Long-Term Refugee Health: Health Behaviors and Outcomes of Cambodian Refugee and Immigrant Women

The now and future of human biology at the extremes: An introduction to the special issue

OBJECTIVES

A hallmark of the human species is our adaptability to a wide range of different ecologies and ecosystems, including some of the most extreme settings. Human biologists have long studied how humans have successfully (and sometimes unsuccessfully) adapted to such extremes, particularly ecological extremes like environments at lower limits of temperature and high altitude. In this special issue, we revisit traditional definitions and explore new conceptions of work in extreme environments. We argue that our definitions of extremes should change with our changing world, and account for extremes unique to the Anthropocene, including environments of inequality and precarity, pandemic landscapes, climate-impacted settings, obesogenic environments, and the environments of human spaceflight. We also explore the future of work at the extremes and provide some suggested guidelines on how human biologists can continue to build and expand on foundational work in this area.

CONCLUSION

While human biologists have done critical work on groups living in extreme environments, our definitions of humans at the limits continue to change as the world around us also changes. Scholars in this area have a responsibility to re-examine the parameters of extremes to stay at the forefront of scientific exploration and collaboration so human biology, as a discipline, can continue to shape our understanding of adaptability, and thus contribute to the continued thriving of all humans as we endure new climatic, environmental, and societal extremes.

Building on Community Research Partnerships and Training Students in a Multi-Phase Community-Based Participatory Research Study With Young Women of Cambodian Heritage in Massachusetts

Refugees bring significant economic and cultural benefits to communities and yet face elevated risk of chronic disease and barriers to good health in the U.S. Community-based participatory research (CBPR) can benefit refugee communities and provide training/mentoring opportunities for students. The Cambodian Women's Health Study was a four-phase, multi-year CBPR university-community collaboration with the Massachusetts Cambodian community that focused on health, nutrition, pregnancy, and food security among primarily young women of Cambodian heritage ages 15-30 years old. Phase 1 was a focus group discussion (FGD, n = 4) and cross-sectional survey (n = 56) with pregnant women. Phase 2 was a cross-sectional survey (n = 107) with nonpregnant women. Phase 3 was a series of FGD (seven FGD, n = 38) with women. Phase 4 was a student-led translational nutrition intervention (three classes) with women (n = 11) and men (n = 10). The study design included compensation and support for the community partner and included structured mentoring of students (six graduates, eight undergraduates) in CBPR methods, adult learning, and cultural humility. Benefits to the community agency included enhanced research capacity, including supervising student research assistants, and robust compensation. Benefits to students included intensive mentoring and training. Successes included cost-effectiveness and strong recruitment and experiences with participants. Challenges included issues with student-led recruitment and organization that required additional mentoring and reflection. To work toward socially just and equitable research and interventions, CBPR collaborative efforts should include intentional meaningful compensation and community capacity-building as well as structured mentoring and training for student researchers and should build on existing work and relationships within communities.

Health Beliefs and Barriers to Healthcare of Rohingya Refugees

In recent years, over 1,000 Rohingya families have been resettled to Milwaukee, Wisconsin from areas where they faced trauma and health disparities. To better understand their health beliefs and barriers to healthcare, we conducted a qualitative study with ten community health workers and stakeholders serving the Milwaukee Rohingya community. Interviews were transcribed, coded, and analyzed. Themes included: 1) health is defined as being able to meet basic needs of the family/community; 2) prior and existing mistrust and fear of systems of authority impact healthcare seeking behavior; 3) past-trauma negatively impacts physical and mental health; 4) religion and spirituality influence beliefs about illness, recovery, and wellbeing; 5) linguistic, cultural, and educational barriers impact access, quality of care, and understanding of disease. These results begin to address the significant gap in our knowledge of the health beliefs and needs of the local Rohingya community and underscore the need for tailored interventions.

Birth Outcomes among Descendants of Foreign-Born and US-Born Women in California: Variation by Race and Ethnicity

This study quantifies the magnitude and persistence of differences in adverse birth outcomes between descendants of foreign-born and US-born women by race/ethnicity. Using 1978-2015 California birth records, I linked records of infants to those of their mothers to create an intergenerational sample (N = 501,323 second generation mothers and 633,102 third generation daughters). Prevalence of low birthweight and preterm birth were calculated in both generations by race/ethnicity, and foreign-born status. An initial foreign-born advantage in birth outcomes is present among most racial/ethnic groups with the exception of foreign-born Asian women. In the subsequent generation, the foreign-origin advantage diminishes for most groups and a foreign-origin disadvantage in low birthweight emerges for descendants of Asian women. Findings largely persist after adjustment for sociodemographic and healthcare-related characteristics. These results underscore the importance of disaggregating by race, ethnicity, and foreign origin when possible to better understand perinatal health disparities in the population.

Beyond Resettlement: Sociocultural Factors Influencing Breast and Colorectal Cancer Screening Among Afghan Refugee Women

Immigrants and refugees have an increased risk for developing chronic health conditions, such as breast and colorectal cancer, the longer they reside in the USA. Moreover, refugees are less even likely to use preventive health services like mammography and colonoscopy screening when compared with US-born counterparts. Focused ethnography was employed to examine sociocultural factors that influenced cancer screening behaviors among aging Afghan refugee women. We conducted 19 semi-structured interviews with Afghan women 50 and older and their family member/caregivers. Interview transcripts were inductively coded using Atlas.ti, where focused codes were sorted and reduced into categories, and we extracted meaning around groups of categories. Findings of this study revealed factors like fear of cancer, pre-migration experiences, family involvement, provider recommendation, and provider gender concordance influenced women's cancer screening behaviors. This study also found that women who have had a recent mammogram or colonoscopy described empowerment factors that helped them withstand the stressful process of screening, through encouragement and reminders from providers, support from adult family members, and finding strength through duaas (prayers). As refugee women continue to age in the USA, clinicians should incorporate multi-level strategies, including family-centered and faith-based approaches to promote preventive screening behaviors in this population.

‘Swallow medicine, eat rice, pray about health’: health, health care and health-seeking experiences of South-East Asian older refugees

South-East Asian refugees have lived in the United States of America for nearly four decades, with early refugee immigrants experiencing ageing and later life within the refugee context. As refugees age, health concerns of this older population grow, highlighting the need for ongoing assessment of refugee health and health-seeking behaviours. This study builds on previous literature that assessed the health and health-seeking patterns of South-East Asian refugees in the early years following resettlement, exploring how health and health-seeking is understood among older refugees 40 years after immigration. This paper includes a subset of 37 older refugees from a larger, community-based participatory, mixed-methods intergenerational study of Cambodian and Laotian refugee families conducted over four years (quantitative N = 433; qualitative N = 183). Thematic analysis of 34 semi-structured interviews with these older refugees in coastal Alabama revealed trends in health and health-seeking practices. Older refugees reported high rates of diabetes and hypertension within their generational cohort, and indicated a shift in health-seeking behaviours, whereby Western biomedicine is sought first for such chronic concerns, followed by traditional medicines for mild ailments such as headaches or colds. Older refugees underscored barriers of language, finances and transportation as limiting access to Western health care. Implications for engaging in community health practices and incorporating services to specifically meet the needs of the ageing refugee population are discussed.

States and Refugee Integration: a Comparative Analysis of France, Germany, and Switzerland

The Syrian civil war led to mass migration and Europe becoming a potential site of refuge. How have Syrians experienced refuge in Europe? Drawing on 58 interviews with Syrian refugees in Germany, France, and Switzerland, we find that refugees continue to experience exclusion in all integration domains including those found as markers and means, social connections, facilitators, and foundations of integration . While our cases demonstrate that Syrian refugees in Europe experience discrimination across all domains, not all conditions are equal. Using narrative analysis, differences were observed within three integration domains. Accessing language programs was more challenging in France, finding housing was more challenging in Germany, and F type residence permits limited refugees’ rights in Switzerland more than in other countries. Discrimination across domains is deepening the socio-cultural-economic divide between autochthonous communities and Syrian refugees, but not all domains are equally divisive across countries. The findings outline that where these states outsourced refugee services, refugees experienced increased barriers to integration.

Associations between Cultural Identity, Household Membership and Diet Quality among Native Hawaiian, Pacific Islander, and Filipino Infants in Hawai'i

Public health efforts to reduce diet-related health disparities experienced by indigenous peoples could be enhanced by efforts to improve complementary infant feeding practices. The latter is possible through interventions informed by cultural determinants. This cross-sectional secondary analysis explored possible determinants of the complementary feeding practices of Native Hawaiian, Pacific Islander, and/or Filipino infants (NHPIF) in Hawai'i, ages 3-12 months. The objective was to determine the association between caregiver cultural identity and infant household membership with indicators of infant diet healthfulness. The cultural identities, infant household memberships, early infant feeding practices and additional demographic information (infant age and sex, household income) were assessed via an online questionnaire. Surrogate reporting of the infants' diets over four days was evaluated using an image-based mobile food record (mFR). Data collected by the mFR were evaluated to derive the World Health Organization's minimum dietary diversity (MDD) indicator and food group consumption. Data were summarized by descriptive statistics and analyzed using multivariate linear and logistic regressions. Seventy infant participants, ages 3-12 months, and their primary caregivers completed the study. Of these, there were 56 infant participants between the age of 6-12 months. Approximately 10% of infants, ages 6-12 months, met MDD for all four days. Meeting MDD and the number of food groups consumed were significantly associated with age. Caregiver cultural identity, infant household membership and infant sex had non-significant associations with indicators of infant diet quality. Findings inform the influences shaping dietary patterns of Native Hawaiian, Pacific Islander and Filipino infants in Hawai'i.

"We Are from Nowhere": A Qualitative Assessment of the Impact of Collective Trauma from the Perspective of Resettled Bhutanese Refugees

Background: Limited research has explored mental health concerns and collective trauma experienced by Bhutanese refugees due to their displacement from Bhutan, refugee camp life in Nepal, and resettlement to U.S. society.

Purpose: To understand how collective trauma experienced by Bhutanese refugees influences the process of resettlement and integration into U.S. society to better address mental health concerns from the community.

Methods: Qualitative data were collected through four focus groups (N=40) with Bhutanese refugee women in central Massachusetts from June to November of 2016 to discuss refugee resettlement experiences and mental health concerns.

Findings: Bhutanese refugees shared insights on their resettlement experiences where several broader themes emerged, including historical collective trauma, closed-door culture, and processing mental health stigma. The displacement from Bhutan, hardships in Nepal refugee camps, and isolation in U.S. society led to a collective trauma among the community. Participants described America as having a closed-door culture that limits their integration into society, causing unique challenges based on their context of integration. The collective trauma also poses challenges toward processing mental health stigma, yet community building offers insights on how Bhutanese refugees can address these issues in collective spaces.

Conclusions: The historical collective trauma must be considered when working with Bhutanese refugees to understand the context of their resettlement to address mental health concerns.

Three Strategies for Describing Social Interactions of Adolescents in a Multicultural Environment-Indicators for the Quality of Life Research

Background: The analysis has involved social interactions in a multicultural environment. The social context has been defined by the Vilnius region (Lithuania), where national, religious, and cultural differences exist across generations (multicultural community). The space of “social relationships”, as one of the modules of the WHO quality of life assessment, has been studied. An innovation of the research has been related to the analysis of the phenomenon of community of nationalities and cultures as a predictor of quality of life (QoL). The social motive of the research has been the historical continuity (for centuries) of the construction of the Vilnius cultural borderland. Here, the local community evolves from a group of many cultures to an intercultural community. Interpreting the data, therefore, requires a long perspective (a few generations) to understand the quality of relationships. We see social interactions and strategies for building them as a potential for social QoL in multicultural environments. Methods: The research has been conducted on a sample of 374 respondents, including Poles (172), Lithuanians (133), and Russians (69). A diagnostic poll has been used. The respondents were adolescents (15–16 years). The research answers the question: What variables form the interaction strategies of adolescents in a multicultural environment? The findings relate to interpreting the social interactions of adolescents within the boundaries of their living environment. The description of the social relations of adolescents provides an opportunity to implement the findings for further research on QoL. Results: An innovative outcome of the research is the analysis of 3 interaction strategies (attachment to national identification, intercultural dialogue, and multicultural community building) as a background for interpreting QoL in a multicultural environment. Their understanding is a useful knowledge for QoL researchers. The data analysis has taken into account cultural and generational (historical) sensitivities. Therefore, the team studying the data has consisted of researchers and residents of the Vilnius region. We used the interaction strategies of adolescents to describe the category of “social relationships” in nationally and culturally diverse settings.

Clinicians as advocates amid refugee resettlement agency closures

As ongoing war and violence forcibly displace people worldwide, resettlement remains a critical response to the unprecedented global refugee crisis. In recent years, however, the USA (US) has diminished admissions, forcing agencies to shutter offices and resettlement programs across the nation-posing a silent threat to the refugee resettlement system. We provide historical context of refugee resettlement, discuss challenges, and offer recommendations for healthcare providers to become more effective advocates for refugee health in the USA. The need is urgent for healthcare providers and institutions-particularly in regions of high resettlement-to advocate for expanding and assuring sustainable capacity to care for refugees. Key elements include promotion of trauma-informed care, integration of social services in primary care settings, partnership with community-based organizations to promote continuation of care, advocacy for resources and services, and opposition to policies detrimental to the health of refugees and immigrants.

The health-related quality of life of Syrian refugee women in their reproductive age

Background

Health-Related Quality of Life (HRQoL) for refugee women in reproductive age is highly affected by physical, political, psychosocial and environmental conditions in countries of asylum. HRQoL is enormously affected by the satisfaction of this vulnerable group with the physical, psychological, emotional and social care services provided in this critical time. Therefore, this study aimed toassess the HRQoL among Syrian refugee women of reproductive age living outside camps in Jordan.

Methods

A cross-sectional correlational study was conducted with a convenience sample of 523 Syrian refugee women in the host communities in Jordan.Health-related quality of life (HRQOL) was measured using the short-form 36 (SF-36) questionnaire.

Results

Significant negative correlations were found between SF-36 individual subscales score and the length of marriage, the number of children, parity and family income. The strongest correlations were between pain scale and length of marriage (r =  − .21), and between Energy/Fatigue and ‘number of children’ (r =  − .21). Conversely, antenatal care was positively correlated with physical, role emotional, pain, and general health. Physical functioning and general health were predicted significantly with less years of marriage, younger age at marriage, less violence and by higher family income.

Conclusion

This study suggests low HRQoL scores for women of reproductive age across all domains. Several factors such as years of marriage, age at marriage, the number of children, violence, antenatal care and family income affected the women’s general health. The provision of appropriate and accessible reproductive and maternal healthcare services in antenatal visits is critical for ensuring the immediate and long-term health and wellbeing of refugee women and their families.

Health screening and preventative health care in refugee women: A qualitative analysis

Background: Regular health screening provides opportunities for early detection and effective treatment of disease. There is underutilisation of health services by migrants from culturally and linguistically diverse backgrounds, particularly refugees in Australia. Aim: To explore the beliefs, understandings, and use of health and healthcare screening services among African refugee women living in Australia. Design/Method: Qualitative secondary analysis. Method: Oral narratives derived from two primary qualitative datasets of Sub-Saharan women in New South Wales, Australia, underwent secondary thematic analysis. Findings: Twenty-two of the forty-two women had refugee status on migrating to Australia. Thematic findings reflection of misinformation, low health literacy, and health screening as not a priority. Conclusions: There is an urgent need to develop innovative strategies to engage refugee migrant women in health screening by provision of culturally meaningful health information. Relevance to clinical practice: Including refugee women's suggestions for information to be provided by health services may improve attitudes towards screening and preventative health care.

Sex Differences and Predictors of Changes in Body Weight and Noncommunicable Diseases in a Random, Newly-Arrived Group of Refugees Followed for Two Years

We have reported that none of the psychological/mental variables examined predicted the increase in BMI and non-communicable diseases (NCDs) in Iraqi refugees after 1 year resettlement in Michigan. We continuously followed the same cohort of refugees for 2 years (Y2 FU) to further determine the gender difference in predicting of increased BMI and NCDs. Only 20% of the BMI variability could be accounted for by the factors examined. Number of dependent children and depression were positively and stress negatively associated with BMI in male refugees but not in females. Number of dependent children was negatively associated with changes in BMI and in males only. Two-third of the NCD variability was accounted for by gender, BMI, employment status, depression, posttraumatic stress disorders and coping skills. Unmarried, unemployed and with high PTSD scores at Y2 in males were positively and number of dependent children was negatively associated with NCD changes in females. Factors such as dietary patterns and lifestyle may have contributed to the increased BMI and NCDs in these refugees at 2 years post-settlement.

Betel Quid Use and Oral Cancer in a High-Risk Refugee Community in the USA: The Effectiveness of an Awareness Initiative

Betel nut (BN) is a psychoactive oral carcinogen that is commonly used among Asian communities. This study aims to investigate BN usage patterns and the effectiveness of a visually guided educational initiative in a high-risk refugee population. All adult patients presenting to a private practice clinic, free community clinic, or health fair in the refugee community of Clarkston, Georgia during days when survey staff were present were approached for the study. Participants were first categorized into a familiar and unfamiliar cohort depending on participant-reported familiarity with BN. Depending on familiarity, subjects were then administered a pre-intervention test surveying health awareness for BN and usage patterns where relevant; subsequently, a visually guided educational brochure was reviewed, and a post-intervention test was administered. Results were statistically analyzed (STATA 12). Forty-eight participants were surveyed for the familiar cohort and 25 for the unfamiliar cohort. Among the familiar cohort, South and Southeast Asians comprised 91% of participants. On frequency of use, 42.8% reported social, 28.6% reported usage during celebrations only, and 28.6% reported daily. The most common reasons for use were for taste (40.9%), enjoyment (38.6%), and addiction (25%). Among the familiar cohort, 75% believed BN was harmful for health compared to 8% among the unfamiliar (p < 0.0001). In the familiar cohort, 52.3% believed BN alone could cause cancer compared to 4% among the unfamiliar (p < 0.0001). Following the educational intervention, 100% of participants believed BN mastication is harmful in both cohorts (p < 0.01), while 87.5% of participants in both cohorts recognized that BN alone could cause cancer (p < 0.0007). This study illustrates gaps in understanding regarding oral cancer and the health consequences of chronic BN mastication, as well as the efficacy of a visually guided educational brochure to improve participant knowledge among a high-risk refugee population.

Integrated Health Care and mHealth: A Model of Care for Refugees with Complex Health Conditions

High rates of comorbid physical and mental health conditions are documented among refugee populations. A dearth of evidence exists on the use of mHealth technologies to support integrated health care models, with interprofessional mental and physical healthcare teams, within the field of refugee health, despite the potential for mHealth technologies to reduce barriers to health care access for vulnerable populations. This conceptual article illustrates how mHealth can facilitate integrated health care models with refugees with comorbid conditions. Implications are made to support the application of mHealth technologies within integrated health care models serving at-risk refugee populations.

Refugee women's experiences negotiating motherhood and maternity care in a new country: A meta-ethnographic review

OBJECTIVES

The aim of this meta-ethnographic review was to examine refugee women's experiences negotiating motherhood and maternity services in a new country with a view to identifying the specific needs of refugee women accessing maternity care in high income countries.

DESIGN

A meta-ethnographic synthesis of qualitative research.

DATA SOURCES

Five databases were searched for papers published in English between January 2000 and January 2017.

REVIEW METHODS

The synthesis process was guided by the seven steps of meta-ethnography. The quality of included studies was assessed using the COREQ tool.

RESULTS

One overarching theme and three major themes emerged from the synthesis. The overarching theme "Living between two cultures" conveyed women's experience of feeling "in between" cultures and described refugee women's experience of striving to maintain a strong cultural identity from their country of origin while simultaneously adapting to their new context and country. This theme permeated the following three major themes: 1) "Constructing maternal identity across cultures" which discusses the cultural conflict experienced by refugees accessing maternity services in their host country; 2) "Understanding in practice" which describes reciprocal issues in communication between women and health professionals; and 3) "Negotiating care" which illustrates a mix of coping mechanisms which refugee women utilise to navigate health services in the context of high income countries.

CONCLUSION

Liminality is a ubiquitous experience for refugee women seeking maternity care in high income countries. It impacts feelings of belonging and connection to services and society. It is often a challenging experience for many women and a time in which they reformulate their identity as a citizen and a mother. This review found that the experience of liminality could be perpetuated by social factors, and inequality of healthcare provision, where communication and cultural barriers prevented women accessing care that was equal, accessible, and meaningful. Findings revealed both positive and negative experiences with maternity care. Continuity, culturally appropriate care, and healthcare relationships played an important role in the positive experiences of women. The review also revealed the damaging effects of disparities in care experienced by refugee women.

Cardiovascular Disease-related Health Beliefs and Lifestyle Issues Among Karen Refugees Resettled in the United States From the Thai-Myanmar (Burma) Border

Objectives

Refugees resettled in the US may be at risk for cardiovascular disease (CVD). However, little is known about CVD-related issues among Karen refugees who have migrated to the US from the Thai-Myanmar border. The purpose of this study was to examine CVD-related health beliefs and lifestyle issues among Karen refugees resettled in the US.

Methods

Karen refugees resettled in the US from the Thai-Myanmar border (n=195) participated in a survey study on health beliefs related to CVD, salt intake, physical activity (PA), and smoking in the fall of 2016.

Results

A high-salt diet, physical inactivity, and smoking were major lifestyle problems. Participants who adhered to a low-salt diet considered themselves to be susceptible to CVD. Most participants did not engage in regular PA. Regular PA was associated with less perceived susceptibility to CVD and greater perceived benefits of a healthy lifestyle for decreasing the likelihood of CVD.

Conclusions

Each refugee population may require individualized strategies to promote PA and a healthy diet. Future studies should develop health education programs that are specifically designed for Karen refugees and evaluate such programs. In addition to health education programs on healthy lifestyle choices, tobacco cessation programs seem to be necessary for Karen refugees. At the same time, it is important to foster strategies to increase the utilization of preventive care among this population by promoting free or reduced-fee resources in the community to further promote their health.

Immigrant Women's Mental Health in Canada in the Antenatal and Postpartum Period

Immigrant women constitute a relatively large sector of Canadian society. In 2011, immigrant women made up a fifth of Canada's female population, the highest proportion in 100 years; based on the current trends of immigration, this proportion is expected to grow over the next 20 years. As women immigrate and find themselves simultaneously experiencing an unfamiliar environment, being unacquainted with societal norms, and lacking vital social networks, they become vulnerable to mental health problems. This article aims to undertake a narrative review of the literature on immigrant women's mental health in Canada during antenatal and postpartum care by employing the transnational theory as a theoretical framework. The article starts with an overview of the theoretical framework, followed by a discussion on a literature review that particularly talks about culture, isolation and social support network, social determinants of health, and access to health care as elements to consider in avoiding mental health problem among immigrant women in antenatal and postpartum care. The literature shows a high number of depression among immigrant women, and mental health problems are higher among visible minorities than Caucasians. The highest antenatal and postpartum depression recorded are 42% and 13%, respectively. As Canada has long been and continues to be the land of immigrants, addressing the multiple factors affecting immigrant women's mental health is paramount to Canada truly achieving "health for all."

Challenges and Strategies in Providing Home Based Primary Care for Refugees in the US

The recent crisis in the Middle East has prompted the exodus of millions of refugees from the region who are at present seeking shelter across Europe and in the United States. Among the most immediate needs of refugees upon arrival in a host country is health care, and it is one of the most sustained interactions they experience. Home visits are a common form of primary care for refugees. The authors review the literature to identify themes related to challenges and strategies for providing home based primary care to refugees. The literature review was performed by searching cross-disciplinary databases utilizing Onesearch, but focusing primarily on results produced through CINAHL, EBSCOHOST, and Pub Med databases. To maximize the number of studies included, there was no time frame placed upon publication dates of articles within the search. A total of 55 articles were included in this paper.

Prevalence of General and Central Obesity and Associated Factors among North Korean Refugees in South Korea by Duration after Defection from North Korea: A Cross-Sectional Study

Previous studies on obesity status among North Korean refugees (NKRs) have been limited. We investigated mean body mass index (BMI), waist circumference (WC), and general and central obesity prevalence among NKRs in South Korea (SK) by duration after defection from North Korea (NK), using cross-sectional data of the North Korean Refugee Health in South Korea (NORNS) study and compared these data with a sample from the general South Korean population (the fifth Korea National Health and Nutrition Examination Survey). The prevalence of general and central obesity among NKRs with duration after defection from NK of less than five years were lower than among South Koreans, except for central obesity among NKR females (obesity prevalence, 19% (12⁻27%) vs. 39% (34⁻44%) for NK vs. SK males (p < 0.001) and 19% (14⁻24%) vs. 27% (24⁻29%) for NK vs. SK females (p = 0.076); central obesity prevalence, 13% (6⁻19%) vs. 24% (20⁻29%) for NK vs. SK males (p = 0.011) and 22% (17⁻28%) vs. 20% (18⁻22%) for NK vs. SK females (p = 0.382)). The prevalence of general and central obesity among NKRs with duration after defection from NK (≥10 years) were comparable to those of South Koreans in both genders (obesity prevalence, 34% (18⁻50%) vs. 39% (34⁻44%) for NK vs. SK males (p = 0.690) and 23% (18⁻29%) vs. 27% (24⁻29%) for NK vs. SK females (0.794); central obesity prevalence, 21% (7⁻34%) vs. 24% (20⁻29%) for NK vs. SK males (p = 0.642); 22% (17⁻28%) vs. 20% (18⁻22%) for NK vs. SK females (p = 0.382)). Male sex, age and longer duration after defection from NK (≥10 years) were positively associated with obesity. As for central obesity, age was the only independently associated factor. NKR females with duration after defection from NK of less than five years had comparable central obesity prevalence to South Korean females in spite of a lower BMI, which suggests that we need further monitoring for their metabolic health among NKRs in SK.

Importance of Interprofessional Healthcare for Vulnerable Refugee Populations

The refugee population in the United States is steadily increasing. These populations face a plethora of diseases and chronic health problems (i.e. obesity, hypertension and depression) as they resettle into their new environment. Due to the lack of understanding, minority population refugee health is scarce and minimal at best. Refugees and healthcare professionals face similar barriers when it comes to seeking treatment and treatment itself. For example, refugees might not be able to communicate efficiently and understand the referral process while healthcare professionals do not understand the culture and language of their patients. However, more data is needed to determine if interprofessional teams consisting of differing healthcare professionals such as nurses, pharmacists, and dieticians that conduct home visits might be able to bridge the health care gap between individualized treatment and refugee needs.

Differences in tobacco smoking prevalence and frequency between adolescent Palestine refugee and non-refugee populations in Jordan, Lebanon, Syria, and the West Bank: cross-sectional analysis of the Global Youth Tobacco Survey

Background

Evidence is conflicting as to the whether tobacco smoking prevalence is higher in refugee than non-refugee populations. The aim of this study was to compare the prevalence and frequency of tobacco smoking in Palestine refugee and non-refugee adolescent populations in the Middle East.

Methods

We conducted a cross-sectional analysis of the Global Youth Tobacco Survey (GYTS) conducted in Jordan, Lebanon, Syria, and the West Bank among adolescent Palestine refugees and non-refugees. Age- and sex-adjusted regression models assessed the association between refugee status and current (past-30 day) tobacco use prevalence and frequency.

Results

Prevalence estimates for current tobacco smoking were similar between Palestine refugee and non-refugee groups in Jordan (26.7 % vs. 24.0 %), Lebanon (39.4 % vs. 38.5 %), and the West Bank (39.5 % vs. 38.4 %). In Syria, Palestine refugees had nearly twice the odds of current tobacco smoking compared to non-refugees (23.2 % vs. 36.6 %, AOR 1.96, 95 % CI 1.46–2.62). Palestine refugees consumed more cigarettes per month than non-refugees in Lebanon (β 0.57, 95 % CI 0.17–0.97) and Palestine refugees consumed more waterpipe tobacco per month than non-refugees in Syria (β 0.40, 95 % CI 0.19–0.61) and the West Bank (β 0.42, 95 % CI 0.21–0.64).

Conclusions

Current tobacco smoking prevalence is in excess of 20 % in both adolescent Palestine refugee and non-refugee populations in Middle Eastern countries, however Palestine refugees may smoke tobacco more frequently than non-refugees. Comparison of simple prevalence estimates may therefore mask important differences in tobacco use patterns within population groups.

Patients' perception of differences in general practitioners' attitudes toward immigrants compared to the general population: Qualicopc Slovenia

INTRODUCTION

Globally, the number of immigrants is rising every year, so that the number of immigrants worldwide is estimated at 200 million. In Slovenia, immigrants comprise 6.5% of the overall population. Immigrants bring along to a foreign country their cultural differences and these differences can affect immigrants' overall health status and lead to chronic health conditions. The aim of this study was to identify patients' perception of general practitioners' (GPs') attitudes toward immigrants in Slovenia.

METHODS

This study was based on the Qualicopc questionnaire. We used the questions that targeted patients' experience with the appointment at their GP on the day that the study was carried out.

RESULTS

There were no differences in GPs' accessibility based on groups included in our study (p>0.05). Compared to the non-immigrant population, first-generation immigrants answered that their GPs were impolite (p=0.018) and that they did not take enough time for them (p=0.038). In addition, they also experienced more difficulties understanding their GP's instructions (p<0.001). Second-generation immigrants experienced more negative behaviour from GPs, and first-generation immigrants had more difficulties understanding GPs' instructions.

CONCLUSION

There may be some differences in patients' perception of GPs' attitudes towards immigrants in comparison with the general Slovenian population. However, based on the perception of the immigrants that do benefit from the medical care it is not possible to judge the GPs' attitudes towards immigrants as worse compared to their attitude towards the non-immigrant population. Indeed, there may be other reasons why the patients answered the way they did.