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[Perinatal outcomes in immigrant women].

OBJECTIVES: To describe the characteristics of immigrant women's newborns in our environment, and to compare them with those of native women's newborns. PATIENTS AND METHODS: All newborns attended in the Neonatology Section of Hospital del Mar in Barcelona, Spain, in 2003 and 2004 were included (n 5 2,735). Data were prospectively collected in a database. Pregnant immigrant women were classified in 6 regions (Eastern Europe, the rest of Europe, Africa, Asia, Latin America and other countries). Twelve diagnoses were defined and compared between native newborns and those of immigrant parents, and their relative risks were calculated. RESULTS: There were 1,296 native newborns (47.8 %) and 1,416 of immigrant origin (52.2 %). Immigrant women showed a higher rate of HBsAg carrier status (2.0 % versus 1.0 %) and a lower rate of hepatitis C virus infection (0.8 % vs 2.0 %; p < 0.01). There was only one HIV-positive pregnant immigrant woman compared with 14 Spanish women (p < 0.01), and drug use was lower in the immigrant group (0.4 % vs 4.0 %; p < 0.01). Immigrant newborns had a lower rate of prematurity (6.0 % vs 7.6 %) and of low birthweight (2.3 % vs 4.6 %; p < 0.01). There were no significant differences in the rate of respiratory distress or fetal acidosis. The incidence of neonatal infection risk was higher in immigrant newborns (49.9 % vs 40.6 %; p < 0.01). CONCLUSIONS: In our environment, immigrant mothers' newborns have better perinatal outcomes than native newborns. The most frequent complications are secondary to an inadequate.

Emigration and Immigration↗

Ethnicity versus migration: two hypotheses about the psychosocial adjustment of immigrant adolescents.

UNLABELLED: STUDY BACKGROUND AND AIMS: This study investigates the psychosocial adjustment of immigrant adolescents and examines two hypotheses: the ethnicity hypothesis, which suggests that ethnic background determines the psychosocial reactions of immigrant adolescents; and the migration hypothesis, which suggests that the migration experience determines such reactions. METHODS: The study compared four groups of respondents: first-generation immigrants (N = 63) and second-generation immigrants (N = 64) from the former Soviet Union (FSU) in Israel; and Jewish (N = 212) and non-Jewish (N = 184) adolescents in the FSU. A self-report questionnaire administered to the respondents collected demographic, educational and psychological data using standardised scales. RESULTS: Immigrant adolescents reported higher psychological distress, lower self-esteem and higher alchohol consumption than non-immigrant adolescents. Second-generation immigrants generally showed a higher level of functioning than first-generation immigrants. These findings favor the migration hypothesis. CONCLUSIONS: Our findings support the widely accepted view of migration as a potentially distress-provoking experience. They suggest that psychological reactions of immigrant adolescents, and in fact all immigrants, are best interpreted as reactive and are related to the universal stressful qualities of the migration experience. Further multiethnic comparative studies, however, are needed to confirm and refine these findings.

Adaptation, Psychological↗

Immigration-associated variables and substance dependence.

OBJECTIVE: Drug-dependent patients show increased negative mood states such as anxiety and depression that interact with drug craving and quality of life. In this study, we compared immigrants with and without drug dependence and assessed whether drug dependence and social status after immigration contributed independently to negative mood states, stress-coping strategies and satisfaction with life in Germany. METHOD: Immigrants (N = 80) who had emigrated from the former Soviet Union to Germany were participants in the study. Drug-dependent immigrants (24 men, 16 women, mean [SD] age 33 [9] years) were compared with healthy immigrants (26 men, 14 women, mean age 35 [12] years) on current emotional status, trait-anxiety, depression, stress-coping strategies, drug craving and immigration-associated data. RESULTS: Compared with healthy immigrants, drug-dependent immigrants showed significantly higher levels of anxiety, depression and negative stress-coping strategies, independent of differences in education or employment status. Satisfaction with being in Germany was associated with both drug dependence and employment status. The severity of drug craving was significantly associated with negative mood states but not with any other measured sociodemographic variable. CONCLUSIONS: This study shows that drug dependence is associated with increased negative mood states and poor stress-coping strategies, independent of the assessed sociodemographic variables. Drug dependence may thus severely interfere with acculturation in the host country. Because immigrants often face reduced treatment options as a result of cultural and language barriers, our findings underline the importance of adequate drug treatment facilities for dependent immigrants.

Adolescent↗

Health insurance coverage of immigrants living in the United States: differences by citizenship status and country of origin.

OBJECTIVES: This study examined health insurance coverage among immigrants who are not US citizens and among individuals from the 16 countries with the largest number of immigrants living in the United States. METHODS: We analyzed data from the 1998 Current Population Survey, using logistic regression to standardize rates of employer-sponsored coverage by country of origin. RESULTS: In 1997, 16.7 million immigrants were not US citizens. Among non-citizens, 43% of children and 12% of elders lacked health insurance, compared with 14% of non-immigrant children and 1% of non-immigrant elders. Approximately 50% of non-citizen full-time workers had employer-sponsored coverage, compared with 81% of non-immigrant full-time workers. Immigrants from Guatemala, Mexico, El Salvador, Haiti, Korea, and Vietnam were the most likely to be uninsured. Among immigrants who worked full-time, sociodemographic and employment characteristics accounted for most of the variation in employer health insurance. For Central American immigrants, legal status may play a role in high un-insurance rates. CONCLUSIONS: Immigrants who are not US citizens are much less likely to receive employer-sponsored health insurance or government coverage; 44% are uninsured. Ongoing debates on health insurance reform and efforts to improve coverage will need to focus attention on this group.

Adolescent↗

The assessment of immigration status in health research.

OBJECTIVE: This report examines methodological issues relating to immigrant health, definition of immigrant, the assessment of immigrant status, and sampling strategies with immigrant populations. METHODS: A literature review was conducted for the period 1977-98, utilizing various computer data bases to identify relevant studies. A total of 179 separate U.S.-based studies were reviewed. Twenty-two sample instruments and two revised versions of instruments for the assessment of immigration status were evaluated. RESULTS: In general, research relating to immigrants and their health has not attended to methodological issues inherent in such investigations. Instruments utilized to assess immigration status differ across studies, making cross-study comparisons difficult. Few studies have relied on probability sampling. Almost no data are available on field performance of instruments developed to assess immigration status. CONCLUSIONS: Development of an appropriate instrument requires consideration of the definition of immigrant to be used, the level of respondent knowledge to be presumed, the political and social climate that exists at the time of the survey administration, the populations and geographic locales with which the instrument will be utilized, the complexity of the instrument, and methods of the instrument administration. In view of the paucity of data pertaining to the field performance of instruments used to assess immigration status, any instrument considered for use must be field tested and revised appropriately before incorporation into a national survey. The appropriateness of any particular sampling strategy should be evaluated in the context of the field testing.

Data Collection↗

Self-reported health status of immigrants from the former Soviet Union in Israel.

BACKGROUND: A mass influx of immigrants from the former Soviet Union to western countries and Israel followed the demise of the Soviet Bloc at the beginning of the 1990s. It was expected that these immigrants would have a higher morbidity and mortality rate similar to that in the former USSR. OBJECTIVES: To measure and compare self-reported diseases, subjective health and health services utilization of a representative sample of veteran Israeli Jews and immigrants from the former USSR. METHODS: A cross-sectional survey of Israeli adults was performed by telephone interviews. The survey included 793 Israeli Jews, of whom 124 were immigrants from the former USSR who arrived in Israel after 1989 (response rate 52%). RESULTS: The immigrants reported a higher rate of diseases and sub-optimal health after adjustment for other variables. However, no excess in health services utilization was reported. A time trend of reporting sub-optimal subjective health was observed: the longer the immigrants spent in Israel the more their reporting patterns resembled those of immigrants who arrived in Israel before 1970. Those who arrived after 1994 more frequently reported having a chronic disease. CONCLUSIONS: Acculturation seems to have been the main effect on the immigrants' health, together with a healthy migrant effect at the beginning of the 1990s. The immigrants' health was worse in the later years of the immigration wave, partially reflecting the poor state of health in the former Soviet Union compared to Israel.

Acculturation↗

[A study on the epidemiology of Helicobacter pyroli infection among immigrants in Three Gorges area].

OBJECTIVE: To investigate the epidemiologic features of Helicobacter pyroli (Hp) sero-prevalence rates among immigrants in Three Gorges area. METHODS: Enzyme labelled immuno-sorbant-assay was used to determine the Hp prevalence rate. A case-control study including 1 600 immigrants as cases and 1 600 non-immigrants as controls was carried out to explore the features of Hp infection in Three Gorges area. RESULTS: The prevalence rate of Hp in immigrant area was 67.50% higher than 53.19% that of Hp in non-immigrant (chi(2) = 13.40, P < 0.01). Rate of Hp infection was highest in infants than in children, increasing with age to clearly show a positive correlation between age and Hp prevalence rate (r = 0.62, P < 0.01). However, there was no marked sex difference in Hp infection rates in the immigrant area. Same results were also presented in the non-immigrant area. Hp prevalence rates were different which related to the stages of flooding. It is 89.17% in the area of first stage, while in second and third stages of flooding, the rates were 76.40% and 62.20% respectively. CONCLUSION: Preliminary result indicated that Hp infection rate of immigrant area was higher than that of non-immigrant area. It appeared that living condition, environment, education condition might possibly have played important role in Hp prevalence. It is more important to prevent from infected children. Further study with respect to Hp prevalence rate was necessary when immigration is completed and the standard of living improved.

Adolescent↗

Continuity and change in Canada's unemployment-immigration linkage (1946-1993).

"Between 1946 and 1976, variation in unemployment rates strongly affected the number of immigrants allowed into Canada. Implementation of the Immigration Act of 1976 should have weakened the effect of unemployment on immigration, for the Act requires that immigration levels be set after consideration of demographic as well as labour market conditions. Our analysis shows the unemployment-immigration linkage actually strengthened after 1978, and only weakened significantly after 1989. Since the government's annual immigration projections are excellent predictors of immigration landings, we conclude the Canadian state is highly capable of controlling immigration levels and thus the tightening of the unemployment-immigration linkage from 1978 to 1989 reflected the choice of regulators. Discussing future research in this area, we argue that if the immigration policymaking process was not restructured in the late 1980s, an adequate model of state-society relations in this area must account for both continuity and change. However, if the process was restructured, a revised or new theoretical framework is needed." (SUMMARY IN FRE)

Americas↗

Immigrant health: legal tools/legal barriers.

The United States is a country of immigrants, our government having been formed by recent arrivals. This trend has continued throughout our history; according to the Center for Immigration Studies, more than 26 million immigrants have settled in the United States since 1970, and approximately one million new immigrants come to the United States each year. The immigrant population faces highly diverse health issues that states, cities, and counties must address, many of which pose significant legal and policy issues. Social, cultural, and linguistic factors complicate those challenges, as does the overlay of federal immigration and health policy. Two federal laws, the Welfare Reform Act of 1996 and Title VI of the federal Civil Rights Act of 1964, have affected immigrants in two very different ways. The former made it difficult for immigrants to qualify for publicly funded benefits. In contrast, Title VI made it easier for immigrants to obtain benefits by requiring federally funded service providers to offer translating services to persons with limited English language skills. Tuberculosis treatment is perhaps the most pressing health need among recent arrivals to the United States. Methods to slow down and hopefully eliminate this disease are underway, but a more comprehensive approach to not only tuberculosis but to immigrant health in general is needed. Indeed, it will benefit those directly affected by tuberculosis and will have serious implications for the entire population for generations to come.

Cultural Characteristics↗

Economic impact of HIV infection and coronary heart disease in immigrants to Canada.

OBJECTIVE: To compare the direct health care costs of illnesses associated with the human immunodeficiency virus (HIV) and of coronary heart disease (CHD) in immigrants to Canada. DESIGN: Comparative cost analysis. PARTICIPANTS: All people who immigrated to Canada in 1988. The numbers with HIV infection and CHD were estimated from country-specific HIV seroprevalence data and national CHD mortality statistics and data from the Framingham study. Health care costs, projected over the 10 years after immigration, were calculated on the basis of data from the Hospital Medical Records Institute and provincial fee schedules. RESULTS: Of the 161,929 immigrants in 1988, 484 were estimated to be HIV positive. The total cost of treatment of HIV-related illnesses from 1989 to 1998 (discounted at 3%) would be $18.5 million: $17.1 million would be spent on the outpatient and inpatient care of the HIV-positive immigrants, $1.0 million on care of the subsequently infected sexual partners and $0.4 million on care of the HIV-positive children born to seropositive immigrant women. In comparison, CHD would develop in 2558 immigrants during the same 10-year period. The total CHD costs would be $21.6 million: $8.4 million would be spent on treating myocardial infarction, $3.2 million on coronary artery bypass grafting, $1.6 million on pacemaker insertion and $8.4 million on treating other CHD events. CONCLUSIONS: The economic impact of HIV infection in immigrants to Canada is similar to that of CHD. This comparison identifies an important shortcoming in current immigration policy: economic considerations can be arbitrarily applied to certain diseases, thereby discriminating against specific groups of immigrants.

Adult↗

Screening and management of tuberculosis in immigrants: the challenge beyond professional competence.

SETTING: Right of entry may sometimes be denied to immigrants because of the threat of tuberculosis. During 1990-2000 some 1050000 immigrants, mostly from countries highly endemic for TB, arrived in Israel, a low prevalence country. Nevertheless, TB rates in Israel have remained low. OBJECTIVE: To emphasise the challenge beyond technical competence for TB control for immigrants from the perspective of Israel's National Tuberculosis Programme (NTP). MATERIALS AND METHODS: We defined criteria for an NTP geared to immigration, and analysed our implementation of the European Task Force recommendations on international migration and TB control. We interviewed immigrants and health care workers to identify barriers to diagnosis, prevention and treatment of TB among immigrants. We used classical epidemiology to evaluate the impact of immigration on TB rates in the host population. RESULTS: Until now there has been no evidence of significant spread of TB from immigrants to the host population. Successful outcome of treatment has been noted in over 75%, although a sub-population of immigrant substance abusers is proving more difficult to treat. CONCLUSIONS: The risk of TB for the host country is very low and it seems possible to enhance TB control in immigrants with measures designed to address their cultural needs.

Emigration and Immigration↗

Perspective: Reproductive isolation caused by natural selection against immigrants from divergent habitats.

The classification of reproductive isolating barriers laid out by Dobzhansky and Mayr has motivated and structured decades of research on speciation. We argue, however, that this classification is incomplete and that the unique contributions of a major source of reproductive isolation have often been overlooked. Here, we describe reproductive barriers that derive from the reduced survival of immigrants upon reaching foreign habitats that are ecologically divergent from their native habitat. This selection against immigrants reduces encounters and thus mating opportunities between individuals from divergently adapted populations. It also reduces the likelihood that successfully mated immigrant females will survive long enough to produce their hybrid offspring. Thus, natural selection against immigrants results in distinctive elements of premating and postmating reproductive isolation that we hereby dub "immigrant inviability." We quantify the contributions of immigrant inviability to total reproductive isolation by examining study systems where multiple components of reproductive isolation have been measured and demonstrate that these contributions are frequently greater than those of traditionally recognized reproductive barriers. The relevance of immigrant inviability is further illustrated by a consideration of population-genetic theory, a review of selection against immigrant alleles in hybrid zone studies, and an examination of its participation in feedback loops that influence the evolution of additional reproductive barriers. Because some degree of immigrant inviability will commonly exist between populations that exhibit adaptive ecological divergence, we emphasize that these barriers play critical roles in ecological modes of speciation. We hope that the formal recognition of immigrant inviability and our demonstration of its evolutionary importance will stimulate more explicit empirical studies of its contributions to speciation.

Animals↗

Dental caries and caries associated factors in Swedish 15-year-olds in relation to immigrant background.

The aim of the present study was to evaluate the prevalence of caries and caries associated variables in 15-year-olds in relation to foreign background and to examine differences in the prevalence of caries in immigrant adolescents according to their length of residence in Sweden. All 15-year-old adolescents (n=143) at one public school in the city of Jönköping, Sweden were asked to participate in the study. The adolescents were divided into two groups according to their background: immigrants and non-immigrants. Data on caries prevalence were extracted from the dental records of the examination made when the participants were 15 years old. The proportions of immigrants and non-immigrants free from carious lesions were equal. Immigrant adolescents, however, had on average more enamel carious lesions. Adolescents born in Sweden of immigrant parents or who had arrived before 1 year of age had a caries prevalence similar to those of non-immigrant adolescents, whereas children who had immigrated to Sweden after 7 years of age had a caries prevalence that was 2-3 times higher. As the caries carious lesions in immigrant adolescents is mainly restricted to the enamel, and possibly reversible, early introduction of preventive programmes seems essential.

Adolescent↗

Comparison of cancer incidence in Iran and Iranian immigrants to British Columbia, Canada.

Migrant studies provided strong evidence about the role of environment and life style in cancer risk. Iran has experienced many immigrants to other countries with different cultures and environment. This study compares cancer incidence rates in Iran, Iranian immigrants to British Columbia (BC), Canada, and the BC general population. Cancer incidence rates were computed from two population-based cancer registries in Iran and from the BC cancer registry. A listing of common Iranian surnames and given names was produced to identify Iranian immigrants within the BC cancer registry. Age-standardized rates (ASRs) were calculated using mid year census data. The overall cancer incidence rate for Iranian female immigrants was intermediate between rates for Iran and the BC general population, and the rate for Iranian male immigrants was lower as compared to the other population groups. For female Iranian immigrants, the incidence of breast cancer was increased four-fold, and for colorectal cancer two-fold, as compared to Iranian rates. A dramatic decrease was found in the incidence of both stomach and oesophageal cancers for Iranian immigrants of both sexes. For male Iranian immigrants, the incidence of prostate cancer was increased as compared to Iranian rates. Differences in incidence rates of specific cancers were observed between BC Iranian immigrants and Iran, with cancer patterns in Iranian immigrants being more similar to the BC general population. This warrants further investigation into differences in lifestyle and cancer detection.

Adolescent↗

Deteriorating health satisfaction among immigrants from Eastern Europe to Germany.

BACKGROUND: Migrants from Eastern Europe constitute more than 5% of Germany's population. Since population health in their countries of origin is poor their health status upon arrival may be worse than that of the native-born German population (hypothesis H1). As a minority, they may be socio-economically disadvantaged (H2), and their health status may deteriorate quickly (H3). METHODS: We compared data from 1995 and 2000 for immigrants from Eastern Europe (n = 353) and a random sample of age-matched Germans (n = 2, 824) from the German Socioeconomic Panel. We tested H1-3 using health satisfaction, as a proxy for health status, and socioeconomic indicators. We compared changes over time within groups, and between immigrants and Germans. We assessed effects of socio-economic status and being a migrant on declining health satisfaction in a regression model. RESULTS: In 1995, immigrants under 55 years had a significantly higher health satisfaction than Germans. Above age 54, health satisfaction did not differ. By 2000, immigrants' health satisfaction had declined to German levels. Whereas in 1995 immigrants had a significantly lower SES, differences five years later had declined. In the regression model, immigrant status was much stronger associated with declining health satisfaction than low SES. CONCLUSION: In contrast to H1, younger immigrants had an initial health advantage. Immigrants were initially socio-economically disadvantaged (H2), but their SES improved over time. The decrease in health satisfaction was much steeper in immigrants and this was not associated with differences in SES (H3). Immigrants from Eastern Europe have a high risk of deteriorating health, in spite of socio-economic improvements.

Journal Article↗

[Incidence study of endemic nephropathy among newcomers (immigrants) to endemic foci in Bulgaria].

The clinical-laboratory studies of 488 immigrants in 17 endemic settlements in Bulgaria are presented. The average age of the immigrants is 56 years and 31 years is the average duration of the sojourn in the endemic foci. From the total group of immigrants 30 per cent are "contact ímmigrants", i.e. immigrants that had lived together or are living at present with patients with endemic nephropathy or members of their families. The average duration of the sojourn of the contact immigrants in the endemic environment is the same as that of the whole group. Ten of the immigrants have come in their child-adolescent age into the endemic settlements. The average age of that group is 61 and the average duration of the sojourn in the endemic foci is 52 years. The following data are stressed upon: The total and renal morbidity of the immigrants in the endemic foci does not differ in structure from that of the country. No sufficient data are available about the existence of family domestic noxae or infections. No data indicating tumours in the urinary system were found in the immigrants examined. It is conculded that, at the stage of the examination, no definite data were established about the endemic nephropathy affection of the immigrants in the endemic foci which though indirectly support the genetic hypothesis of endemic nephropathy etiology. The dispensarization of the immigrants in the endemic foci favours the longitudinal examination which is the final aim of the authors.

Bulgaria↗

The changing skill of new immigrants to the United States: recent trends and their determinants.

"The objective of this paper is to describe and understand the determinants of changes in the number and quality of new legal immigrants to the United States over the last 25 years. Our main interest is in understanding the behavioral response of potential immigrants to changes in the U.S. immigration law regime (as well as in the origin-country determinants of demand for immigration to the United States) and how these affect and have affected the skill composition of immigrants.... [The authors] assembled a new data set based on annual INS records of all new, legal immigrants over the period 1972 through 1995.... Inspection of our new data indicates that since the mid 1980s the average skill of new, U.S. legal immigrants has been rising relative to that of the U.S. population. An econometric analysis of a panel of country-specific measures of the skill of immigrants based on these data over the period 1972-1992 indicates that these changes are due in part to changes in immigration law and to the overall rise in the real purchasing power of countries outside the United States."

Americas↗

The "amnesty" aftermath: current policy issues stemming from the legalization programs of the 1986 Immigration Reform and Control Act.

"The 1986 Immigration Reform and Control Act (IRCA) created two one-time only legalization programs affecting nearly 3 million undocumented immigrants. Legalization has produced important changes among immigrants and in immigration policy. These changes include new patterns of immigrant social and economic adaptation to the United States and new immigrant flows through family ties to IRCA-legalized aliens.... This article combines data from a longitudinal survey of the IRCA-legalized population with qualitative field data on current immigration issues from key informants in eight high-immigration metropolitan areas. It reviews the political evolution and early implementation of legalization, the current socioeconomic position of legalized aliens, and changes in the immigration ¿policy space' resulting from legalization."

Acculturation↗