Disparities in vaccinations and cancer screening among U.S.- and foreign-born Arab and European American non-Hispanic White women

Health Information Technology Use among Foreign-Born Adults of Middle Eastern and North African Descent in the United States

Health information technology (HIT) use among foreign-born adults of Middle Eastern and North African (MENA) descent is understudied. MENA Americans are currently categorized as "White" in the United States (US) on federal forms. Our purpose was to uncover the prevalence of HIT use among MENA immigrants compared to US- and foreign-born White adults before and after adjusting for covariates. The 2011-2018 National Health Interview Survey data (n = 161,613; ages 18 + years) were analyzed. HIT uses evaluated were searching for health information, filling prescriptions, scheduling appointments, and communicating with healthcare providers via email (last 12 months). Crude and multivariable logistic regression models were used to estimate the odds of each HIT use (searching for health information, filling prescriptions, scheduling appointments, and/or communicating with healthcare providers via email), and overall use of any HIT before and after adjustment. The most common HIT use was looking up health information (46.4% foreign-born MENA, 47.8% foreign-born White, 51.2% US-born White; p = .0079). Foreign-born adults of MENA descent had lower odds (OR = 0.64; 95% CI = 0.56-0.74) of reporting any HIT use, but no difference in reporting all HIT uses compared to US-born White adults. This is the first study to explore HIT use among MENA Americans. Results contribute to growing body of literature showing the health of MENA Americans differs from White Americans. A separate racial/ethnic identifier is needed to better capture HIT uses among populations of MENA descent.

Cervical cancer screening and vaccination acceptability and attitudes among Arab American women in Southeastern Michigan: a qualitative study

Among Arab-American women in Michigan, rates of cervical cancer screening are lower than those in non-Hispanic White and Black women in the state. A deep understanding of the Arab community's perspective on cervical cancer screening is needed to address the disparity in rates across populations in Michigan. Arab and Chaldean women across Michigan were invited to participate in Zoom-based focus groups to understand the attitudes, acceptability, and barriers of cervical cancer screening among this population. Four focus groups with a total of 19 women aged 30 to 61 were conducted. The focus groups were conducted in English, Arabic, or both languages. The guided discussion was focused on knowledge of cervical cancer and Human papillomavirus (HPV) and its transmission, attitudes towards HPV vaccination, and attitudes towards cervical cancer screening. HPV self-sampling as an alternative to traditional provider-based screening was specifically discussed as this has been proposed as a way to increase screening in hard-to-reach populations. The conversations revealed insights related to barriers at the individual and community levels for screening and vaccination, attitudes towards preventive health care including screening, a need for accessible women's health literature, and health education. The women also discussed vaccine hesitancy related to HPV and COVID-19, suggesting a need for targeted community interventions.

Maternal and Perinatal Health Disparities Among Middle Eastern and North African Women and Children in the United States

INTRODUCTION

Few studies have evaluated the health of Middle Eastern and North African (MENA) women and children in the United States. Objectives were to determine the odds of well-visits, preventive behaviors during pregnancy, and low birthweight among foreign-born non-Hispanic MENA women and children compared to their US- and foreign-born non-Hispanic White counterparts after adjusting for covariates (hereafter, reported as MENA and White).

METHODS

We analyzed 2000-2018 National Health Interview Survey data (411,709 women, 311,961 children). Outcomes included well-woman visits (past 12 months); dentist visits (past 6 months) and current smoking among pregnant women; and low, moderately low, and very low birthweight among children. Covariates included age, family income, and health insurance for children. Education and marital status were also evaluated among women.

RESULTS

Over half (53.4%) of foreign-born MENA women were of childbearing age (ages 18-45) compared to 47.7% US-born and 43.2% foreign-born White women. The odds of completing a well-women visit were 0.73 times lower (95% CI = 0.38-0.89) among foreign-born MENA women compared to US-born White women after adjusting for age, education, and marital status. There was no statistically significant difference in dental visits between groups. No foreign-born MENA pregnant women reported current smoking. Foreign-born MENA children had higher odds of low (OR = 1.65; 95% CI = 1.16-2.35) and moderately low birthweight (OR = 1.78; 95% CI = 1.19-2.66) compared to US-born White children in adjusted models.

DISCUSSION

MENA women and children are classified as White by the federal government. Our results highlight that the health of foreign-born MENA women and children differ from their White counterparts.

Arab, Middle Eastern, and North African Health Disparities Research: A Scoping Review

BACKGROUND

Research in health disparities and how they affect underserved populations continues to grow and expand. However, the experiences of Arab/Middle Eastern and North African (MENA) Americans often go unnoticed, and yet, preliminary data suggests there are significant disparities between this population and other groups. The purpose of this scoping review is to examine and synthesize the extent of available literature on health disparities and outcomes for this group.

METHODS

A scoping review was conducted to investigate the current state of research on health disparities and outcomes among Arab/MENA individuals within the USA. The PRISMA protocol for scoping reviews was utilized.

RESULTS

Through the use of PubMed and PsychInfo databases, the search identified 43 articles that were eligible for inclusion in the final review. Five themes emerged: prevalence and health outcomes, factors impacting health, comparison studies, barriers, and health literacy and beliefs. Extant data was equivocal, suggesting the need for further research.

CONCLUSIONS

Research on Arab/MENA health disparities and outcomes is in the detection phase, indicating that more research is needed to elucidate the state of Arab/MENA health in the USA. These findings can help healthcare professionals and researchers understand the emerging literature on health disparities within the Arab/MENA community and inform further research and clinical practice within this population.

Examining cancer screening disparities by race/ethnicity and insurance groups: A comparison of 2008 and 2018 National Health Interview Survey (NHIS) data in the United States

BACKGROUND

Pervasive differences in cancer screening among race/ethnicity and insurance groups presents a challenge to achieving equitable healthcare access and health outcomes. However, the change in the magnitude of cancer screening disparities over time has not been thoroughly examined using recent public health survey data.

METHODS

A retrospective cross-sectional analysis of the 2008 and 2018 National Health Interview Survey (NHIS) database focused on breast, cervical, and colorectal cancer screening rates among race/ethnicity and insurance groups. Multivariable logistic regression models were used to assess the relationship between cancer screening rates, race/ethnicity, and insurance coverage, and to quantify the changes in disparities in 2008 and 2018, adjusting for potential confounders.

RESULTS

Colorectal cancer screening rates increased for all groups, but cervical and mammogram rates remained stagnant for specific groups. Non-Hispanic Asians continued to report consistently lower odds of receiving cervical tests (OR: 0.42, 95% CI: 0.32-0.55, p<0.001) and colorectal cancer screening (OR: 0.55, 95% CI: 0.42-0.72, p<0.001) compared to non-Hispanic Whites in 2018, despite significant improvements since 2008. Non-Hispanic Blacks continued to report higher odds of recent cervical cancer screening (OR: 1.98, 95% CI: 1.47-2.68, p<0.001) and mammograms (OR: 1.32, 95% CI: 1.02-1.71, p<0.05) than non-Hispanic Whites in 2018, consistent with higher odds observed in 2008. Hispanic individuals reported improved colorectal cancer screening over time, with no significant difference compared to non-Hispanics Whites in 2018, despite reporting lower odds in 2008. The uninsured status was associated with significantly lower odds of cancer screening than private insurance for all three cancers in 2008 and 2018.

CONCLUSION

Despite an overall increase in breast and colorectal cancer screening rates between 2008 and 2018, persistent racial/ethnic and insurance disparities exist among race/ethnicity and insurance groups. These findings highlight the importance of addressing underlying factors contributing to disparities among underserved populations and developing corresponding interventions.

A Scoping Review of Cancer Interventions with Arab Americans

This scoping review provides an overview of cancer interventions implemented with Arab Americans across the cancer control continuum, including an examination of outcomes and implementation processes. The search strategy included database searching and reviewing reference lists and forward citations to identify articles describing interventions with Arab adults living in the US, with no restrictions on date of publication or research methodology. The review included 23 papers describing 12 unique cancer interventions. Most interventions focused on individual-level determinants of breast and cervical cancer screening; used non-quasi-experimental research designs to evaluate intervention effectiveness; and demonstrated improvements in short-term cancer screening knowledge. Implementation processes were less commonly described. Most interventions were culturally and linguistically tailored to communities of focus; were delivered in educational sessions in community settings; engaged with the community mostly for recruitment and implementation; and were funded by foundation grants. Suggestions for research and intervention development are discussed.

Inequities in routine preventive care utilization among persons with overweight/obesity in the United States: An analysis of nativity, racial and ethnic identity, and socioeconomic status

Extant literature documented various health disparities among immigrants and racial and ethnically marginalized individuals in the United States. However, health disparities in the intersection of nativity and race are generally less visited. This cross-sectional study assessed utilization of routine preventive care among adults with overweight/obesity at the junction of their nativity, racial/ethnic identity, and socioeconomic status (i.e., income and education). Pooling data on 120,184 adults with overweight/obesity from the 2013-2018 waves of the National Health Interview Survey (NHIS), we estimated modified Poisson regressions with robust standard errors to obtain adjusted prevalence rates of preventive care visit, receiving flu shot, and having blood pressure, cholesterol and blood glucose screened. We found that immigrant adults with overweight/obesity had lower rates of utilization of all five preventive care services. However, these patterns varied by racial and ethnic sub-populations. While White immigrants had comparable rates of cholesterol and blood glucose screening, they had 2.7%, 2.9%, and 14.5% lower rates of preventive care visit, blood pressure screening, and getting a flu shot respectively, compared to native-born Whites. These patterns were similar for Asian immigrants as well. Black immigrants, on the other hand, had comparable rates of getting a flu shot and blood glucose screening, and had 5.2%, 4.9%, and 4.9% lower rates of preventive care visit, blood pressure screening, and cholesterol screening respectively. Lastly, the rates of utilization among Hispanic immigrants were significantly lower (ranging from 9.2% to 20%) than those of their native-born counterparts for all five preventive care services. These rates further varied by education, income, and length of stay in the US, within the racial and ethnic subgroups. Our findings thus suggest a complex relationship between nativity and racial/ethnic identity in relation to preventive care utilization among adults with overweight/obesity.

Suitability of Middle Eastern and North African immigrant minimal reporting category for Arab immigrant health research in the national health interview survey

Studies of Middle Eastern immigrants using national data, with and without African immigrants, have provided important discoveries on the health of this group. However, they do not directly measure health among Arab immigrants. It is yet to be determined whether using a Middle Eastern and North African (MENA) classification can represent the health needs of Arab immigrants. The objective of this study was to assess if MENA immigrant health reflects the same patterns found in previous research focusing on Arab immigrant health. We used multiple years of data from the National Health Interview Survey in alignment with each former study methodology to compare our findings with four previous research studies. The independent variable was region of birth among non-Hispanic Whites. The dependent variables were chronic diseases, women's preventive health behaviors, men's preventive health behaviors, and cigarette smoking. Logistic regression was conducted to determine the odds of each outcome for MENA immigrants compared to US-born Whites. Then, adjusted 95% confidence intervals representing the more inclusive MENA immigrant categorization were compared to previous studies among Arab immigrants. Chronic conditions, women's and men's preventive health behaviors and cigarette smoking did not differ whether the MENA or Arab definition was used. However, statistically significant differences were observed between MENA and Arab immigrants regarding bachelor's degree or higher, not employed and years in the US. The MENA category reflects the Arab immigrant experience, even though it includes a wider set of origins, some of which are not Arab. Including a MENA identifier on future data collections will both represent Arab Americans, as well as identify this population as distinct from Whites to better represent and track health disparities.

Health information technology use among foreign-born adults of Middle Eastern and North African decent in the United States

Health information technology (HIT) use among foreign-born adults of Middle Eastern and North African (MENA) descent living in America is an understudied population. They are currently categorized as "White" in the United States (US) on federal forms. The purpose was to uncover the prevalence of HIT use among MENA immigrants compared to US- and foreign-born White adults before and after adjusting for other factors. The 2011-2018 National Health Interview Survey data (n = 161,613; ages 18 + years) was analyzed. HIT uses evaluated were searching for health information, filling prescriptions, scheduling appointments, and communicating with healthcare providers via email (last 12 months). Crude and multivariable logistic regression models were used to estimate the odds of each HIT use, any HIT use, and all HIT uses before and after adjustment. The most common HIT use was looking up health information, with 46.4% of foreign-born adults of MENA, 47.8% of foreign-born White, and 51.2% of US-born White adults reporting its use (p = .0079). Foreign-born adults of MENA descent had lower odds (OR = 0.64; 95%CI = 0.56-0.74) of reporting any HIT use, but no difference in reporting all HIT uses compared to US-born White adults in adjusted models. This is the first study to explore HIT use among Americans of MENA descent. Patterns of HIT use among adults of MENA descent differ from White adults. Results contribute to growing body of literature showing the health of Americans of MENA descent differs from White Americans. A separate racial/ethnic identifier is needed to better capture HIT uses among populations of MENA descent.

Suspected Undiagnosed ADRD Among Middle Eastern and North African Americans

ADRD underdiagnosis among minority populations is well-established and known to be more prevalent among women. Yet, it remains unclear if these patterns exist among adults of Middle Eastern and North African (MENA) descent. We estimated ADRD underdiagnosis among adults of MENA descent and other US- and foreign-born non-Hispanic Whites and compared sex-stratified results. We linked 2000-2017 National Health Interview Survey and 2001-2018 Medical Expenditure Panel Survey data (ages > = 65 years, n = 23,981). Undiagnosed ADRD was suspected if participants reported cognitive limitations without corresponding ADRD diagnosis. Undiagnosed ADRD was highest among adults of MENA descent (15.8%) compared to non-Hispanic Whites (US-born = 8.1%; foreign-born = 11.8%). Women of MENA descent had 2.52 times greater odds (95% CI = 1.31-4.84) of undiagnosed ADRD compared to US-born White women after adjusting for risk factors. This study contributes the first national estimates of undiagnosed ADRD among adults of MENA descent. Continued research is needed to facilitate policy changes that more comprehensively address health disparities and related resource allocation.

Improving the Collection of National Health Data: the Case for the Middle Eastern and North African Checkbox for Communities in the USA

INTRODUCTION

The Office of Management and Budget (OMB) is reviewing current minimum standards for collecting race/ethnicity data on federal forms. This review is extremely important for Middle Eastern and North African (MENA) Americans, who have been overlooked and unable to receive federal funding for their communities for decades. MENA individuals are defined as "White," which is particularly concerning given that research continues to identify that their health and lived experiences differ from Whites. From January to April 2023, the OMB requested public comments on a separate MENA checkbox. The purpose of this research was to describe public comments regarding the addition of the MENA checkbox on the US Census and other federal forms.

METHODS

A public comment period outlining changes to the collection of race/ethnicity data on the US Census and other federal forms opened in January 2023. Public comments were reviewed to determine whether MENA was mentioned, whether comments supported a MENA checkbox, and whether comments mentioned acceptance for health-related reasons.

RESULTS

There were 6700 comments reviewed. Most (73.88%) mentioned adding a MENA checkbox. Of those, 99.31% accepted adding the checkbox. Among the comments that accepted adding a MENA checkbox, 29.09% mentioned health, 44.75% mentioned linguistic/language services, and 44.75% mentioned education-related reasons.

CONCLUSIONS

Overall, the comments reviewed demonstrated strong acceptance of the addition of a MENA checkbox on federal forms. These findings are encouraging, yet further review is needed to contribute to the OMB's final decision on whether to add the checkbox and uncover the health of this population.

Improving the Collection of National Health Data: The Case for the Middle Eastern and North African Checkbox in the United States

Objectives To describe public comments posted in relation to the Office of Management and Budget (OMB) Statistical Policy Directive 15 proposals regarding the addition of a separate Middle Eastern and North African (MENA) checkbox on the US Census and other required federal forms. Methods A public comment period outlining changes to the collection of race and ethnicity data on the US Census and other federal forms opened in January 2023. Public comments posted in February and March 2023 were reviewed to determine whether MENA was mentioned, whether comments supported a MENA checkbox, and whether comments mentioned support for health-related reasons. Results There were 3,062 comments reviewed. Most (71.49%) mentioned adding a MENA checkbox. Of those, 98.86% supported adding a MENA checkbox. Among those, 31.98% mentioned adding a MENA checkbox for health-related reasons. Conclusions Overall, the comments reviewed demonstrated strong support for the addition of a MENA checkbox on federal forms. These findings are encouraging yet further review is needed to contribute to the OMB’s final decision on whether to add the checkbox and uncover the health of this underrepresented population.

Suspected undiagnosed ADRD among Middle Eastern and North African Americans

Background ADRD underdiagnosis among minority populations is well-established and known to be more prevalent among women. Yet, it remains unclear if these patterns exist among Middle Eastern and North African (MENA) adults. We estimated ADRD underdiagnosis among MENA and other US- and foreign-born non-Hispanic Whites and compared sex-stratified results. Methods We linked 2000-2017 National Health Interview Survey and 2001-2018 Medical Expenditure Panel Survey data (ages > = 65 years, n = 23,981). Undiagnosed ADRD was suspected if participants reported cognitive limitations without corresponding ADRD diagnosis. Results Undiagnosed ADRD was highest among MENA adults (15.8%) compared to non-Hispanic Whites (US-born = 8.1%; foreign-born = 11.8%). MENA women had 2.52 times greater odds (95% CI = 1.31-4.84) of undiagnosed ADRD compared to US-born White women after adjusting for risk factors. Discussion This study contributes the first national estimates of undiagnosed ADRD among MENA adults. Continued research is needed to facilitate policy changes that more comprehensively address health disparities and related resource allocation.

Acceptance of COVID-19 vaccination in a sample of Middle Eastern and North African (MENA) Houston residents

BACKGROUND

COVID-19 vaccination has averted a significant number of deaths in the United States, but vaccination hesitancy continues to be a problem. Therefore, examining vaccination acceptance and/or hesitancy in local communities is critical.

METHODS

A quantitative survey and a multivariable logistic regression model was utilized to determine predictors of COVID-19 vaccination in Middle Eastern and North African (MENA) origin Houston residents. The outcome of interest was COVID-19 vaccination status (vaccinated versus not vaccinated). Covariates included: demographics, health, and COVID-19 factors. Statistical analyses included SAS version 9.4 at a priori significance level of 0.05.

RESULTS

The overall vaccine acceptance rate was significantly high in this population subset (N = 366), with 77.60% vaccinated, and 22.40% not vaccinated. MENA individuals with some college degrees were less likely to report vaccination than those with a graduate degree [Odds Ratio (OR): 0.18; 95% Confidence Interval (CI): 0.04, 0.77]. Homeowners were more likely to get vaccinated than renters (OR: 2.58; 95%CI: 1.17, 5.68). Individuals practicing Islamic faith were more likely to get vaccinated than other religious affiliations (OR: 3.26; 95%CI: 1.15, 9.19). Individuals with hypertension were less likely to get vaccinated than those without it (OR: 0.34; 95%CI: 0.13, 0.92), and those with anxiety were more likely to get vaccinated than those without anxiety (OR: 4.23; 95%CI: 1.68, 10.64).

CONCLUSIONS

Health status, education level, financial stability, and religious affiliation are some of the determining factors that potentially influence vaccination acceptance/hesitancy among the MENA community.

Cognitive Limitations Among Middle Eastern and North African Immigrants

OBJECTIVES

To estimate and compare the prevalence of cognitive limitations among Middle Eastern and North African (MENA) immigrants compared to US- and foreign-born non-Hispanic Whites from Europe (including Russia/former USSR) and examine differences after controlling for risk factors.

METHODS

Cross-sectional data using linked 2000-2017 National Health Interview Survey and 2001-2018 Medical Expenditure Panel Survey data (ages >=65 years, n = 24,827) were analyzed.

RESULTS

The prevalence of cognitive limitations was 17.3% among MENA immigrants compared to 9.6% and 13.6% among US- and foreign-born non-Hispanic Whites from Europe. MENA immigrants had higher odds (OR = 1.88; 95% CI = 1.06-3.34) of reporting a cognitive limitation than US-born non-Hispanic Whites after controlling for age, sex, education, hearing loss, hypertension, depression, social isolation, and diabetes.

DISCUSSION

To further examine cognitive health among the MENA aging population, policy changes are needed to identify this group that is often absent from research because of their federal classification as non-Hispanic Whites.

Vaccine hesitancy in the refugee, immigrant, and migrant population in the United States: A systematic review and meta-analysis

Refugees, immigrants, and migrants (RIM) in the United States (US) have been identified as an underimmunized population prior to the COVID-19 pandemic. Vaccine acceptance is critical to combat the public health threat incited by COVID-19 and other vaccine-preventable disease. To better understand escalating vaccine hesitancy among US RIM, a comprehensive evaluation of the problem and solutions is necessary. In this systematic review, we included 57 studies to describe vaccination rates, barriers, and interventions addressing vaccine hesitancy over the past decade. Meta-analysis was performed among 22 studies, concluding that RIM represent an underimmunized population compared to the general US population. Narrative synthesis and qualitative methods were used to identify critical barriers, including gaps in knowledge, poor access to medical care, and heightened distrust of the medical system. Our results demonstrate the need for effective, evidence-based interventions to increase vaccination rates among diverse RIM populations.

Vaccine uptake and barriers to vaccination among at-risk adult populations in the US

To reduce morbidity and mortality associated with vaccine-preventable diseases (VPD), it is imperative that vaccination programs are implemented and prioritized throughout all stages of life across all populations. This study aimed to determine vaccine uptake and barriers to vaccination against VPDs among at-risk adult populations in the United States. We conducted a systematic literature review for articles published between January 2010 and June 2020 and identified 153 publications. The review identified 17 at-risk populations. Vaccine uptake was suboptimal among many populations, with factors including age, gender, and disease severity, associated with uptake. This review identified several barriers that impact vaccine uptake among at-risk populations, with concerns over safety, vaccine costs, lack of insurance, and lack of provider recommendation commonly reported across populations. Embracing a national life-course immunization framework that integrates developing policies, guidelines, and education would be a step to addressing these barriers.

Risk Factors for COVID-19 Positivity and Hospital Admission Among Arab American Adults in Southern California

Objective:

Little is known about risk factors associated with COVID-19 infection among Arab American people. We aimed to understand the predictors of receiving a positive COVID-19 test result and being admitted to the hospital for COVID-19 among Arab American adults using data from a hospital near an Arab ethnic enclave.

Methods:

We used electronic medical record data for Arab American adults aged ≥18 years from March 1, 2020, through January 31, 2021, at Sharp Grossmont Hospital in La Mesa, California. The primary outcomes were receiving a positive COVID-19 test result and being admitted to the hospital for COVID-19. We ran logistic regression models with individual- and population-level risk factors to determine the odds of each primary outcome.

Results:

A total of 2744 Arab American adults were tested for COVID-19, of whom 783 (28.5%) had a positive test result. In the fully adjusted model, women had lower odds of receiving a positive test result than men (adjusted odds ratio [aOR] = 0.77; 95% CI, 0.64-0.92), and adults living in high-poverty areas had higher odds of receiving a positive test result than adults in lower-poverty areas (aOR = 1.25; 95% CI, 1.04-1.51). Of the 783 Arab American adults with data on admission, 131 (16.7%) were admitted. For every 1-unit increase in the Charlson Comorbidity Index, the odds of admission increased by 66% (aOR = 1.66; 95% CI, 1.36-2.04).

Conclusion:

The risk of receiving a positive test result for COVID-19 was higher among Arab American adults living in high-poverty areas than in lower-poverty areas. The risk of admission was directly related to overall health status. Future work should aim to understand the barriers to prevention and testing in this population.

COVID-19 Vaccine Hesitancy among Arab Americans

(1) Background: Coronavirus disease-2019 (COVID-19) vaccines have a significant impact on reducing morbidity and mortality from infection. However, vaccine hesitancy remains an obstacle in combating the pandemic. The Arab American (AA) population is understudied; thus, we aimed to explore COVID-19 attitudes within this community. (2) Methods: This was a cross-sectional study. An anonymous online survey was distributed to members of different AA associations and to the community through the snowball method. (3) Results: A total of 1746 participants completed the survey. A total of 92% of respondents reported having received at least one dose of a COVID-19 vaccine. A total of 73% reported willingness to receive a booster, and 72% plan to give their children the vaccine. On multivariate analysis, respondents were more likely to be vaccine-hesitant if they were hesitant about receiving any vaccine in general. They were less likely to be vaccine-hesitant if they were immigrants, over the age of 40, up to date on their general vaccination and if they believed that COVID-19 vaccines are safe and effective in preventing an infection. The belief that all vaccines are effective at preventing diseases was also associated with lower hesitancy. (4) Conclusions: This sample of AAs have higher vaccination rates and are more willing to vaccinate their children against COVID-19 when compared to the rest of the population. However, a reemergence of hesitancy might be arising towards the boosters.

The Disproportionate Burden of COVID-19 Cases among Arab Americans

Racial and ethnic disparities in COVID-19 cases are pervasive. Some minority, immigrant, and marginalized groups, such as Arab Americans, have been excluded from the research. This population confronts barriers to health care, discrimination, and other factors that may affect understanding, testing, and treatment as it relates to COVID-19. Arab Americans are unique compared to Hispanic, non-Hispanic black, and Asians because Arab Americans do not have a specific ethnic identifier and are classified as non-Hispanic white. Given these issues, this study will estimate COVID-19 cases and examine associations among Arab Americans compared to Hispanic, non-Hispanic black, non-Hispanic white, and Asian adults. Data from the Michigan Disease Surveillance System (March 2020-July 2021), the American Community Survey (2015-2019), and an Arab/Chaldean surname algorithm were used. Chi-square tests were used to determine statistically significant differences between groups. Logistic regression was used to estimate age-adjusted and sex-stratified proportions among Arab Americans compared to non-Hispanic whites before and after adjusting for age and sex. Approximately 17% of Arab Americans tested positive for COVID-19 compared to 11.32% of Hispanics, 9.80% of non-Hispanic blacks, 7.50% of non-Hispanic whites, and 4.24% of Asians. Arab Americans had 2.63 (95% CI: 2.59, 2.66) times greater odds of testing positive for COVID-19 compared to non-Hispanic whites. When Arab Americans were disaggregated from non-Hispanic whites, alarming patterns in COVID-19 cases were observed for Arab Americans. To accurately represent the burden of COVID-19 among Arab Americans, this population needs to have an ethnic identifier that informs appropriate health policy decisions and practice.

Perception Regarding Knowledge of COVID-19 Prevention in a Sample of a Middle Eastern and North African (MENA) Community in Houston, Texas, USA

(1) Background: Knowledge of COVID-19 prevention among communities is the first step towards protective behaviors. The objective of this study was to assess COVID-19 prevention knowledge among a Middle Eastern and North African community in Houston, Texas. (2) Methods: A cross-sectional study was conducted using a validated quantitative survey; survey questions consisted of three parts: COVID-19 specific questions, general health questions, and sociodemographic questions. A multivariable logistic regression model was used to determine predictors of perception of knowledge on preventing COVID-19 spread. The outcome of interest comprised of "good/excellent" versus "average and below" knowledge. (3) Results: A total of 366 participants (66.39% males) completed the survey. A univariate analysis demonstrated significant differences in self-reported COVID-19 prevention knowledge among those with and without health insurance, different ages, level of knowledge, and perceived severity of COVID-19 infection. In the multivariate logistic regression, two predictors were identified: those in the 18-25-year-old group were more likely to have "excellent/good" knowledge on COVID-19 spread compared to the ≥40-year-old group (OR: 6.36; 95% CI: 1.38, 29.34). Those who somewhat agree with knowing how to protect themselves from COVID-19 were more likely to have "excellent/good" knowledge of preventing COVID-19 spread compared to those that neither agree nor disagree or disagree (OR: 7.74; 95% CI: 2.58, 23.26). (4) Conclusions: Younger adults reported higher knowledge of COVID-19 prevention.

Associations between Spiritual Health Locus of Control, Perceived Discrimination and Breast and Cervical Cancer Screening for Muslim American Women in New York City

BACKGROUND

We sought to understand the impacts of religion-related factors, namely perceived discrimination and spiritual health locus of control, on breast and cervical cancer screening for Muslim American women.

METHODS

A total of 421 Muslim American women were surveyed at baseline of a breast and cervical cancer screening intervention, measuring discrimination through the Perceived Ethnic Discrimination Questionnaire (PED-Q), a 17-item scale measuring perceived interpersonal racial/ethnic discrimination; and spiritual beliefs through the Spiritual Health Locus of Control Scale, a 13-item scale measuring the link between control over one's health with a connection to religious beliefs. Multivariable logistic regression models were used to determine factors associated with an up-to-date mammogram and Pap test.

RESULTS

Most women preferred to receive medical care from a healthcare provider of their same gender (75.2%) and same race, ethnicity or religion (62.1%). The middle age group (50-59) and a lower God's Grace Spiritual Health Locus of Control subscale were associated with up-to-date mammogram. Younger age, lower education, higher Exclusion/Rejection subscale, and lower Spiritual Life/Faith Subscale were associated with an up-to-date Pap test.

CONCLUSION

The spiritual beliefs of Muslim American women impact their likelihood of obtaining breast and cervical cancer screenings. Therefore, these services need to be better tailored to match these needs, for example, by ensuring that Muslim American women have access to healthcare providers of their same gender, race, ethnicity or religion.

A National Survey Assessing COVID-19 Vaccine Hesitancy Among Arab Americans

BACKGROUND

Arab Americans' experiences during the COVID-19 pandemic have been largely undocumented. Disparities in vaccine hesitancy between non-Hispanic Whites and minoritized groups have been observed, warranting exploration into the prevalence of COVID-19 vaccine hesitancy among Arab Americans.

METHODS

Data from the Survey of Arab Health in America (SAHA) (n = 638), collected between May 2020 and September 2020, were analyzed to determine predictors for vaccine intention among Arab Americans. Chi-squared tests and logistic regression models were performed to determine the relationship between sociodemographic, immigration, acculturation, and COVID-19 risk variables and vaccine intention.

RESULTS

More than half (56.7%) of respondents reported an intention to be vaccinated with a COVID-19 vaccine, 35.7% reported uncertainty, and 7.5% reported being unlikely to receive a vaccine. Of those unlikely to receive the vaccine, 72.9% were women and 85.4% reported moderate to high religiosity (p < 0.01). Arab American women had higher odds of being uncertain of their vaccine intention (OR = 1.68; 95% CI: 1.10, 2.57) or being unlikely to receive the vaccine (OR = 5.00; 95% CI: 1.95, 12.83) than men in this sample.

DISCUSSION

Factors such as high religiosity and gender were positively associated with being unlikely to receive a COVID-19 vaccine. Future studies should qualitatively assess the beliefs that undergird vaccine intention among Arab Americans.

Disaggregating Heterogeneity among Non-Hispanic Whites: Evidence and Implications for U.S. Racial/Ethnic Health Disparities

Research has made strides in disaggregating health data among racial/ethnic minorities, but less is known about the extent of diversity among Whites. Using logistic regression modeling applied to data on respondents aged 40+ from the 2008 to 2016 American Community Survey, we disaggregated the non-Hispanic White population by ancestry and other racial/ethnic groups (non-Hispanic Black, non-Hispanic Asian, and Hispanic) by common subgroupings and examined heterogeneity in disability. Using logistic regression models predicting six health outcome measures, we compared the spread of coefficients for each of the large racial/ethnic groups and all subgroupings within these large categories. The results revealed that health disparities within the White population are almost as large as disparities within other racial groups. In fact, when Whites were disaggregated by ancestry, mean health appeared to be more varied among Whites than between Whites and members of other racial/ethnic groups in many cases. Compositional changes in the ancestry of Whites, particularly declines in Whites of western European ancestry and increases in Whites of eastern European and Middle Eastern ancestry, contribute to this diversity. Together, these findings challenge the oft-assumed notion that Whites are a homogeneous group and indicate that the aggregate White category obscures substantial intra-ethnic heterogeneity in health.

The Burden of and Factors Associated with Age-Related Eye Diseases in Arab American Adults

To estimate the age- and sex-adjusted proportions of cataract, diabetic retinopathy, glaucoma, and macular degeneration among the Arab American community, a notably understudied minority that is aggregated under whites. The Arab American Eye Study is a multicenter retrospective chart review involving 10 years of electronic medical records (1/1/2010 through 1/1/2020). The study sample included 1390 Arab Americans and 4950 whites 45 years of age and older, totaling 6340 subjects. Arab Americans were identified using an Arab American name algorithm. Subjects with race variables other than white or Arab American or those under age 45 were excluded from the study. Age- and sex-adjusted proportions of cataract, diabetic retinopathy, glaucoma, and macular degeneration were determined. Odds ratios with 95% confidence intervals were used to examine the association between race/ethnicity and eye diseases. Of the 6340 participants (4950 whites and 1390 Arab Americans), males comprised 46.3% and the median age group was 55-64 years. Arab Americans displayed higher age- and sex-adjusted proportions of cataracts (45.4% versus 40.7%), dry age-related macular degeneration (10% versus 8.9%), glaucoma (8% vs 6%), and diabetic retinopathy (11.7% versus 4.2%). Fully adjusted logistic regression revealed that Arab Americans were 19% more likely to have cataracts (OR 1.19; 95% CI 1.05, 1.35) and 272% more likely to have diabetic retinopathy (OR 2.72; 95% CI 2.17; 3.41). Results from the Arab American Eye Study suggest that the burden of cataract and diabetic retinopathy is significantly higher among Arab Americans in comparison to whites.

Trends in access to female cancer screening in Brazil, 2007-16

BACKGROUND

This study aims to analyse changes in the prevalence of cervical cancer (CCa) and breast cancer (BCa) screening among women in the Brazilian capitals and Federal District in the last decade (2007-16).

METHODS

Data from the surveillance system of risk and protective factors for chronic diseases through telephone interviews (n = 267 949) were used. Adequate screening consisted of, at least, one Pap test triennially, for women aged between 25 and 64 years, and mammography exam biannually, for women aged between 50 and 69 years. The prevalence of adequate screening was investigated for each type of cancer isolated and combined (women aged between 50 and 64 years). The prevalence of adequate screening was estimated for the total population and according to socioeconomic variables. Linear regression models were used.

RESULTS

The prevalence of adequate screening test for CCa remained stable, around 82%, while the screening test for BCa increased from 71 to 78% between 2007 and 2016. Higher increases were observed among women with low schooling and from less developed regions. The percentage of adequate screening (considering both types), for women aged between 25 and 69 years, remained stable, close to 78%.

CONCLUSIONS

Screening for BCa increased significantly. Smaller coverage rates are verified among women with low schooling and from less developed regions.

Factors associated with seasonal influenza and HPV vaccination uptake among different ethnic groups in Arab and Jewish society in Israel

Background

Parents in the Arab population of Israel are known to be “pro-vaccination” and vaccinate their children at higher rates than the Jewish population, specifically against human papilloma virus (HPV) and seasonal influenza.

Objectives

This study seeks to identify and compare variables associated with mothers’ uptake of two vaccinations, influenza and HPV, among different subgroups in Arab and Jewish society in Israel.

Methods

A cross-sectional study of the entire spectrum of the Israeli population was conducted using a stratified sample of Jewish mothers (n = 159) and Arab mothers (n = 534) from different subgroups: Muslim, Christian, Druse and Northern Bedouins. From March 30, 2019 through October 20, 2019, questionnaires were distributed manually to eighth grade pupils (13–14 years old) who had younger siblings in second (7–8 years old) or third (8–9 years old) grades.

Results

Arab mothers exhibited a higher rate of uptake for both vaccinations (p < .0001, HPV – 90%; influenza – 62%) than Jewish mothers (p = 0.0014, HPV – 46%; influenza – 34%). Furthermore, results showed that HPV vaccination uptake is significantly higher than seasonal influenza vaccination uptake in both populations. Examination of the different ethnic subgroups revealed differences in vaccination uptake. For both vaccinations, the Northern Bedouins exhibited the highest uptake rate of all the Arab subgroups (74%), followed by the Druse (74%) and Muslim groups (60%). The Christian Arab group exhibited the lowest uptake rate (46%). Moreover, the uptake rate among secular Jewish mothers was lower than in any of the Arab groups (38%), though higher than among religious/traditional Jewish mothers, who exhibited the lowest uptake rate (26%). A comparison of the variables associated with mothers’ vaccination uptake revealed differences between the ethnic subgroups.

Moreover, the findings of the multiple logistic regression revealed the following to be the most significant factors in Arab mothers’ intake of both vaccinations: school-located vaccination and mothers’ perceived risk and perceived trust in the system and in the family physician. These variables are manifested differently in the different ethnic groups.

Conclusions

This research shows that all Arabs cannot be lumped together as one monolithic group in that they exhibit major differences according to religion, education and access to information. Ranking of variables associated with uptake of the two vaccines can provide decision-makers an empirical basis for tailoring appropriate and specific interventions to each subgroup to achieve the highest vaccine uptake rate possible. Media campaigns targeting the Arab population should be segmented to appeal to the various sub-groups according to their viewpoints, needs and health literacy.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12939-021-01523-1.

Cancer risk perception and physician communication behaviors on cervical cancer and colorectal cancer screening

Background

Women 50-65 years of age have the lowest cervical and colorectal cancer (CRC) screening rates among ages recommended for screening. The primary aim of this work is to determine how cancer risk perceptions and provider communication behaviors, in addition to known demographic factors, influence the uptake of both cervical and CRC screening or a single screen among women in southeast Michigan.

Methods

Fourteen health services and communication behavior questions were adapted from the Health Information National Trends Survey (HINTS) and administered to a multiethnic sample of adults in southeast Michigan. The outcome variable was self-reported up-to-date cervical cancer and/or CRC screening as defined by the United States Preventive Services Task Force (USPSTF). Demographic and cancer risk/communication behavior responses of the four screening populations (both tests, one test, no tests) were analyzed with multinomial regression for all comparisons.

Results

Of the 394 respondents, 54% were up to date for both cervical and CRC screening, 21% were up to date with only cervical cancer screening and 12% were up to date for only CRC screening. Of the 14 risk perception and communication behavior questions, only 'Did your primary care physician (PCP) involve you in the decisions about your health care as much as you wanted?' was significantly associated with women having both screens compared to only cervical cancer screening (aOR 1.67; 95% CI: 1.08, 2.57). The multivariate model showed age, and Middle East and North African (MENA) ethnicity and Black race, in addition to PCP-patient dyad decision-making to be associated with the cancer screenings women completed.

Conclusions

Optimizing PCP-patient decision-making in health care may increase opportunities for both cervical cancer and CRC screening either in the office or by self-sampling. Understanding the effects of age and the different interventional strategies needed for MENA women compared to Black women will inform future intervention trials aimed to increase both cancer screenings.

Funding

This work was supported by NIH through the Michigan Institute for Clinical and Health Research UL1TR002240 and by NCI through The University of Michigan Rogel Cancer Center P30CA046592-29-S4 grants.

Disparities in influenza vaccination: Arab Americans in California

Background

Influenza vaccination among minoritized groups remains below federal benchmarks in the United States (US). We used data from the 2004–2016 California Health Interview Surveys (CHIS) to characterize influenza vaccination patterns among Arab Americans in California.

Methods

Influenza vaccination was self-reported by Arab American adults (N = 1163) and non-Hispanic Whites (NHW, N = 166,955). Differences in influenza vaccination prevalence and odds were compared using chi-squared tests and survey-weighted logistic regression, respectively.

Results

Across all years, 30.3% of Arab Americans self-reported receiving an influenza vaccine (vs. 40.5% for NHW, p < 0.05). After sequential adjustment by sociodemographic, health behavior, and acculturation variables no differences in odds of self-reported influenza vaccination were observed between Arab Americans and NHW (odds ratio: 1.02, 95% confidence interval: 0.76–1.38). Male and unemployed Arab Americans had higher odds of reporting influenza vaccination than female and employed Arab Americans.

Conclusions

Future work should consider specific barriers to influenza vaccination in Arab American communities.

Differences in Health Characteristics of Geographic Subgroups of Arab Americans in a Northern California Health Plan

INTRODUCTION

Arab Americans are a diverse ethnic group originating from a large geographic area in the Middle East and North Africa (MENA). We aim to characterize differences in health between Arab Americans from different geographic subgroups within MENA.

METHODS

We used cross-sectional electronic health record (EHR) data for a subset of 4913 Arab Americans aged 20-84 in a 2016 Northern California health plan study cohort who could be assigned to one of 4 geographic subgroups (Gulf, African, Levant, and Other) based on EHR ethnicity data. We calculated age-adjusted prevalence estimates for men and women and used generalized linear models to compare Gulf, African, and Other subgroups to Levant Arabs on risk factors (obesity and smoking), chronic conditions (diabetes, hypertension, hyperlipidemia, and asthma), and mental health (depression and anxiety).

RESULTS

Among women, prevalence of smoking was lower among Gulf, African, and Other Arabs than Levant Arabs. Among men, prevalence of obesity, diabetes, and hyperlipidemia was lower among Gulf, African, and Other Arabs than Levant Arabs, while prevalence of depression was higher for these subgroups than Levant Arabs.

DISCUSSION

We found substantial differences in health characteristics across Arab Americans from different geographic subgroups. Our results suggest that more detailed race and ethnicity information should be collected on Arab Americans to better understand their diverse health risks.

Prevalence of Self-reported Cognitive Impairment Among Arab American Immigrants in the United States

Background and Objectives

Studies evaluating self-reported cognitive impairment among Arab American immigrants have not been conducted. Our objective was 2-fold: (a) to estimate and compare the age- and sex-adjusted prevalence of self-reported cognitive impairment between Arab American immigrants and U.S.- and immigrant non-Hispanic Whites, non-Hispanic Blacks, Hispanics and non-Hispanic Asians and (b) to examine associations between race, ethnicity, nativity status, and cognitive impairment among Arab American immigrants and non-Hispanic Whites (U.S.- and foreign-born) after controlling for explanatory factors.

Research Design and Methods

We used 18 years (2000–2017) of National Health Interview Survey data (n = 228 985; ages ≥ 45 years). Weighted percentages, prevalence estimates, and multivariable logistic regression models were calculated.

Results

The age- and sex-adjusted prevalence of self-reported cognitive impairment was significantly higher among Arab American immigrants (9.7%) compared to U.S.-born and non-Hispanic White immigrants (~7.4%).

Discussion and Implications

This is the first study to indicate that ethnic disparities in self-reported cognitive impairment may extend to Arab American immigrants. Additional studies need to be conducted to better understand the prevalence of cognitive impairment.

Racial and Citizenship Disparities in Health Care Among Middle Eastern Americans

OBJECTIVE

To assess differences in health access and utilization among Middle Eastern American adults by White racial identity and citizenship.

METHODS

Data from the 2011 to 2018 National Health Interview Surveys (N=1013) and survey-weighted logistic regression analyses compare Middle Eastern immigrants by race and citizenship on access and utilization of health care in the United States.

RESULTS

White respondents had 71% lower odds of delaying care [adjusted odds ratio (AOR)=0.34; 95% confidence interval (CI)=0.13, 0.71] and 84% lower odds of being rejected by a doctor as a new patient (AOR=0.16; 95% CI=0.03, 0.88) compared to non-White respondents. US citizens had higher odds of visiting the doctor in the past 12 months compared with noncitizens (AOR=1.76; 95% CI=1.25, 2.76).

CONCLUSION

Middle Eastern immigrants who do not identify as White and who are not US citizens are significantly less likely to access and utilize health care compared with those who identify as White and are US citizens.

POLICY IMPLICATIONS

This study shows that racial and citizenship disparities persist among Middle Eastern Americans at a national-level, playing a critical role in access to and use of health care.

Uptake of cancer screenings among a multiethnic refugee population in North Texas, 2014-2018

Background

Refugees are less likely than US born populations to receive cancer screenings. Building Bridges is a community health worker prevention program designed to increase refugee’s cancer screening uptake. The purpose of this cross sectional analysis was to assess differences in uptake of cervical, breast, liver, and colorectal screens across six cultural groups.

Methods

Data was abstracted in 2018 for this analysis. Participants were categorized into six cultural groups (Myanmar, Central Africa, Bhutan, Somalia, Arabic Speaking Countries, and Other) to assess differences in sociodemographic measures and screening uptake. Uptake proportions were calculated for each cancer type (cervical, breast, liver, and colon) among eligible participants, by gender and cultural group. Differences in uptake across groups were assessed using stratified analysis and logistic regression. Prevalence odds ratios (POR) and 95% confidence intervals (CIs) were calculated for each group to assess the association between screening completion and cultural group.

Findings

874 refugees were asked about cancer screening history. The majority of participants were either ‘never had been screened’ or ‘not up-to-date’ for every cancer screening. Among age eligible, 82% had no prior pap exam within the past 3 years, 81% had no prior mammogram within the past year, 69% didn’t know their Hepatitis B status and 87% never had a colon cancer screening. Overall, higher uptake of all types of cancer screenings was observed in Myanmar and Bhutanese groups, except colon cancer screening which was higher among Central African Region and Arabic Speaking participants.

Conclusion

Screening uptake varied by ethnic group and screening type. The program reached an under and never screened population, however, the proportion of refugees who received a cancer screening remained low compared to the US population. Diversity within refugee communities requires adaptation to specific cultural and linguistic needs to include new Americans in cancer elimination efforts.

The Contested Whiteness of Arab Identity in the United States: Implications for Health Disparities Research

In response to the Institute on Minority Health and Health Disparities' (NIMHD) new health disparities research framework, we call on the National Institutes of Health (NIH) to acknowledge Arabs in the United States as a health disparity population. Arab classification as White leads to their cultural invisibility and perpetuates a cycle of undocumented health disparities.We provide examples of how this contested identity reinforces challenges associated with identifying this population and contributes to enactments of structural violence and undocumented health disparities. Decades of research with Arabs in the United States provides consistent evidence that their health does not fit the health profile of White Americans and that Arabs do not benefit from Whiteness and White privilege associated with their White racial categorization. On the contrary, Arabs in the United States experience discrimination and health disparities that require urgent attention; this can be achieved only by identifying the population with a racial category other than White.We conclude with recommendations to NIH and NIMHD to revise their definition of health disparity populations to include Arabs in the United States.

Differences in health behaviors and health outcomes among non-Hispanic Whites and Arab Americans in a population-based survey in California

Background

Few population-based studies of Arab American health behaviors and outcomes exist outside of Michigan. We aimed to provide prevalence estimates of health behaviors and outcomes for Arab Americans and compare them to non-Hispanic Whites in California.

Methods

We used data from the 2003–2016 California Health Interview Surveys. We determined Arab American ethnicity using an algorithm that considered place of birth of the respondent or parent and use of Arabic language at home. Survey-weighted frequencies, chi-squared statistics, and logistic regression analyses were used to compare Arab Americans and non-Hispanic Whites on socioeconomic indicators, health behaviors and health outcomes. Multivariable models were adjusted for age, education level, and insurance status.

Results

Arab Americans had higher prevalence of no insurance, living below the federal poverty level, and home ownership than non-Hispanic Whites despite high levels of education and low unemployment prevalence. Arab Americans had reduced odds of alcohol consumption (OR: 0.33, 95% CI: 0.24, 0.45), binge drinking (OR: 0.28, 95% CI: 0.19, 0.40), and suicidal ideation (OR: 0.41, 0.25, 0.66) when compared to non-Hispanic Whites in multivariable models. Arab Americans had decreased odds of hypertension (OR: 0.64, 95% CI: 0.50, 0.83) and increased odds of diabetes (OR: 2.03, 95% CI: 1.23, 3.34) when compared to non-Hispanic Whites in multivariable models.

Conclusions

Arab Americans in California participate in less risky health behaviors and have better health outcomes than non-Hispanic Whites, except with regards to diabetes. Future work aiming to understand the health of Arab Americans should allow for self-identification and less reliance on country of origin and language use at home for sample selection.

Prevalence, Perceived Benefits, and Perceived Barriers Regarding Breast Cancer Screening Among Three Arab American Women Subgroups

Introduction: Mammography screening (MS) has been identified as a valuable tool to decrease mortality rates from breast cancer (BC). Arab American women (AAW) have been recognized as an ethnic group that needs further research to promote their participation in BC screening. This study aims to explore MS rates, and investigate differences in attitudes and beliefs about BC screening in AAW. Method: This comparative, cross-sectional study investigated 316 American Muslim and Christian women from three Arab countries. The Arab Culture-Specific Barriers instrument was employed. Results: The results revealed lower MS rates in AAW compared with national screening rates. Cultural and religious benefits and barriers were identified. Discussion: This study was able to provide a better understanding of AAW beliefs, attitudes, and behaviors regarding BC screening based on their unique ethnic identity and religion. Implications of such findings include increasing efforts to improve MS rates and providing cultural training for health care professionals.

Attitudes towards health research participation: a qualitative study of US Arabs and Chaldeans

BACKGROUND

The Arab Muslim and Chaldean Christian American community is unified by language but culturally diverse. Researchers are challenged to engage the Arab/Chaldean community to meet immigrant health needs. Arabs/Chaldeans are identified as white in clinical data sets making it difficult to identify health behaviours and patterns unique to the community.

OBJECTIVES

To explore the views of members of the Arab/Chaldean community, including researchers and the lay public, regarding health research participation and the role of clinicians, researchers and community leaders in the research process.

METHODS

A qualitative study of Arab and Chaldean adults and researchers conducted in a US community with a large Arab/Chaldean population. Five semi-structured focus group discussions were triangulated with five in-depth semi-structured interviews with Arab or Chaldean primary care researchers. Responses were audio-recorded and transcribed verbatim. Transcripts were coded and thematically analysed, and findings confirmed with community representatives.

RESULTS

Three themes were identified: (i) research expectations: risks and benefits; (ii) health care environment: clinicians as recruiters and (iii) research participations: risks and benefits. Themes captured concerns with social relationships, reputation or trust and the cost and benefit of research participation. In the Arab/Chaldean community, institutional and political fears and distrust are amplified. Respect for physicians, teachers and faith leaders connected with or recruiting for studies enhances likelihood of research participation.

CONCLUSION

Clinical researchers should address the cultural and immigration histories of Arab/Chaldean research participants. Studies that maximize trust will minimize participation bias and lay the groundwork for improved health. Institutional, sociocultural and personal factors require a pre-study phase to engage and educate participants.

Cervical Cancer Screening Among Women by Birthplace and Percent of Lifetime Living in the United States

OBJECTIVE

The aim of the study was to provide national estimates of Pap test receipt, by birthplace, and percent of lifetime in the United States (US).

MATERIALS AND METHODS

Pooled nationally representative data (2005, 2008, 2013, 2015) from the National Health Interview Survey were used to examine differences in Pap test receipt among adult US women by birthplace and percent of lifetime in the US. Descriptive estimates were age-adjusted. Regression models were adjusted for selected sociodemographic and healthcare access and utilization factors and presented as predicted margins.

RESULTS

Foreign-born women 18 years and older were more than twice as likely to have never received a Pap test compared with US-born women (18.6% vs 6.8%). Regression models showed that foreign-born women from Mexico (9.8%), South America (12.6%), Caribbean (14.6%), Southeast Asia (13.7%), Central Asia (20.4%), South Asia (22.9%), Middle East (25.0%), Africa (27.8%), Europe (16.4%), and Former Soviet Union (28.2%) were more likely to be unscreened compared with US-born women (7.6%). Foreign-born women who spent less than 25% of their life in the US had higher prevalence of never having a Pap test (20%) compared with foreign-born who spent more than 25% of their life in the US (12.7%).

CONCLUSIONS

Using national survey, we found that where a woman is born and the percent of her lifetime spent residing in the US do impact whether she gets screened at least once in her lifetime.

IMPACT

These findings may inform cervical cancer screening efforts targeting foreign-born women.

Screening and follow-up for depression among Arab Americans

BACKGROUND

The authors compared proportions and associations of depression screening, major depression, and follow-up care of Arab Americans compared to non-Hispanic whites, non-Hispanic blacks, Asians, and Hispanics.

METHODS

Administrative data was electronically abstracted from a large health system in metropolitan Detroit among 97,918 adult patients in 2014 and 2015. A valid and reliable surname list was used to identify Arab Americans. Using chi-squares, we examined the relationship between race/ethnicity and depression screening, major depression, and follow-up care. We calculated odds ratios (OR) and 95% confidence intervals (CI) to examine the relationship between the main independent variable of race/ethnicity and the dependent variables of depression screening and major depression while controlling for confounders.

RESULTS

Arab American women were 23% less likely to be screened for depression compared to non-Hispanic white women (OR = 0.77; 95% CI = 0.70, 0.86). The age- and sex-adjusted proportions of major depression were 5.5% for Arab Americans compared to 7.0% for Hispanics, 6.0% for non-Hispanic blacks, 5.9% for non-Hispanic whites, and 1.5% for Asians. Arab Americans with major depression were less likely to follow up with a behavioral specialist and more likely to follow up with a primary care physician compared to other racial and ethnic groups.

CONCLUSIONS

Our study adds to the discourse on depression care among Arab Americans by highlighting the existing disparities related to adequate screening and appropriate management of depression. Future studies should include information about the influences of acculturation, culture, stigma, family, and religion on depression care.

The Health of Arab Americans in the United States: An Updated Comprehensive Literature Review

Background: Arab Americans are a historically understudied minority group in the United States and their health needs and risks have been poorly documented. We aim to provide an updated comprehensive review of the literature on Arab American physical and mental health and provide suggestions for future work in this field.

Methods: A comprehensive review of the English language medical and public health literature published prior to 2017 identified through multiple database searches was conducted with search terms describing Arab Americans and health outcomes and behaviors. The literature was qualitatively summarized by health behavior (vaccination, tobacco use, drug and alcohol use, and physical activity), health outcome (diabetes, mental health, cardiovascular disease, cancer, women's, and child health), and populations at increased risk of poor health outcomes (adolescents and the elderly).

Results: The majority of studies identified exploring Arab American health have been published since 2009 with an increase in the number of longitudinal and intervention studies done with this population. The majority of research is being undertaken among individuals living in ethnic enclaves due to the lack of an ethnic or racial identifier that may help identify Arab Americans from population-based studies. Studies highlight the conflicting evidence in the prevalence of diabetes and cardiovascular disease based on study sample, an increased understanding of cancer incidence and barriers to identification, and an increased level of knowledge regarding mental health and sexual health needs in the population. Information on health behaviors has also increased, with a better understanding of physical activity, alcohol and drug use, and vaccination.

Conclusion: More research on Arab American health is needed to identify risks and needs of this marginalized population given the current social and political climate in the United States, especially with regard to acculturation status and immigrant generation status. We provide recommendations on approaches that may help improve our understanding of Arab American health.

HPV Vaccination Among Foreign-Born Women: Examining the National Health Interview Survey 2013-2015

INTRODUCTION

Human papillomavirus vaccination is less prevalent among foreign-born than U.S.-born women and may lead to disparities in human papillomavirus-related cancers in the future. There is limited research on factors associated with vaccination uptake between these two groups. This study examined the association between place of birth and human papillomavirus vaccine uptake, and what determinants of vaccination attenuate this relationship.

METHODS

The 2013-2015 National Health Interview Survey data on women was analyzed in 2016, to determine differences in prevalence of human papillomavirus vaccination between foreign- and U.S.-born women. Multivariate binary logistic regression analysis was used to examine the association between foreign-born status and human papillomavirus vaccine initiation, after controlling for health insurance status, having a usual source of care, obstetrician/gynecologist visits, Pap tests, length of U.S. residency, and citizenship.

RESULTS

Human papillomavirus vaccination prevalence varied significantly among women born in different regions of the world. European and South-American women had the highest vaccination rates among all foreign-born women. Compared with U.S.-born women, foreign-born women were significantly less likely to report human papillomavirus vaccine initiation. This relationship was partially attenuated after adjusting for the covariates. Among foreign-born women, Asians were significantly less likely to report human papillomavirus vaccination uptake than white women. Additionally, living in the U.S. for >5 years was significantly associated with vaccine initiation, but attenuated by U.S. citizenship status.

CONCLUSIONS

Public health interventions to improve human papillomavirus vaccination need to be developed to address multicultural audiences with limited access to health insurance and health care.

Mammography Use in Portugal: National Health Survey 2014

INTRODUCTION

Understanding the patterns of mammography use and monitoring changes in use are essential to improving national health policy for breast cancer control. We aimed to describe the use of mammography in Portugal and to identify the determinants of its nonuse and underuse by examining data from the National Health Survey 2014.

METHODS

We analyzed data on 8,758 women aged 30 years or older. We defined women at an eligible age for mammography as women aged 45 to 69. Women who reported a previous mammography test were classified as ever-users and grouped according to time since the most recent test. We computed the prevalence of mammography use, and we used Poisson regression models to obtain age-adjusted and education-adjusted prevalence ratios and 95% confidence intervals.

RESULTS

The overall prevalence of mammography use was 80.0%, whereas nonuse was 20.0% and underuse 27.3% among users. The prevalence of nonuse and underuse were lower and associations with sociodemographic characteristics, use of health care services, and behavioral factors were stronger among women aged 45 to 69 than among women aged 30 to 44 and women aged 70 or older. The prevalence of mammography use was generally higher in the northern areas of Portugal than in southern areas and varied by marital status, educational level, and household size. A more frequent use of health care services and healthier behaviors were associated with lower prevalences of both nonuse and underuse.

CONCLUSION

This study illustrates inequalities in mammography use and provides useful information for better allocation of resources in breast cancer screening.

Cervical Cancer Screening Among Arab Women in the United States: An Integrative Review

PROBLEM IDENTIFICATION

Arab American women are an ethnic minority and immigrant population in the United States with unique and nuanced sociocultural factors that influence preventive health behaviors. The aims of this article are to evaluate and synthesize the existing evidence on cervical cancer screening behaviors, as well as determine factors that influence these behaviors, among Arab American women.
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LITERATURE SEARCH

Extensive literature searches were performed using PubMed, CINAHL®, Scopus, Embase, and Cochrane databases; articles published through October 2015 were sought. 
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DATA EVALUATION

Of 17 articles, 14 explicitly identified Arab and/or Muslim women and cervical cancer screening in either the title or the abstract; the remaining three focused on cancer attitudes and behaviors in Arab Americans in general but measured cervical cancer screening. Eleven articles reported different aspects of one intervention. Because of methodologic heterogeneity, the current authors synthesized results narratively.
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SYNTHESIS

Key factors influencing cervical cancer screening were identified as the following.

CONCLUSIONS

Cervical cancer screening rates among Arab American women are comparable to other ethnic minorities and lower than non-Hispanic White women. Findings are inconsistent regarding factors influencing cervical cancer screening behaviors in this underrepresented group. 
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IMPLICATIONS FOR RESEARCH

Significant need exists for more research to better understand cervical cancer prevention behaviors in this group to inform culturally relevant interventions. Healthcare providers play a crucial role in increasing cervical cancer screening awareness and recommendations for Arab American women.

Factors Associated with Adherence to Routine Screening Mammography in HIV-Infected Women

BACKGROUND

Both HIV-infected women and minority women have historically lower rates of screening mammography. The objective of this study was to identify factors related to adherence to routine screening mammography in a diverse inner-city cohort of HIV-infected women, to inform future work on targeted interventions to address disparities.

MATERIALS AND METHODS

This retrospective cohort study reviewed the electronic medical record of HIV-infected women aged 40 and older engaged in care between October 1, 2003 and March 31, 2008 at a large urban safety-net HIV clinic. Analyses included chi square testing and multivariate logistic regression to assess for patient-specific factors associated with adherence to breast cancer screening, defined as obtaining a screening mammogram within 2 years of engaging in care.

RESULTS

The 292 women were a racially diverse group, with 70% black, 11% Hispanic, and 42% foreign born. There was suboptimal HIV control, with only 33% having an undetectable viral load (VL). One hundred forty-six (50%) were adherent to screening mammography. In multivariate analysis, women who were foreign born (OR 2.65 [CI 1.52-4.64]) had not completed high school (OR 1.77 [CI 1.06-2.95]) or had an undetectable VL (OR 2.51 [CI 1.44-4.40]) had increased odds of obtaining a mammogram.

CONCLUSIONS

Among a racially diverse urban population of HIV-infected women engaged in care, only half had a mammogram. Foreign-born women had higher odds of undergoing mammography, suggesting that nativity status and social determinants of health are under-recognized drivers of adherence in this population. Future programs targeting screening must be mindful of the multiple predictors of adherence.