendations, perceived health-care professionals' competence, central role of vaccination in CPC and caregivers' socio-economic conditions. Other determinants were specifically mentioned by immigrant caregivers: expectations about traditional versus pharmacological treatments, cultural mismatches in children's care practices, perceived quality of Portuguese CPC services versus CPC from countries of origin. These results provide innovative theoretical and empirical contributions to the field of primary health care and, particularly, to immigrant caregivers' adherence behaviors. Implications for research on treatment adherence in primary care contexts, the development of interventions that promote caregivers' adherence to CPC health recommendations and for child protection will be discussed.
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Affiliation(s)
- Susana Mourão
- Department of Social and Organizational Psychology, Instituto Universitário de Lisboa (ISCTE-IUL), Lisboa, Portugal
- Department of Social and Organizational Psychology, Centro de Investigação e Intervenção Social (CIS-IUL), Lisboa, Portugal
| | - Sónia F. Bernardes
- Department of Social and Organizational Psychology, Instituto Universitário de Lisboa (ISCTE-IUL), Lisboa, Portugal
- Department of Social and Organizational Psychology, Centro de Investigação e Intervenção Social (CIS-IUL), Lisboa, Portugal
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Moon H, Badana ANS, Hwang SY, Sears JS, Haley WE. Dementia Prevalence in Older Adults: Variation by Race/Ethnicity and Immigrant Status. Am J Geriatr Psychiatry 2019; 27:241-250. [PMID: 30573327 DOI: 10.1016/j.jagp.2018.11.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 10/26/2018] [Accepted: 11/19/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To examine differences in prevalence and risk factors of dementia by race/ethnicity and immigrant status using a nationally representative sample of Medicare beneficiaries. METHODS This was a cross-sectional study performed in the United States among non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanic, and other Medicare beneficiaries from round 1 of the National Health and Aging Trends Study (N = 7,609). The authors used log-binomial regression analyses to investigate risk factors and interactions between race/ethnicity and immigrant status and dementia. Stratified log-binomial regression analyses by race/ethnicity were used to interpret the results of interaction effects of immigrant status found in these surveys. Analyses were conducted in three forms: probable dementia versus possible and no dementia, probable and possible dementia versus no dementia; and probable dementia versus no dementia. RESULTS Consistent with previous studies, U.S.-born NHBs have a higher prevalence of dementia than U.S.-born whites, Hispanics, and others. Immigrant status moderated the relationship between race/ethnicity and dementia. NHWs, Hispanics, and other immigrants had a higher prevalence of dementia compared with their U.S.-born counterparts. However, U.S.-born NHBs had a higher prevalence of dementia compared with NHB immigrants. Results were consistent across the three forms of analysis. Greater age predicted higher dementia across the four racial/ethnic groups. CONCLUSION Immigrant status may have complex effects on dementia risk. Selection factors affecting immigration-varied health and educational systems in diverse countries of origin, acculturative stress, and validity of dementia assessment across diverse groups-deserve further attention.
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Affiliation(s)
- Heehyul Moon
- Raymond A. Kent School of Social Work (HM, JSS), University of Louisville, Louisville.
| | - Adrian N S Badana
- the School of Aging Studies (ANSB, WEH), University of South Florida, Tampa, FL
| | - So-Yeon Hwang
- Department of Social Welfare (SH), Seoul National University, Seoul, South Korea
| | - Jeanelle S Sears
- Raymond A. Kent School of Social Work (HM, JSS), University of Louisville, Louisville
| | - William E Haley
- the School of Aging Studies (ANSB, WEH), University of South Florida, Tampa, FL
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Hall BJ, Garabiles MR, Latkin CA. Work life, relationship, and policy determinants of health and well-being among Filipino domestic Workers in China: a qualitative study. BMC Public Health 2019; 19:229. [PMID: 30797233 PMCID: PMC6387740 DOI: 10.1186/s12889-019-6552-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 02/15/2019] [Indexed: 02/07/2023] Open
Abstract
Background Overseas Filipino workers (OFWs) comprise one of the largest populations of migrant workers globally. Within China, they represent the largest group of imported domestic workers. Little is known about their working conditions or how this might affect their health and wellbeing. Methods This qualitative study explored the working conditions and risk factors for poor health in a sample of temporary female Filipino domestic workers in Macao, China. Focus group discussions with female domestic workers (n = 22) and in-depth interviews with key informants (n = 7) were conducted. Results Domestic workers reported physical (e.g., hypertension, chronic pain, diabetes, poor sleep), and mental health problems (depression, anxiety), and addictive behaviors (gambling, alcohol misuse), along with significant structural, linguistic, financial, and cultural barriers to healthcare access to address these concerns. Adverse working conditions including poor treatment and abuse by employers, lack of privacy and inadequate sleeping areas in employers’ homes or in crowded boarding houses, language barriers, inadequate and poor enforcement of labor protections, and discrimination. Domestic workers also cited exorbitant agency fees and remittances causing significant financial stress. Kinship network ties with family members back home were fraught with infidelity, difficulty parenting, misuse of remittances, and family misconceptions of domestic workers’ situation abroad. Lack of quality social support and peer social networks exacerbated these conditions. Conclusions In this sample of Filipino migrant domestic workers, stressors experienced within the host country were commonly reported. Indebtedness and low salaries limits social mobility. Psychosocial and policy-level interventions are needed to improve the health and wellbeing of this population of migrant women.
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Affiliation(s)
- Brian J Hall
- Global and Community Mental Health Research Group, Faculty of Social Sciences (E21), Psychology Department, University of Macau, Avenida da Universidade, Taipa, Macau, SAR, People's Republic of China. .,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Melissa R Garabiles
- Global and Community Mental Health Research Group, Faculty of Social Sciences (E21), Psychology Department, University of Macau, Avenida da Universidade, Taipa, Macau, SAR, People's Republic of China.,Department of Psychology, School of Social Sciences, Ateneo de Manila University, Quezon City, Philippines
| | - Carl A Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Cheng TC, Guo Y. Adult Immigrants’ Utilization of Physician Visits, Dentist Visits, and Prescription Medication. J Racial Ethn Health Disparities 2018; 6:497-504. [DOI: 10.1007/s40615-018-00548-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 11/16/2018] [Accepted: 11/23/2018] [Indexed: 10/27/2022]
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HIV Infection-Related Care Outcomes among U.S.-Born and Non-U.S.-Born Blacks with Diagnosed HIV in 40 U.S. Areas: The National HIV Surveillance System, 2016. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112404. [PMID: 30380715 PMCID: PMC6267013 DOI: 10.3390/ijerph15112404] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 10/17/2018] [Accepted: 10/27/2018] [Indexed: 12/25/2022]
Abstract
HIV care outcomes must be improved to reduce new human immunodeficiency virus (HIV) infections and health disparities. HIV infection-related care outcome measures were examined for U.S.-born and non-U.S.-born black persons aged ≥13 years by using National HIV Surveillance System data from 40 U.S. areas. These measures include late-stage HIV diagnosis, timing of linkage to medical care after HIV diagnosis, retention in care, and viral suppression. Ninety-five percent of non-U.S.-born blacks had been born in Africa or the Caribbean. Compared with U.S.-born blacks, higher percentages of non-U.S.-born blacks with HIV infection diagnosed during 2016 received a late-stage diagnoses (28.3% versus 19.1%) and were linked to care in ≤1 month after HIV infection diagnosis (76.8% versus 71.3%). Among persons with HIV diagnosed in 2014 and who were alive at year-end 2015, a higher percentage of non-U.S.-born blacks were retained in care (67.8% versus 61.1%) and achieved viral suppression (68.7% versus 57.8%). Care outcomes varied between African- and Caribbean-born blacks. Non-U.S.-born blacks achieved higher care outcomes than U.S.-born blacks, despite delayed entry to care. Possible explanations include a late-stage presentation that requires immediate linkage and optimal treatment and care provided through government-funded programs.
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Sabri B. Perspectives on Factors Related to HIV Risk and Preventative Interventions at Multiple Levels: A Study of African Immigrant Women Survivors of Cumulative Trauma. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2018; 30:419-433. [PMID: 30332311 PMCID: PMC6223625 DOI: 10.1521/aeap.2018.30.5.419] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
African immigrant women survivors of cumulative trauma are at high risk for HIV infection. This study aims to identify survivors' perceptions of (a) contextual (i.e., community, and relationship) and individual-level risk and protective factors for HIV among African immigrant women in the United States and (b) areas and strategies of HIV prevention intervention at contextual and individual levels. Qualitative data for this study were collected from African-born women (n = 39) in Maryland, Virginia, and Washington, DC, from February 2017 to March 2018. Seventeen in-depth interviews and five focus groups were conducted with African immigrant survivors of cumulative trauma. Results revealed HIV prevention intervention needs and risk and protective factors for HIV at the community (e.g., community education), relationship (e.g., intimate partner violence, family), and individual (e.g., women's empowerment) levels. These findings can inform the development of culturally tailored multilevel HIV prevention interventions for African immigrant women.
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Affiliation(s)
- Bushra Sabri
- John Hopkins University School of Nursing, Community Public Health Nursing, Baltimore, Maryland
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40
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Kerani R, Bennett AB, Golden M, Castillo J, Buskin SE. Foreign-Born Individuals with HIV in King County, WA: A Glimpse of the Future of HIV? AIDS Behav 2018; 22:2181-2188. [PMID: 28965262 DOI: 10.1007/s10461-017-1914-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To better understand country of birth-related shifts in the demography of people newly diagnosed with HIV infection, we compared demographic and clinical characteristics of foreign-born and U.S.-born residents of King County, WA diagnosed with HIV from 2006 to 2015. The proportion of cases that were foreign-born increased from 23 to 34% during this time. Most foreign-born cases were born in Africa (34%), Latin America (32%), Asia (22%), or Europe (7%). Latin Americans and Asians were similar to U.S.-born individuals by HIV risk factor and gender, while Africans were more likely to be female and less often men who have sex with men. In 2015, approximately 15% of cases presumptively newly diagnosed in King County were foreign-born individuals who self-reported a pre-immigration HIV diagnosis. Increases in foreign-born individuals previously diagnosed out of country may lead to inaccuracy in the count of new diagnoses, including an over-estimate of community-acquired HIV in King County.
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Affiliation(s)
- Roxanne Kerani
- HIV/STD Program, Public Health - Seattle & King County, Seattle, WA, USA.
- Division of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA.
- Center for AIDS and STD, Harborview Medical Center, Box 359931, 325 9th Ave, Seattle, WA, 98104, USA.
| | - Amy B Bennett
- HIV/STD Program, Public Health - Seattle & King County, Seattle, WA, USA
| | - Matt Golden
- HIV/STD Program, Public Health - Seattle & King County, Seattle, WA, USA
- Division of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA
| | - Jocelyn Castillo
- HIV/STD Program, Public Health - Seattle & King County, Seattle, WA, USA
| | - Susan E Buskin
- HIV/STD Program, Public Health - Seattle & King County, Seattle, WA, USA
- Division of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA
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Kwakwa HA, Wahome R, Goines DS, Jabateh V, Green A, Bessias S, Flanigan TP. Engaging African and Caribbean Immigrants in HIV Testing and Care in a Large US City: Lessons Learned from the African Diaspora Health Initiative. J Immigr Minor Health 2017; 19:818-824. [PMID: 27198156 DOI: 10.1007/s10903-016-0431-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The lifting in 2010 of the HIV entry ban eliminated an access point for HIV testing of the foreign-born. The African Diaspora Health Initiative (ADHI) was developed to examine alternative pathways to testing for African and Caribbean persons. The ADHI consists of Clinics Without Walls (CWW) held in community settings. HIV testing is offered to participants along with hypertension and diabetes screening. A survey is administered to participants. Descriptive data were analyzed using SAS 9.2. Between 2011 and 2015, 4152 African and Caribbean individuals participated in 352 CWW. Participants were mostly (67.7 %) African. HIV rates were lowest in Caribbean women (0.4 %) and highest in Caribbean men (8.4 %). Efforts to engage African and Caribbean communities in HIV testing are important given the elimination of the HIV entry ban and continued immigration to the US from areas of higher prevalence. The ADHI offers a successful model of engagement.
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Affiliation(s)
- Helena A Kwakwa
- Ambulatory Health Services, Philadelphia Department of Public Health, 500 South Broad Street, Suite 360, Philadelphia, PA, 19146, USA.
| | | | - Djalika S Goines
- African Cultural Alliance of North America, Philadelphia, PA, USA
| | - Voffee Jabateh
- African Cultural Alliance of North America, Philadelphia, PA, USA
| | - Arraina Green
- Ambulatory Health Services, Philadelphia Department of Public Health, 500 South Broad Street, Suite 360, Philadelphia, PA, 19146, USA
| | - Sophia Bessias
- Ambulatory Health Services, Philadelphia Department of Public Health, 500 South Broad Street, Suite 360, Philadelphia, PA, 19146, USA
| | - Timothy P Flanigan
- Department of Infectious Diseases, Brown University School of Medicine, Providence, RI, USA
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Ojikutu BO, Mazzola E, Fullem A, Vega R, Landers S, Gelman RS, Bogart LM. HIV Testing Among Black and Hispanic Immigrants in the United States. AIDS Patient Care STDS 2016; 30:307-14. [PMID: 27410494 PMCID: PMC4948212 DOI: 10.1089/apc.2016.0120] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Late presentation is common among black and Hispanic US immigrants living with HIV. Little is known about HIV testing in this population because data are aggregated into racial and ethnic categories without regard to nativity. This study was undertaken to determine HIV testing patterns in these populations. We used data from the National Health Interview Survey (2007-2010), a nationally representative source of HIV testing data disaggregated by nativity. The sample consisted of 10,397 immigrants (83.9% Hispanic white, 13.1% non-Hispanic black, and 3.0% Hispanic black). The majority of participants were from the Caribbean, Central America, and Mexico (81.5%). Hispanic white immigrants were least likely to have undergone testing compared with non-Hispanic and Hispanic black immigrants (46.7% vs. 70.5% and 65.8%). Among immigrants with known risk factors or prior STDs, 59.2% and 74.8% reported previous HIV testing. Immigrants who had not recently talked to a healthcare provider were less likely to report testing: Hispanic white (AOR 0.65, 95% CI 0.58-0.72), non-Hispanic black (AOR 0.64, 95% CI 0.48-0.85), and Hispanic black (AOR 0.26, 95% CI 0.14-0.48). Only 17.2% of all immigrants intended to undergo HIV testing in the 12 months following participation in the survey. Among all three racial and ethnic groups, immigrants who reported a history of prior STDs were more likely to intend to test for HIV in the future. Many black and Hispanic immigrants to the United States have not undergone HIV testing. Interventions to increase access to HIV testing and awareness of transmission risk should be developed.
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Affiliation(s)
- Bisola O. Ojikutu
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts
- John Snow Research and Training Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Emanuele Mazzola
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Andrew Fullem
- John Snow Research and Training Institute, Boston, Massachusetts
| | - Rodolfo Vega
- John Snow Research and Training Institute, Boston, Massachusetts
| | - Stewart Landers
- John Snow Research and Training Institute, Boston, Massachusetts
| | - Rebecca S. Gelman
- Harvard Medical School, Boston, Massachusetts
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Laura M. Bogart
- Harvard Medical School, Boston, Massachusetts
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
- RAND Corporation, Santa Monica, California
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