Effects of length of stay and language proficiency on health care experiences among immigrants in Canada and the United States

Transition, Adjustment, and Healthcare Avoidance: African Immigrant Women's Experiences and Perceptions of Navigating Primary Healthcare in the USA

This study explores the transition and adjustment of African immigrant women, particularly Ethiopian immigrant women (EIW), as they navigate the U.S. healthcare system and their ability to access and utilize healthcare services. A qualitative cross-sectional design with a mix of purposive and snowball sampling techniques was utilized to recruit EIW (N = 21, ≥18 years) who arrived in the U.S. within the last five years. One-on-one in-depth interviews were conducted to collect data. The interviews were audio-recorded, transcribed verbatim, and analyzed thematically using Nvivo12 software. The thematic analysis revealed three major themes: (1) settling into new life in the U.S. delays EIWs' ability to access primary healthcare; (2) adjusting to the U.S. healthcare system: confusions and mixed perceptions; and (3) avoidance of care: EIW's reasons for PHC visits changed in the U.S. Participants avoided healthcare, except for life-threatening conditions, general check-ups, and maternal healthcare services. Transitional support for legal, residential, employment, and health information could help tackle the challenges of accessing primary healthcare for EIW. Future research should analyze access to healthcare in relation to the everyday struggles of immigrant women, as well as legal and complex structural issues beyond acculturative issues.

The effects of residential segregation on cognition among U.S. older adults: a systematic review based on the social determinants of health model

OBJECTIVES

This systematic review aims to advance the understanding of the complicated effects of segregation on older adults' cognition and provide guidance for future research.

METHOD

A systematic review using the Social Determinants of Health framework to examine the relationship between segregation and cognition across the selected literature.

RESULTS

Eight papers met the criteria for inclusion. All selected studies examined the influence of living in a segregated area on older adults' cognition, covering older adults from different racial/ethnic groups. The association between segregation and cognition was found in different directions across different racial/ethnic groups. The effects can be varied depending on race/ethnicity, level of education, neighborhood socioeconomic status, or social context.

CONCLUSION

This review identified existing gaps in understanding the relationship between segregation and cognition. Future studies should carefully adopt the segregation measures, acknowledge the varying segregation experience among different racial/ethnic groups, and consider more social determinant factors in research.

Characterizing trauma encounters among patients with language other than English preference at a level 1 trauma center's emergency department

Objectives

Injury-related visits constitute a sizeable portion of emergency department (ED) visits in the United States. Individuals with language other than English (LOE) preference face barriers to healthcare and visits for traumatic injury may be the first point of contact with the healthcare system. Yet, the prevalence of traumatic injuries in this population is relatively unknown. Our objective was to characterize the prevalence and purpose of trauma encounters, and healthcare utilization, among a LOE cohort.

Methods

We conducted a retrospective chart review of LOE patients who presented for a trauma encounter at a level 1 trauma and emergency care center between January 1, 2019 and December 31, 2021. LOE participants were identified by utilization of video-based language interpretive services. Variables evaluated included injury patterns and primary and subspeciality healthcare utilization. Quantitative analysis of categorical and continuous variables was performed.

Results

A total of 429 patients were included. Most patients presented for one trauma encounter and the majority spoke Spanish. The most common causes of injury were motor vehicle collisions (MVCs) (28.5%, n = 129), ground-level falls (15.9%, n = 72), and falls from heights (14.2%, n = 64). Occupational injuries made up 27.2% of trauma encounters (n = 123) and only 12.6% (n = 54) of patients had a primary care visit.

Conclusion

Our findings highlight the need for increased research and attention to all causes of injury, especially MVCs and occupational injuries, among those with LOE preference. Results reaffirm an underutilization of healthcare among this population and the opportunity for trauma encounters as points of access to care.

Disparities by Race/Ethnicity and Immigration Status in Perceived Importance of and Access to Culturally Competent Health Care in the United States

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.

Limited English Proficiency Is Not Associated With Poor Postoperative Outcomes or Follow-Up Rates in Patients Undergoing Breast Reduction Mammoplasty - A Single Institution Retrospective Cohort Study

INTRODUCTION

Limited English Proficiency (LEP) status has been associated with worse patient outcomes on a variety of metrics.

METHODS

A retrospective review of all bilateral breast reduction mammoplasty patients at our institution between 2015 and 2019 was performed. Data collected include patient demographics, language status, interpreter usage, complications, and follow-up clinic/emergency department visits. Patients were grouped into high and low follow-up cohorts by median follow-up. Bivariate testing and regression modeling were used for analysis.

RESULTS

A total of 1023 patients were included. Average age and body mass index (BMI) were 37.7 years and 31.7 kg/m2. All LEP (21%) patients used interpreters. There were 590 individuals in the low follow-up and 433 in the high follow-up group. Those in low follow-up were younger, with lower BMI, and were more likely to use Medicaid. Prevalence of diabetes and postoperative emergency department visits were higher in the high follow-up cohort. There were no significant differences in race/ethnicity, smoking status, and interpreter use between groups. Poisson modeling demonstrated that presence of complications is associated with a 0.435 increase in the number of clinic visits and a 1-y increase in age is associated with a 0.006 increase (P < 0.001). Interpreter use was not significantly associated with postoperative clinic visits. Multivariable regression modeling demonstrated BMI and diabetes to be significantly associated with incidence of any complication (odds ratio: 1.08 & 2.234; P < 0.001 &P = 0.01, respectively).

CONCLUSIONS

LEP status was not associated with worse postoperative outcomes or follow-up length in patients undergoing breast reduction mammoplasty. This may be due to interpreter use and effective patient education.

Usability of technological tools to overcome language barriers in health care: a scoping review protocol

INTRODUCTION

In many healthcare contexts globally, where the languages of care providers and patients do not match, miscommunication or non-communication can lead to inaccurate diagnoses and subpar treatment outcomes. In order to bridge these language barriers, a range of informal practices are used, such as family members or staff acting as interpreters, 'receptive multilingualism' or machine translation. The development and use of technological tools are increasing, but factors such as translation quality for complex health-related texts vary widely between languages. The objective of this scoping review is to (1) identify and describe the technological tools used in direct patient-provider communication to overcome a language barrier in a healthcare setting, (2) identify how the usability of these tools was evaluated and (3) assess the usability of the technological tools.

METHODS AND ANALYSIS

The scoping review will follow the Joanna Briggs Institute methodology. A search strategy using variations of the keywords 'technological tools', 'language barrier' and 'healthcare' will be applied in the following databases and research platforms: PubMed, PsycArticle, Scopus, EBSCOhost, ProQuest and Web of Science. All literature where individuals use a technological tool to overcome a language barrier in a healthcare context will be included and exported into the screening assistant software Rayyan. The search will be limited to articles written in German or English. Two independent reviewers will screen the articles, and all relevant extracted data will be presented in a descriptive summary.

ETHICS AND DISSEMINATION

This scoping review does not require ethical approval, as the study's methodology consists of collecting data from publicly available sources. The findings will be disseminated through publication in an open-access, peer-reviewed journal and presentations at scientific conferences. The scoping review results will also guide future research in a multinational project investigating multilingualism in providing (mental) healthcare to migrants.

Health Service Utilization of Black Immigrant Women Residing in the United States: A Systematic Review

Black immigrants constitute a rapidly growing population group in the U.S. A comprehensive understanding of health services used by Black immigrant women is necessary to support the complex needs of this population. We conducted a systematic review to (1) understand the types of health services used by Black immigrant women living in the U.S. and (2) examine barriers and motivators to using health services. Relevant studies were identified in the following databases: PubMed, PsychInfo, CINAHL, and Embase. Articles published until October 2022 were included in the review. From a total of 15,245 records, 47 articles that reported on health service utilization practices of Black immigrant women were included in the review. A variety of different health services were accessed by Black immigrant women, such as hepatitis screening, reproductive health services, cancer screenings, substance abuse treatment, mental health services, HIV services, dental services, genetic testing, cardiovascular risk testing, and general health services/ hospitalizations. Motivators for using health services included possession of health insurance, knowledge of health resources and conditions, and positive experiences with providers. Barriers to using health services included challenges navigating the health system, language barriers, and cultural beliefs. Factors that positively influence health service utilization must be expanded at the institutional, societal, and policy levels to improve access to health services for Black immigrant women.

Language Disparity Predicts Poor Patient-Reported Outcome and Follow-Up in Microsurgical Breast Reconstruction

BACKGROUND

 Patients with limited English proficiency (LEP) have starkly different health care experiences compared with their English-proficient counterparts. The authors aim to examine the link between LEP and postoperative outcomes in patients undergoing microsurgical breast reconstruction.

METHODS

 A retrospective review of all patients who underwent abdominal-based microsurgical breast reconstruction at our institution between 2009 and 2019 was performed. Variables collected included patient demographics, language status, interpreter usage, perioperative complications, follow-up visits, and self-reported outcomes (Breast-Q). Pearson's χ 2 test, Student's t-test, odds ratio analysis, and regression modeling were used for analysis.

RESULTS

 A total of 405 patients were included. LEP patients comprised 22.22% of the overall cohort with 80% of LEP patients utilizing interpreter services. LEP patients reported significantly lower satisfaction with an abdominal appearance at the 6-month follow-up and lower physical and sexual well-being scores at the 1-year follow-up (p = 0.05, 0.02, 0.01, respectively). Non-LEP patients had significantly longer operative times (539.6 vs. 499.3 minutes, p = 0.024), were more likely to have postoperative donor site revisions (p = 0.05), and more likely to receive preoperative neuraxial anesthesia (p = 0.01). After adjusting for confounders, LEP stats was associated with 0.93 fewer follow-up visits (p = 0.02). Interestingly, compared with LEP patients who did not receive interpreter services, LEP patients who did had 1.98 more follow-up visits (p = 0.02). There were no significant differences in emergency room visits or complications between the cohorts.

CONCLUSION

 Our findings suggest that language disparities exist within microsurgical breast reconstruction and underscore the importance of effective, language-conscious communication between surgeon and patient.

A longitudinal study of immigrant mothers' destination-language proficiency and their children's psychological well-being: Evidence and mechanisms from a study in South Korea

RATIONALE

Despite the well-established link between an immigrant's destination-language proficiency and psychological well-being, little is known about the relationship between an immigrant's destination-language proficiency and well-being of their children.

OBJECTIVE

This study investigated whether and how immigrant mothers' Korean proficiency is associated with life satisfaction and depressive symptoms among their children in South Korea. A comprehensive set of potential underlying mechanisms was also examined.

METHODS

Using four waves of data from the Multicultural Adolescents Panel Study (MAPS), this study estimated fixed effects regression models to reduce the possibility of bias due to individual-level heterogeneity. To test for mediation formally, Sobel mediation tests were conducted.

RESULTS

Fixed effects estimates suggested that immigrant mothers' Korean proficiency is positively associated with their children's psychological well-being. Specifically, a one-standard-deviation increase in Korean proficiency was associated with an increase in life satisfaction by 13% of a standard deviation and a decrease in depressive symptoms by 9% of a standard deviation. Mediation tests revealed that this association is explained by a combination of social-psychological factors. Friend support was the most salient mediator, followed by lower acculturation stress, positive perceptions of local community, and teacher support.

CONCLUSIONS

The findings of this study suggest that efforts to improve immigrant mothers' destination-language proficiency would also benefit their children's psychological well-being. Furthermore, promoting children's relationships with peers at school may mitigate the negative psychological consequences of immigrant mothers' limited language proficiency.

[Evaluation of a referral protocol to primary health care for patients eligible for health service access points following hospitalization]

INTRODUCTION

PASS is a hospital care unit that provides access to health care for precarious persons and supports them as soon as they have obtained primary health care insurance. No details of this support had previously been described. A Hospital-to-Community protocol for referral to the public health system has been developed at the adult PASS unit of the Marseille public hospitals (AP-HM). The objectives of this study are to describe how this protocol is applied, to evaluate at six months the inclusion in general practice of patients having benefited (or not) from this protocol and to determine the key influencing factors.

MATERIAL AND METHOD

This two-arm prospective observational study collected data on the primary care pathways of precarious patients six months after their having obtained health coverage, and found out whether or not the newly existing protocol had been effectively implemented. It was carried out on a cohort of people included in the PASS-MULTI study who had acquired complete health coverage.

RESULTS

Sixty patients were included between November 2020 and August 2022, 35 of whom had availed themselves of the Hospital-to-Community protocol. Among them, 68.8% in the interventional group had consulted their referring general practitioner within six months, vs. 40% in the control group (p = 0.04). The initiation of follow-up in general medicine was associated with application of the protocol (p = 0.04).

CONCLUSION

This study described an initial Hospital-to-Community protocol for referral to the primary healthcare system of patients followed up in the PASS unit and found an association between application of this protocol and initiation of follow-up in primary healthcare.

Impact of patient nationality on the severity of early side effects after radiotherapy

BACKGROUND

Major demographical changes in Germany commenced in the 1960s. Ongoing humanitarian crises in the Ukraine with subsequent immigration will have also long-range effects on national provision of cancer treatment. Ensuring the best possible outcomes for each cancer patient undergoing radiotherapy requires the prediction and prevention of unfavorable side effects. Given that recent research has primarily focused on clinical outcome indicators solely, less is known regarding sociodemographic predictors of therapeutic outcomes, such as patient nationality. Here, we investigated whether the severity of early side effects after radiotherapy are associated with patient nationality and other sociodemographic and clinical characteristics.

METHODS

Out of 9187 patients treated at a German university medical center between 2017 and 2021, 178 German and 178 non-German patients were selected for matched-pair analysis based on diagnostic and demographic criteria. For all 356 patients, data on side effects from follow-up care after radiotherapy were collected.

RESULTS

Non-German patients were more likely to have severe side effects than German patients. Side effect severity was also associated with tumor entity, concomitant therapy, body mass index, and age.

CONCLUSION

Foreign cancer patients are at higher risk of experiencing severe side effects of radiotherapy, suggesting a need to develop and implement targeted preventive measures for these patients. Further research investigating factors predicting the occurrence of radiotherapy side effects, including other sociodemographic characteristics, is needed to better personalize therapy regimens for cancer.

Indicators of integrating oral health care within universal health coverage and general health care in low-, middle-, and high-income countries: a scoping review

BACKGROUND

The World Health Organization (WHO) has recently devoted special attention to oral health and oral health care recommending the latter becoming part of universal health coverage (UHC) so as to reduce oral health inequalities across the globe. In this context, as countries consider acting on this recommendation, it is essential to develop a monitoring framework to measure the progress of integrating oral health/health care into UHC. This study aimed to identify existing measures in the literature that could be used to indicate oral health/health care integration within UHC across a range of low-, middle- and high-income countries.

METHODS

A scoping review was conducted by searching MEDLINE via Ovid, CINAHL, and Ovid Global Health databases. There were no quality or publication date restrictions in the search strategy. An initial search by an academic librarian was followed by the independent reviewing of all identified articles by two authors for inclusion or exclusion based on the relevance of the work in the articles to the review topic. The included articles were all published in English. Articles concerning which the reviewers disagreed on inclusion or exclusion were reviewed by a third author, and subsequent discussion resulted in agreement on which articles were to be included and excluded. The included articles were reviewed to identify relevant indicators and the results were descriptively mapped using a simple frequency count of the indicators.

RESULTS

The 83 included articles included work from a wide range of 32 countries and were published between 1995 and 2021. The review identified 54 indicators divided into 15 categories. The most frequently reported indicators were in the following categories: dental service utilization, oral health status, cost/service/population coverage, finances, health facility access, and workforce and human resources. This study was limited by the databases searched and the use of English-language publications only.

CONCLUSIONS

This scoping review identified 54 indicators in a wide range of 15 categories of indicators that have the potential to be used to evaluate the integration of oral health/health care into UHC across a wide range of countries.

Acculturation and Children's dental service utilization in the United States

OBJECTIVE

The study examined changes in acculturation level, socio-economic status, and their association with preventive dental service use, receipt of restorative, or surgical care, and unmet dental needs.

METHODS

Data from the Medical Expenditure Panel Survey (MEPS) for children aged 1 to 17 years from 2007 to 2015 were analysed. Firstly, a cross-sectional structural equation model (SEM) that included both a measurement model and a structural model was fitted simultaneously to obtain predicted latent variables for acculturation, socio-economic status (SES), dental service utilization, and unmet dental needs. Secondly, the change in acculturation, SES, dental service utilization, and unmet dental needs were calculated over two consecutive years within the same child. Finally, the structural model in these changes was fitted, and the indirect and direct pathways between acculturation and SES were tested with dental insurance as a mediator.

RESULTS

Data for 33 507 children in both panel years were analysed. An increase in family acculturation resulted in lower utilization of preventive dental service and more unmet dental need, with socio-economic status and dental insurance kept constant between the panel years, and after adjusting for race/ethnicity, gender, and age. In addition, increased acculturation was associated with higher SES, and a higher probability of having obtained dental insurance, both of which resulted in increased preventive dental service utilization and less unmet dental need. The positive direct effect and negative indirect effect of acculturation on unmet dental need cancelled each other out and resulted to almost zero total effect between acculturation and unmet dental need. Similarly, the negative direct effect and positive indirect effect of acculturation on preventive dental service cancelled each other out leading to a small increase in preventive dental service utilization.

CONCLUSION

Children of immigrant families are at risk of inadequate access to dental care as their families becomes more acculturated, without increase in SES and access to dental insurance. This study supports policies that promote immigrant family's adequate access to dental insurance and employment to improve their socio-economic status.

The Experience of Informal Newcomer Cancer Caregivers with Limited Language Proficiency: A Scoping Review

This scoping review explored what is known about the experiences of informal cancer caregivers (CGs) who are newcomers with limited language proficiency. A literature search was performed in seven databases and the search yielded 11,289 articles. After duplicate removal and title and abstract screening, 216 articles underwent full text review and 57 articles and were synthesized. Most studies (n = 41, 72%) were qualitative and were published in North America (n = 35, 61%). Most CG participants were female (69%) and only 19 studies explicitly identified the CG country of origin. Of those that did, 26% originated from Asia, with most migrating from East Asia. Significant challenges were experienced by newcomer CGs and chief among these were related to communication challenges with HCPs that were exacerbated by a lack of availability of medical interpreters and the complexity of oncology health information. Efforts are needed to better integrate newcomer CGs into cancer care.

Association Between Social Support and Depression Help-Seeking Behaviors Among U.S. Chinese Older Adults

Objectives: Depression has become one major mental health concern among Asian older adults. Yet, less is known about the role of social support on depression help-seeking among this population. This study examined the association between positive (i.e., open up to, rely on) and negative (i.e., too many demands, criticism) social support and depression help-seeking among U.S. Chinese older adults. Methods: Data were derived from the Population Study of Chinese Elderly in Chicago (PINE). Study sample consisted of 994 U.S. Chinese older adults with depressive symptoms. Results: Stepwise logistic regression results indicated that greater positive social support was associated with increased likelihood of both formal and informal help-seeking behaviors, whereas negative support was not a significant predictor. Discussion: Findings highlight the key role of positive social support in influencing U.S. Chinese older adults' depression help-seeking behaviors. Tailored strategies are recommended to better meet the mental health needs of this vulnerable population.

Utilization of healthcare by immigrants in Canada: a cross-sectional analysis of the Canadian Community Health Survey

Background

Immigrants to Canada face unique barriers to health care, which leads to inequities in health care utilization. Lower utilization of health care by immigrants to Canada is associated with the deteriorating health of individual immigrants as well as increased costs to the health care system. The existing literature suggests that time since immigration is an important predictor for utilization of health care for Canadian immigrants; however, few studies have included this variable in their analysis. This study aims to examine the relationships between having a regular health care provider and time since immigration, and number of medical consultations in the past year and time since immigration.

Methods

A secondary cross-sectional data analysis using Andersen and Newman’s Framework of Health Service Utilization and data from the 2015–2016 Canadian Community Health Survey (CCHS) was conducted to examine health care utilization among immigrants in Canada. We used multiple logistic regression to examine the relationship between time since immigration and having a regular physician and negative binomial regression to compare the number of consultations of recent (less than 10 years since immigration) and established (10 or more years since immigration) immigrants.

Results

Eighty four percent of immigrant respondents to CCHS 2015–2016 had a regular health care provider. After controlling for other independent variables, established immigrants were 1.75 (95% confidence interval: 1.45–2.10) times more likely to have a regular health care provider compared to recent immigrants. Immigrants had a mean of 3.37 (standard deviation 4.53) medical consultations in the preceding year. There was no difference in the mean number of medical consultations by recent and established immigrants.

Conclusions

After controlling for other independent variables, this study found that time since immigration had a significant effect on having a regular provider but not on number of consultations. Differences in health care utilization for recent and for established immigrants observed in this study may be partially explained by Canada’s evolving immigration policy and the economic and social integration of immigrants over time.

Dialect culture and the utilization of public health service by rural migrants: Insights from China

The right to health is a fundamental human right for human beings to live in dignity. Everyone has the right to enjoy the fair and accessible highest standard of health by utilizing public health services. However, access to essential public health services also highly depends on the dialect culture. It is believed that the dialect culture also influences the efficiency of public health policies. To explore the phenomenon empirically, the current study utilized data sourced from geographical distribution information of Chinese dialects and the China Migrants Dynamic Survey for 2017. The study employed the Probit, IVprobit, and Eprobit models to estimate the impact of dialect culture on migrants' use of public health services. The findings revealed that the dialect culture significantly hinders the migrants' utilization of public health services. Further, by employing heterogeneity analysis, the findings revealed that the results are more pronounced in migrants, born after 1980, and are female with low educational background and also those migrants having local medical experiences and moving toward non-provincial cities. Finally to explore the mechanism of dialect culture influencing migrants' public health service, the study employed mediation analysis and KHB Method. The findings revealed that information transmission, health habits, social capital, and cultural identity are the potential pathways influencing the migrants' use of public health services. The findings conclude that rural-to-urban migrants' access to public health services is influenced by their cultural adaptation. Hence, the study proposes that the government should amend the policy inefficiency concerns caused by cultural differences and strengthen the regional cultural exchanges to build trust.

Mi Plan: Using a Pediatric-Based Community Health Worker Model to Facilitate Obtainment of Contraceptives Among Latino Immigrant Parents with Contraceptive Needs

BACKGROUND

Bilingual community health workers (CHWs) play an important role in helping Latino immigrants with limited English proficiency (LEP) access health care services and information. Contraceptive health care services and Spanish-language contraceptive information are particularly challenging to access for uninsured LEP immigrants. Contraceptive and reproductive care are longitudinal health needs, and pediatric settings pose a unique opportunity to address these needs among parents whose children access pediatric care. The purpose of this study was to pilot the feasibility of a CHW to support parental contraceptives needs within a pediatric setting serving a high number of Latino immigrant families. This article describes Mi Plan/My Plan, a CHW contraceptive counseling and resource navigation pilot program.

METHODS

The research team conducted a retrospective analysis of demographic and contraceptive use data from a 15-month CHW pilot within an urban, primary care pediatrics clinic. The CHW provided contraceptive counseling, referral, and appointment coordination. The outcome was desired contraceptive method obtainment within three months of counseling.

RESULTS

All 311 individuals counseled were Latina mothers with median child age of 3 months. At baseline, 64.3% were using contraception and 76.5% desired to start or change their current method. Among those who desired a change, 47.9% (114/238) obtained their desired method within three months of initial counselor contact.

CONCLUSION

Bilingual CHW contraceptive counseling and care coordination is feasible and acceptable in a pediatric setting serving a high number of Latino immigrant families. CHWs in pediatric settings support health care access equity and are relevant to optimal maternal and child health.

Health insurance status of cross-border migrant children and the associated factors: a study in a Thai-Myanmar border area

Background

Although policies of Thailand for migrant health protection are inclusive for all migrant groups, due to existing constraints in practices and policy implementation, many migrant children still lack the protection. This study aimed to assess the health insurance status of children aged 0-14 whose parents were cross-border migrant workers in Thailand, and factors related to the status.

Methods

A Thai-Myanmar border area, being developed as a ‘special economic zone’ by the Thai government, was selected as a study site. With a cross-sectional research design, the study collected primary data in late 2018 by a structured questionnaire from 402 migrant households that contained 803 children. The logistic generalized estimating equation (GEE) technique was applied to examine factors associated with the children’s health insurance status. These included socio-economic factors, migration factors, and health insurance-related factors.

Results

It is found that 83.2% of the migrant children did not have health insurance. Factors associated with the health insurance status included age 12-14 years (Odds ratio (OR) 2.34; 95% confidence interval (CI) 1.23-4.46), having a birth certificate (OR 1.89, 95% CI 1.04-3.45), and plan of the family in the future to remain the child in Thailand (OR 2.37, 95% CI 1.09-5.17). The primary carer’s factors that were important health insurance-related factors included having no legal work permit (OR 4.12, 95% CI 1.88-9.06), having health insurance (OR 8.51, 95% CI 3.93-18.41), little or no ability to communicate in Thai (OR 0.31, 95% CI 0.14-0.66), and understanding the right of migrant children to purchase health insurance (OR 2.57, 95% CI 1.52-4.34).

Conclusions

The findings point to the need for every migrant child to have a birth certificate, diminishing language barriers, and providing education and motivation about the need for health insurance for migrants and their accompanying dependents, especially children. For further studies, it is suggested to include migrant health insurance supply-side factors with qualitative analyses to understand how all the factors interactively determine the health insurance status of migrant children.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08681-0.

Access to Health-Related Information, Health Services, and Welfare Services among South and Southeast Asian Immigrants in Japan: A Qualitative Study

Migrants face several challenges in their daily lives in the host country due to limited knowledge about the language, culture, and social system of the host country. Their vulnerability increases in a time of crisis. During the COVID-19 pandemic, migrant communities were severely affected. Evidence on migrants' access to COVID-19-related information and services is limited. We conducted a qualitative, descriptive study among migrants from Vietnam, Myanmar, and Nepal living in Japan to explore the barriers and promoting factors for their access to health-related information, health services, and welfare services during the first wave of COVID-19. We used a thematic analysis to identify key themes according to the study's objectives. Further, these themes were assessed using an adapted version of the ecological model. The migrants mainly relied on the information available on social networking sites and were not aware of formal sources of information. Language was a major barrier, followed by cognitive bottlenecks and time constraints for migrants accessing health-related information and services. Social media, short-form information provided using their native language or plain Japanese and illustrations, and supportive people around could help them to access health-related information and services. The findings from this study demonstrate how migrants can represent a vulnerable group in a host country, even more so in a time of crisis.

Experiences of Migrant People Living with HIV in a Multidisciplinary HIV Care Setting with Rapid B/F/TAF Initiation and Cost-Covered Treatment: The ‘ASAP’ Study

This study aimed to explore the experiences of migrant people living with HIV (MLWH) enrolled in a Montreal-based multidisciplinary HIV care clinic with rapid antiretroviral treatment (ART) initiation and cost-covered ART. Between February 2020 and March 2022, 32 interviews were conducted with 16 MLWH at three time-points (16 after 1 week of ART initiation, 8 after 24 weeks, 8 after 48 weeks). Interviews were analyzed via the Framework Method. Thirty categories were identified, capturing experiences across the HIV care cascade. At diagnosis, most MLWH described “initially experiencing distress”. At linkage, almost all MLWH discussed “navigating the health system with difficulty”. At treatment initiation, almost all MLWH expressed “being satisfied with treatment”, particularly due to a lack of side effects. Regarding care retention, all MLWH noted “facing psychosocial or health-related challenges beyond HIV”. Regarding ART adherence, most MLWH expressed “being satisfied with treatment” with emphasis on their taking control of HIV. At viral suppression, MLWH mentioned “finding more peace of mind since becoming undetectable”. Regarding their perceived health-related quality of life, most MLWH indicated “being helped by a supportive social network”. Efficient, humanizing, and holistic approaches to care in a multidisciplinary setting, coupled with rapid and free ART initiation, seemed to help alleviate patients’ concerns, address their bio-psycho-social challenges, encourage their initial and sustained engagement with HIV care and treatment, and ultimately contribute to positive experiences.

Health risks among long-term immigrants in Norway with poor Norwegian language proficiency

BACKGROUND

Poor health among immigrants has been associated with longer duration of residence in the host country, poor host language proficiency and low education. However, the interplay among these factors is under-studied.

OBJECTIVE

To assess health among immigrants in Norway by combinations of duration of residence, Norwegian language proficiency and education.

METHODS

In 2015/2016 Statistics Norway carried out two cross-sectional Living Conditions Surveys in the general adult population (N=5703, response rate 59%) and among immigrants from 12 countries, with ⩾2 years of residence (N=3993, response rate 54%). Health outcomes (poor self-reported health, diabetes, cardiovascular disease, hypertension, obesity, mental health problems, back/neck pain) were assessed with logistic regressions according to combinations of duration of residence, Norwegian language proficiency and education.

RESULTS

Negative health conditions were more common among immigrants than in the general population, and varied by duration of residence, proficiency in the Norwegian language and education. In age- and sex-adjusted regressions, immigrants had higher odds of all negative health conditions, except hypertension, regardless of their duration of residence, proficiency of the Norwegian language and educational level. Immigrants with a long duration of residence and poor proficiency in the Norwegian language had the highest odds of negative health conditions.

CONCLUSIONS

Special attention is warranted towards health among immigrants who have lived in Norway the longest without acquiring good Norwegian language proficiency.

Evaluating chronic pain interventions in recent refugees and immigrant populations: A systematic review

OBJECTIVES

Many studies investigating the management of chronic pain often exclude participation of people from refugee and immigrant backgrounds. This review seeks to understand and evaluate the effectiveness of interventions for chronic pain management when applied in the context of refugee and immigrant populations.

METHODS

A systematic review was undertaken using six databases and the PICO search strategy. Included studies were published in English, comprised of patients over 18 years of age and excluded cancer-related chronic pain.

RESULTS

Twenty-one papers met the inclusion criteria: 13 cohort studies and eight randomised control trials. The majority of interventions involved multidisciplinary or psychological interventions, with the remaining studies based on education, exercise therapy or culturally adapted information. Studies integrating multidisciplinary care to manage chronic pain showed more consistent improvements in pain intensity and function than other unimodal interventions.

CONCLUSIONS

Multidisciplinary interventions reduce pain intensity, improve functional impairment, and alleviate other psychosocial symptoms exhibited chronic pain patients from refugee or immigrant backgrounds. Additional well-designed, large-scale studies are needed to decisively estimate the effectiveness of culturally adapted, multidisciplinary intervention programs over time.

PRACTICE IMPLICATIONS

Clinical practice may benefit from adapting interventions to better support the management of chronic pain in refugee and immigrant populations.

Transnational Parenthood and Migrant Subjective Well-Being in Italy

Transnational parents are migrant mothers and fathers who have at least one child left behind in the home country. Despite their non-negligible prevalence in many destination countries, scarcity of data on the topic has caused a lack of attention to this phenomenon in both policy and scholarship. In particular, little is known about how the interplay between migration and family relations at a distance affects the individual well-being of both migrant parents and their left-behind children, especially in a European context. This article evaluates the subjective well-being of migrant couples currently residing in Italy who have children left behind, compared with childless migrants and with migrant parents living with their children in Italy. Multivariate logistic regression applied to individual-level data from Istat's Survey on Social condition and integration of foreign citizens, 2011–2012, shows that transnational parents experienced lower levels of self-rated health compared with migrants with different family statuses and that the well-being loss associated with transnational parenthood is strongly gendered. Controlling for individual characteristics, socio-economic conditions, the presence of minor children, and migration background, our analysis demonstrates that men's subjective wellbeing did not vary based on their family status while transnational mothers experienced significantly lower well-being compared with childless migrant women. Our research suggests the need for adopting a transnational approach to migration starting from data gathering, for instance through the design and implementation of multi-sited and retrospective surveys.

National origins, social context, timing of migration and the physical and mental health of Caribbeans living in and outside of Canada

Objectives: Differences in health among migrant groups are related to the length of stay in host countries. We examined the health of people reporting Caribbean ethnic origins within and outside of Canada; and the possible associations between length of stay and poorer physical and mental health outcomes.Method: Analyses were conducted on population data collected in Canada (2000/2001, 2003, 2005), Jamaica (2005) and Guyana (2005). Physician-diagnosed and self-rated health measures were used to assess physical and mental health statuses.Results: Rates of chronic conditions were generally higher among people reporting Caribbean ethnic origins in Canada compared to those living in the Caribbean region. Self-rated fair or poor general health rates, however, were higher among participants in the Caribbean region. Higher rates of any mood disorders were also found among Caribbean region participants in comparison to those in Canada. Logistic regression analyses revealed that new Caribbean immigrants (less than 10 years since immigration) in Canada had better physical health than those who were more established. Those who immigrated more than 20 years ago showed consistently better health conditions than those who had immigrated between 11 and 20 years ago. This healthy immigration effect, however, was not present for all chronic conditions among all Caribbean origin migrant groups. Moreover, mood disorders were highest among new immigrants compared to older immigrants.Conclusions: When and where ethnic Caribbeans migrate to and emigrate from matters in health statuses. These results have implications for policies related to health and well-being in support of ethnic Caribbean origin individuals who relocate to Canada. The paper concludes with suggestions for future studies regarding the health of ethnic origin Caribbeans living within and outside their regions of birth.

The impact of medical tourism on cervical cancer screening among immigrant women in the U.S

Background

Research on the relationship between medical tourism—traveling abroad for healthcare and cervical cancer screening is lacking. This study examines (1) the association between medical tourism and cervical cancer screening among immigrant women and (2) whether the association varies across years in the U.S.

Methods

We analyzed the New Immigrant Survey data of immigrant women aged 21–65 (n = 999). The outcome was having had a Pap smear since becoming a permanent resident, and the main predictor was medical tourism. Logistic regressions were conducted.

Results

Immigrant women who engaged in medical tourism had higher cervical cancer screening rates compared to those who did not engage in medical tourism (84.09% vs. 71.68%). This relationship was statistically significant only among women who have recently immigrated, after controlling for covariates.

Conclusions

Immigrant women who engaged in medical tourism had 2.18 higher odds of receiving a Pap smear than immigrant women who did not, after controlling for other covariates. Health educators should be aware of the practice of medical tourism and consider providing education on adherence to cancer screening guidelines and follow up abnormal results to ensure that immigrant women receive continuous cancer care.

Too long to wait: South Asian migrants' experiences of accessing health care in Australia

BACKGROUND

Migrants settling in a new country experience multiple complexities in navigating health care systems and adapting to a new way of life in the host country. In South Asia, migrating to another country for better life opportunities has been an ongoing trend and migration to Australia has significantly increased in recent years. Lower utilisation of health services and higher risks of chronic diseases among South Asian migrants poses a continuing challenge for the Australian health care system and little is known about why this demographic group does not access health services at the same rate. This study aimed to explore factors influencing access to health care by South Asian migrants in Australia.

METHODS

Using a mixed-method design, we conducted 62 online survey and 14 in-depth interviews with participants from four South Asian countries: Nepal, India, Bhutan, and Sri Lanka. Participants were recruited using a purposive snowball sampling approach following a standard ethical approval process. Survey data were analysed descriptively in SPSS and interview data were recorded, transcribed, and analysed thematically.

RESULTS

South Asian migrants experienced various complexities while accessing health services in Australia. The findings of this study highlighted a number of negative factors influencing their experiences of accessing health care: long waiting times for public health care, the expense of private health care, and communication problems due to socio-cultural differences. South Asian migrants also expressed their concern for a greater investment of resources into public health care to enable them to access quality and affordable care in these settings.

CONCLUSIONS

Given limited evidence available to help understand factors leading to the lower utilisation of health care and higher risks of chronic diseases among South Asian migrants, this study plays an important role in highlighting social, cultural, financial, and institutional factors that are critical to designing appropriate health-care strategies. This study recommends incorporating a collaborative and culturally competent model of care to increase access to health care and thereby help reduce existing disparities in health outcomes among South Asian migrant populations.

Comparison of End-of-Life Care Between Recent Immigrants and Long-standing Residents in Ontario, Canada

IMPORTANCE

Recent immigrants face unique cultural and logistical challenges that differ from those of long-standing residents, which may influence the type of care they receive at the end of life.

OBJECTIVE

To compare places of care among recent immigrants and long-standing residents in Canada in the last 90 days of life.

DESIGN, SETTING, AND PARTICIPANTS

This population-based retrospective cohort study used linked health administrative data on individuals from Ontario, Canada, who died between January 1, 2013, and December 31, 2016, extracted on February 26, 2020. Individuals were categorized by immigration status: recent immigrants (since 1985) and long-standing residents. Data were analyzed from December 27, 2019, to February 26, 2020.

EXPOSURES

All decedents who immigrated to Canada between 1985 and 2016 were classified as recent immigrants. Subgroup analyses assessed the association of region of origin.

MAIN OUTCOMES AND MEASURES

The main outcome was place of care, including institutional and noninstitutional settings, in the last 90 days of life. Descriptive statistics were used to compare characteristics and health service utilization among recent immigrants and long-standing residents. Negative binomial regression models estimated the rate ratios (RR) of using acute care and long-term care in the last 90 days of life.

RESULTS

A total of 376 617 deceased individuals (median [IQR] age, 80 [68-88] years; 187 439 [49.8%] women and 189 178 [50.2%] men) were identified, among whom 22 423 (6.0%) were recent immigrants; recent immigrants were younger than long-standing residents (median [IQR] age, 76 [60-85] years vs 81 [69-88] years; P < .001), more likely to be living in lower income neighborhoods (12 357 immigrants [55.1%] vs 166 017 long-standing residents [46.9%] in the lower 2 income quintiles; P < .001), and had a higher Charlson Index score (score ≥5, 6294 immigrants [28.1%] vs 74 809 long-standing residents [21.1%]; P < .001). In the last 90 days of life, recent immigrants spent more days in intensive care units than long-standing residents (mean [SD], 2.64 [8.73] days vs 1.47 [5.70] days; P < .001), while long-standing residents spent more days using long-term care than recent immigrants (mean [SD], 19.49 [35.81] days vs 10.45 [27.42] days; P < .001). Being a recent immigrant was associated with a greater likelihood of acute inpatient care use (RR, 1.21; 95% CI, 1.18-1.24) and lower likelihood of long-term care use (RR, 0.66; 95% CI, 0.63-0.70), after adjusting for covariates.

CONCLUSIONS AND RELEVANCE

These findings suggest that at the end of life, recent immigrants were significantly more likely to receive inpatient and intensive care unit services and die in acute care settings compared with long-standing residents. Further research is needed to examine differences in care preference and disparities for immigrant groups of different origins.

Sociological contributions to race and health: Diversifying the ontological and methodological agenda

Sociologists have made fundamental contributions to the study of race and health in the United States. They have disrupted biological assumptions of race, uncovered individual and structural factors that drive racial health disparities and explored the effects of racism on health. In recent years, however, with broader shifts towards big data, the work to understand the dynamics between race and health has been increasingly pursued from a quantitative perspective. Often, such analyses isolate intermediary mechanisms to further explain race as a cause of disease. While important, these approaches potentially limit our investigations of underlying assumptions about race and the complexity of this critical social construct. We argue that the resulting dearth of qualitative research on race and health substantially limits the knowledge being produced. After providing an overview of the overwhelming shift towards quantitative methods in the study of race and health, we present three areas of study that would benefit from greater qualitative inquiry as follows: (1) Healthy Immigrant Effect, (2) Maternal Health and (3) End-of-Life Care. We conclude with a call to the discipline to embrace the critical role of qualitative research in exploring the dynamics of race and health in the United States.

Regular Dental Care Utilization: The Case of Immigrants in Ontario, Canada

Considering the critical role of oral health on people's well-being, access to regular dental care to improve oral health may be a useful medium for improving immigrant integration and settlement in Canada. Using the 2013-14 Canadian Community Health Survey, this study contributes to the literature and policy by examining if there are disparities in regular utilization of dental care among recent immigrants, established immigrants, and the native-born in Ontario, Canada. Adopting Andersen's behavioural model of health services use as a conceptual framework, we introduce three sets of variables in our statistical analysis including predisposing, need, and enabling factors. At the bivariate level, recent (OR = 0.42, p < 0.001) and established immigrants (OR = 0.81, p < 0.001) are less likely to use dental care at least once a year than their native-born counterparts. Once accounting for enabling characteristics, however, we observe that the direction of the association becomes positive for established immigrants (OR = 1.15, p < 0.05). The difference between recent immigrants and the native-born is partially attenuated when we control for enabling characteristics but remains statistically significant (OR = 0.73, p < 0.05). Based on these findings, we provide several implications for policymakers and future research.

Utilization of preventive care among migrants and non-migrants in Germany: results from the representative cross-sectional study 'German health interview and examination survey for adults (DEGS1)'

BACKGROUND

In Germany, different health checks for adults are offered for primary and secondary prevention. Previous findings indicate that preventive care utilization varies according to social determinants, especially migration background. This study examined the extent to which migration background is associated with preventive care utilization, independent of factors like age and socioeconomic status and whether length of stay in Germany has a positive effect on the use of preventive care.

METHODS

The first wave of the 'German Health Interview and Examination Survey for Adults' (DEGS1) is a comprehensive data collection facilitating the description of the utilization of general health checks, dental check-ups, skin cancer screening, and cervical cancer screening among people aged 18-79 years with and without migration background. Migration background was differentiated in first-generation migrants having immigrated to Germany themselves or second-generation migrants born in Germany. First-generation migrants were further differentiated by length of stay in Germany, and second-generation migrants as having one or two parents who were born abroad. Multivariate binary logistic regression models with average marginal effects were calculated to analyse the associations between preventive care utilization and migration background.

RESULTS

The sample comprised 7987 participants, 1091 of whom had a migration background. Compared with non-migrants, women and men with migration background- particularly first-generation migrants with length of stay <=20 years in Germany - make less use of preventive care. This association was observed statistically independent from sociodemographic factors. For dental check-ups a significantly lower use was also found for first-generation migrants who have lived in Germany for more than 20 years and second-generation of migrants with two parents born abroad. Post-model predictions showed that the utilization rates of first-generation migrants are gradually converging to the average values for non-migrants.

CONCLUSIONS

Our findings suggest inequalities in realized access to preventive care for first-generation migrants particularly for those who have lived in Germany for 20 years or less. Barriers to the utilization of preventive care may be addressed by informing migrant communities about preventive health care services at an early stage after immigration using migrant-sensitive information strategies.

A pathway to negative acculturation: marital maladjustment mediates the relationship between the length of residency and depressive symptoms in immigrant women in Taiwan

Background

Immigrant women in Taiwan experience a variety of acculturative and marital problems that result in a mental-health problems. We examined the mediational effect of marital adjustment on the relationship between acculturation and depressive symptoms in immigrant women in Taiwan.

Methods

All participants (N = 127) were interviewed to collect data regarding their basic sociodemographics, depressive symptoms, acculturation (using language proficiency and years in Taiwan as indicators), and marital adjustment. We used a Sobel test to examine how marital adjustment mediates the relationship between acculturation and depressive symptoms.

Results

Our results indicated that an increased length of residency exacerbated depressive symptoms (β = 0.62, p = 0.03) and that this relationship contributed, in part, to the mediational effect of marital adjustment. That is, marital adjustment deteriorated with the length of residency (β =  − 0.26, p = 0.0013), resulting in the development of depressive symptoms (β =  − 0.95, p = 0.0013).

Conclusion

Although the duration of residency may be useful as a proxy for acculturation in the assessment of some health outcomes, our findings imply that it is better to conceptualize it as a cumulative stress when considering the mental health of immigrant women. Marital maladjustment acts as a mediator in this relationship. As such, it is important to provide immigrant families with programs and resources to assist them in adapting to their marriages and to improve the mental health of immigrant women.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-021-01334-0.

Recency of immigration and utilization of dental care services in Canada

OBJECTIVES

To investigate the association between recency of immigration to Canada and the utilization of dental health services.

METHODS

The cross-sectional study sample (n = 2137) was drawn from the 2015-2016 Canadian Community Health Survey (CCHS). It consisted of Canadian residents aged 12 years and older who resided in the two provinces and one territory who opted into the optional dental module and gave valid responses to the questions 'How often do you usually see a dental professional, such as a dentist, a dental hygienist or a denturologist?' and 'Length of time since immigration to Canada?' for the outcome and independent variable, respectively. Multinomial logistic regression was used to analyse the data, and all statistics were weighted using sampling weights provided by Statistics Canada.

RESULTS

The adjusted odds ratios were lower for recent immigrants than for established immigrants and for visits more than once per year (OR = 0.35; 95% CI 0.14, 0.92), about once per year (OR = 0.34; 95% CI 0.13, 0.90) and for less than once per year (OR = 0.22; 95% CI 0.07, 0.64) than for those who never visited a dental professional. Recent immigrants, males, individuals aged 70 years or more and those with a low household income were less likely to visit a dental professional than established immigrants, females, younger age groups or those with higher incomes.

CONCLUSION

Better policies are needed to address the dental health concerns of recent immigrants who may suffer from poorer dental health, to ensure that they receive the care they require.

Trajectories of sickness absence, disability pension and unemployment in young immigrants with common mental disorders

BACKGROUND

The aims were to elucidate if trajectories of labour market marginalization (LMM), measured as sickness absence (SA)/disability pension (DP) or unemployment, differed between young immigrants and natives before and after an incident diagnosis of a common mental disorder (CMD), and to investigate if educational level, psychiatric comorbidity and duration of residence in Sweden (in immigrants) had different associations with subsequent LMM in natives compared with immigrants.

METHODS

A total of 28 971 young adults (19-30 years), with an incident CMD (inpatient or specialized outpatient healthcare due to CMDs or dispensed prescribed antidepressants during 2007) were included. Group-based trajectory models were utilized to identify trajectories of annual months of LMM 3 years before and 6 years after the diagnosis. The associations of risk factors with different trajectories were investigated by multinomial logistic regression, χ2-test and Nagelkerke R2 to measure the associations' strength. Immigrants were categorized into Western and non-Western immigrants.

RESULTS

Young natives and immigrants showed similar trajectories of SA/DP. A higher proportion of non-Western immigrants (20.5%) followed trajectories of high levels of unemployment (>2 annual months) compared with Western immigrants (15%) and natives (16.5%). Educational level and duration of residence in Sweden (in immigrants) discriminated trajectories of both SA/DP and unemployment, whereas psychiatric comorbidity only discriminated trajectories of SA/DP.

CONCLUSIONS

Differences in trajectories of unemployment between young natives and immigrants with an incident CMD were found. Educational level and psychiatric comorbidity provided information on differences between natives and immigrants and duration of residence gave information for subgroups of immigrants.

COVID-19 Pandemic: Exacerbating Racial/Ethnic Disparities in Long-Term Services and Supports

What services are available and where racial and ethnic minorities receive long-term services and supports (LTSS) have resulted in a lower quality of care and life for racial/ethnic minority users. These disparities are only likely to worsen during the COVID-19 pandemic, as the pandemic has disproportionately affected racial and ethnic minority communities both in the rate of infection and virus-related mortality. By examining these disparities in the context of the pandemic, we bring to light the challenges and issues faced in LTSS by minority communities with regard to this virus as well as the disparities in LTSS that have always existed.

Disparities in Health Insurance Coverage and Access to Care by English Language Proficiency in the USA, 2006-2016

BACKGROUND

In the USA, people with limited English proficiency (LEP) disproportionately experience gaps in health insurance coverage and access to care. The Patient Protection and Affordable Care Act (ACA) of 2010 included reforms that could improve these outcomes.

OBJECTIVE

To describe changes in insurance coverage and access to health care by English language proficiency over 2006-2016.

DESIGN

We used regression models to estimate changes in coverage and access after 2010 for adults with high vs. limited English proficiency, adjusting for socio-economic status, demographic characteristics, and health care needs. We used difference-in-differences models to assess adjusted changes in disparities by English proficiency after 2010. Supplemental analyses used nearest-neighbor propensity score matching to balance the characteristics of respondents.

PARTICIPANTS

Respondents aged 18-64 in the Medical Expenditure Panel Survey over 2006-2016, with high (n = 174,214) or limited (n = 16,484) English language proficiency.

MAIN MEASURES

Insurance coverage was a binary variable indicating any health insurance coverage during the past 12 months. Access to care was measured using binary variables indicating whether the respondent had a usual source of care and received necessary medical, dental, and preventive care.

KEY RESULTS

Gains in health insurance coverage after 2010 were significant for adults with high English proficiency (1.7 percentage points, p < 0.001) and adults with limited English proficiency (4.6 percentage points, p = 0.007); gains did not significantly vary by English proficiency. Adults with LEP showed larger improvements than adults with high English proficiency in having a usual source of care (5 percentage points, p = 0.007) and receiving needed medical care and dental care (1.4 percentage points, p = 0.013, and 2.8 percentage points, p = 0.009, respectively). Findings remained similar when matching was used to balance the measured characteristics of respondents with high vs. limited English proficiency.

CONCLUSIONS

Disparities in health care access by English proficiency narrowed after 2010, the year of passage of the ACA.

Harms of Workplace Inspections for Im/Migrant Sex Workers in In-Call Establishments: Enhanced Barriers to Health Access in a Canadian Setting

Given shifting sex work criminalization and enforcement in Canada, this study examined worrying about workplace inspections by authorities amongst indoor sex workers in Vancouver (2014-2017). Data were drawn from a community-based prospective cohort of sex workers (AESHA). Bivariate and multivariable logistic regression were used to investigate factors associated with worry about inspections. 23.9% of participants experienced workplace inspections; 51.6% worried about inspections. In multivariable analyses, worrying about inspections was associated with recent im/migration [adjusted odds ratio (AOR) 3.13; 95% confidence interval (CI) 1.77-5.53], police harassment (AOR 3.49; 95% CI 1.92-6.34), and workplace violence (AOR 1.66, 95% CI 1.09-2.51). In a multivariable confounder model, worry was independently associated with barriers to health access (AOR 1.45, 95% CI 1.06-1.98). Im/migrant indoor workers are disproportionately impacted by concerns about workplace inspections, which was independently linked to enhanced barriers to health access. Current criminalization measures may exacerbate health inequities among im/migrant sex workers.

Barriers and Facilitators to Breast and Cervical Cancer Screening Among Immigrants in the United States

To summarize the literature on barriers and facilitators to breast and cervical cancer screening among immigrants to the US. A literature review was conducted for studies on breast and cervical cancer screening among immigrant populations. A thematic analysis of 180 studies identified a variety of barriers and facilitators to screening at the personal and system levels. Personal barriers included lack of knowledge and insurance coverage, high cost of care, and immigration status. System barriers included poor access to services, lack of interpreter services, and insensitivity to patient needs. Facilitators to screening included knowledge of disease, access to information sources, physician recommendation, and social networks. Cultural norms and resource availability at the individual and system levels influence screening among immigrants. Health insurance coverage was found to be an important predictor of preventative screening use. Future research should seek to identify the best way to address this and other barriers to cancer screening among immigrants groups.

Explaining Health Outcomes of Asian Immigrants: Does Ethnicity Matter?

The present study intended to evaluate whether 4 discrete ethnic groups of Asian immigrants could, for empirical reasons, be assigned a set of unique operating factors explaining health outcomes of members. The set comprised several acculturation, social structure, lifestyle, and health-related factors. Our study asked if these factors uniformly explained health outcomes across the 4 groups. We pooled National Health Interview Survey (NHIS) data dating 1999-2015 and developed 2 outcomes: self-rated health and self-reported chronic illness (specifically, diagnosis of cardiovascular disease, prediabetes/diabetes, hypertension, cancer, or stroke). Since data for smaller Asian ethnic groups are not readily available, we confined our analyses to respondents of Chinese, Filipino, Asian Indian, and "other Asian" ethnicity. Descriptive statistics suggested that Asian Indian respondents were least likely to report having 1 of the 5 specified serious illnesses and self-rated their health higher than the other 3 respondent groups. Additionally, while some factors (e.g., body mass index, depression) proved related to the health outcomes across the 4 ethnic groups, we did observe for each group a unique pattern of factors associated with the outcomes. Our results confirmed, furthermore, a moderating role for ethnicity in associations between the outcomes and those operating factors in the set we evaluated. The study results should be of use in tailoring preventive and intervention programs to various ethnic groups of Asian immigrants; clearly, in promoting health, one approach will not fit all.

Depression in middle and older adulthood: the role of immigration, nutrition, and other determinants of health in the Canadian longitudinal study on aging

BACKGROUND

Little is known about depression in middle-aged and older Canadians and how it is affected by health determinants, particularly immigrant status. This study examined depression and socio-economic, health, immigration and nutrition-related factors in older adults.

METHODS

Using weighted comprehensive cohort data from the baseline Canadian Longitudinal Study on Aging (n = 27,162) of adults aged 45-85, gender-specific binary logistic regression was conducted with the cross-sectional data using the following variables: 1) Depression (outcome) measured using the Center for Epidemiologic Studies Short Depression (CESD-10) rating scale; 2) Immigration status: native-born, recent and mid-term (< 20 years), and long-term immigrants (≥20 years); and 3) covariates: socioeconomic status, physical health (e.g., multi-morbidity), health behavior (e.g., substance use), over-nutrition (e.g., anthropometrics), under-nutrition (e.g., nutrition risk), and dietary intake.

RESULTS

The sample respondents were mainly Canadian-born (82.6%), women (50.6%), 56-65 years (58.9%), earning between C$50,000-99,999 (33.2%), and in a relationship (69.4%). When compared to Canadian-born residents, recent, mid-term (< 20 years), and longer-term (≥ 20 years) immigrant women were more likely to report depression and this relationship was robust to adjustments for 32 covariates (adjusted ORs = 1.19, 2.54, respectively, p < 0.001). For women, not completing secondary school (OR = 1.23, p < 0.05), stage 1 hypertension (OR = 1.31, p < 0.001), chronic pain (OR = 1.79, p < 0.001), low fruit/vegetable intakes (OR = 1.33, p < 0.05), and fruit juice (OR = 1.80, p < 0.001), chocolate (ORs = 1.15-1.66, p's < 0.05), or salty snack (OR = 1.19, p < 0.05) consumption were associated with depression. For all participants, lower grip strength (OR = 1.25, p < 0.001) and high nutritional risk (OR = 2.24, p < 0.001) were associated with depression. For men, being in a relationship (OR = 0.62, p < 0.001), completing post-secondary education (OR = 0.82, p < 0.05), higher fat (ORs = 0.67-83, p's < 0.05) and omega-3 egg intake (OR = 0.86, p < 0.05) as well as moderate intakes of fruits/vegetables and calcium/high vitamin D sources (ORs = 0.71-0.743, p's < 0.05) predicted a lower likelihood of depression. For men, chronic conditions (ORs = 1.36-3.65, p's < 0.001), chronic pain (OR = 1.86, p < 0.001), smoking (OR = 1.17, p < 0.001), or chocolate consumption (ORs = 1.14-1.72, p's < 0.05) predicted a higher likelihood of depression.

CONCLUSIONS

The odds of developing depression were highest among immigrant women. Depression in middle-aged and older adults is also associated with socioeconomic, physical, and nutritional factors and the relationships differ by sex. These results provide insights for mental health interventions specific to adults aged 45-85.

Associations Between Immigration-Related User Factors and eHealth Activities for Self-Care: Case of First-Generation Immigrants From Pakistan in the Oslo Area, Norway

BACKGROUND

Immigrant populations are often disproportionally affected by chronic diseases, such as type 2 diabetes mellitus (T2DM). Use of information and communication technology (ICT) is one promising approach for better self-care of T2DM to mitigate the social health inequalities, if designed for a wider population. However, knowledge is scarce about immigrant populations' diverse electronic health (eHealth) activities for self-care, especially in European countries.

OBJECTIVE

With a target group of first-generation immigrants from Pakistan in the Oslo area, Norway, we aimed to understand their diverse eHealth activities for T2DM self-care in relation to immigration-related user factors specific to this target group: proficiency in relevant languages (Urdu, Norwegian, English), length of residence in Norway, and diagnosis of T2DM compared with general user factors (age, gender, education and digital skills, and self-rated health status).

METHODS

Data were from a survey among the target population (N=176) conducted in 2015-2016. Using logistic regression, we analyzed associations between user factors and experiences of each of the following eHealth activities for T2DM self-care in the last 12 months: first, information seeking by (1) search engines and (2) Web portals or email subscriptions; second, communication and consultation (1) by closed conversation with a few acquaintances using ICT and (2) on social network services; and third, active decision making by using apps for (1) tracking health information and (2) self-assessment of health status. Using Poisson regression, we also assessed the relationship between user factors and variety of eHealth activities experienced. The Bonferroni correction was used to address the multiple testing problem.

RESULTS

Regression analyses yielded the following significantly positive associations: between Urdu literacy and (1) information seeking by Web portals or email subscriptions (odds ratio [OR] 2.155, 95% CI 1.388-3.344), (2) communication and consultation on social network services (OR 5.697, 95% CI 2.487-13.053), and (3) variety (estimate=0.350, 95% CI 0.148-0.552); between length of residence in Norway and (1) communication and consultation by closed conversation with a few acquaintances using ICT (OR 1.728, 95% CI 1.193-2.503), (2) communication and consultation on social network services (OR 2.098, 95% CI 1.265-3.480), and (3) variety (estimate=0.270, 95% CI 0.117-0.424); between Norwegian language proficiency and active decision making by using apps for self-assessment of health status (OR 2.285, 95% CI 1.294-4.036); between education and digital skills and active decision making by using apps for tracking health information (OR 3.930, 95% CI 1.627-9.492); and between being a female and communication and consultation by closed conversation with a few acquaintances using ICT (OR 2.883, 95% CI 1.335-6.227).

CONCLUSIONS

This study implies immigration-related factors may confound associations between general user factors and eHealth activities. Further studies are needed to explore the influence of immigration-related user factors for eHealth activities in other immigrant groups and countries.

INTERNATIONAL REGISTERED REPORT

RR2-DOI 10.2196/resprot.5468.

Oral health disparities: Racial, language and nativity effects

This study examined racial oral health disparities among Non-Hispanic Whites, Non-Hispanic Blacks, and Hispanics. For Hispanics, this study also examined the role of language in oral health disparities between English-speaking Hispanics and Spanish-speaking Hispanics. This study included 12, 307 adults older than 20 from the National Health and Nutrition Examination Survey (NHANES) 2011–2016. Oral health is measured by self-rated oral health, the frequencies of dentist visits, and the number of missed teeth. Exposures of interest referred to social gradients, which include education, annual family income, foreign born, and citizenship. Covariates included age, gender, and marital status. Ordinal logistic regression models were used to estimates the effects of social gradients on self-rated oral health and dentist visits. Negative binomial regression model was applied to estimate the effects of social gradients on the number of missed teeth. Overall, Spanish-speaking Hispanics presented the most disadvantaged social gradients and the worst oral health results. Non-Hispanic Blacks and English-speaking Hispanics reported disadvantaged oral health status when compared to Non-Hispanic Whites. Foreign-born, higher education levels and annual family income play protective role on oral health outcomes, while respondents who do not have citizenship are at higher risk of self-rated fair/poor oral health and dentist visits.

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Language is a stratification factor: Spanish-preferred Hispanics present the worst dental visits and oral health status, and the poorest SES. English-preferred Hispanics present better oral health than Non-Hispanic blacks, but worse than Non-Hispanic Whites.

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Non-Citizenship indicates irregular dentist visits among Spanish-preferred Hispanics and Non-Hispanic Blacks, but not significant for English-preferred Hispanics.

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Foreign-born English-preferred Hispanics present better dentist visits and self-rated oral health. Foreign-born Non-Hispanic Blacks present better oral health outcomes.

Acculturation and Unmet Health Needs Among Refugees in Omaha, Nebraska

This study assessed the association between acculturation and unmet health needs among refugees. Based on data from the Refugee Health Needs Assessment Survey (n = 291) recently conducted in Omaha, Nebraska, Chi square tests and multivariate logistic regressions were estimated to examine how acculturation among refugees was related to their unmet health needs. Relative to refugees who had been in the U.S. for less than 3 years, refugees who had been in the U.S. for 3-5 years were more likely to report lack of health insurance coverage (AOR 2.87, 95% CI 1.19, 6.92) and delaying to see a health care provider due to cost during the 12 months prior to the survey (AOR 4.01, 95% CI 1.18, 13.67). Acculturation among refugees did not necessarily alleviate their unmet health needs. Addressing these needs calls for sustainable medical assistance to refugees that well go beyond the 8-month health insurance coverage currently provided to newly arrived refugees.

Impact of acculturation on oral health among immigrants and ethnic minorities: A systematic review

OBJECTIVE

Cultural changes faced by immigrants and ethnic minorities after moving to a host country may have a detrimental or beneficial influence on their oral health and oral health-related behaviors. Therefore, this paper reviews the literature to see the impact of acculturation on immigrants and ethnic minorities' oral health outcomes.

METHODS

We searched seven electronic databases up to January 2018. All cross-sectional and longitudinal quantitative studies that examined associations between acculturation and oral health status and/or oral health behaviors among ethnic minority and immigrant population[s] were included. Study selection, data extraction, and risk of bias assessment were completed in duplicate. The Newcastle-Ottawa checklist was used to appraise the methodological quality of the quantitative studies. A meta-analytic approach was not feasible.

RESULTS

A total of 42 quantitative studies were identified. The studies showed a positive association between acculturation and oral health status/behaviors. The most frequently used acculturation indicators were language spoken by immigrant and ethnic minorities and length of stay at the host country. High-acculturated immigrant and ethnic minority groups demonstrated better oral health outcomes, oral health behaviors, dental care utilization, and dental knowledge.

CONCLUSIONS

According to existing evidence, a positive effect of acculturation on oral health status and behaviors was found.

PRACTICAL IMPLICATIONS

Dental practitioners should be culturally competent to provide the appropriate services and treatments to immigrant and ethnic minorities. Policymakers should also be sensitive to cultural diversities and properly address the unique needs of each group in order to maintain oral health equity.

Immigration factors and potentially avoidable hospitalizations in Canada

Objective

Estimate the effect of immigration characteristics on the risk of a hospitalization for an ambulatory care sensitive condition (ACSC).

Research design

We analyzed data on the Canadian resident adult population aged 18 to 74 years who responded to the 2006 long form Census. The Census data were linked to the Canadian Institute for Health Information (CIHI)’s Discharge Abstract Database (DAD) for fiscal years 2006–2007, 2007–2008, and 2008–2009. We conducted a logistic regression on the binary variable we created for an ACSC admission.

Measures

The CIHI definition of ACSC hospitalizations was used to identify potentially avoidable hospitalizations in the DAD. Immigration factors analyzed included years in Canada, ethnic origin, and ability to speak one of the official languages.

Results

There were 3,342,450 respondents aged between 18 and 74. Using the Canadian at birth as our reference population, recent immigrants (up to five years in Canada) had lower odds of an ACSC hospitalization, regardless of their ethnic origins, with the exception of immigrants from Oceania and from other North American countries for whom the effect was not significant. The protective effect was still present in children of immigrants (AOR=0.89). Immigrants from the Caribbean, from Southern, Eastern, and Western Europe, as well as those from East Asia had lower odds across categories of time spent in Canada. The protective effect was stronger in immigrants from East Asia and lower in those of Oceanic and other North American countries.

Conclusions

Our results suggest that the healthy immigrant effect dissipates with time in Canada but remains even in children of immigrants. The protective effect differs depending on the ethnic origin of the immigrant.

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Immigrants generally arrive in a country with a higher health status than that of the local population.

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Immigrants and children of immigrants have lower odds of having an ACSC hospitalization are lower than Canadians at birth.

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Odds of an ACSC hospitalization vary depending on immigration characteristics such as the ethnic origin and the time lived in Canada.