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Depression and anxiety disorders among Jews from the former Soviet Union five years after their immigration to Israel.

BACKGROUND: Epidemiological studies have shown that the prevalence rates of major depression and anxiety are lower in the elderly than in younger adults. In a recent survey, we found, among immigrants, that the association of age with psychological distress was the reverse. OBJECTIVE: The objective of the present study was to examine, among immigrants, whether the relationship of age with clinically diagnosed depression and anxiety disorders is also reversed. This was done by assessing the age-specific incidence and prevalence of depression and anxiety among immigrants from the former Soviet Union to Israel five years after their immigration. METHODS: A stratified subsample was chosen from a larger random sample of immigrants from the Former Soviet Union who arrived in Israel in 1990. We selected the subsample to include an over-representation of those with a high level of distress in order to increase the probability of finding people suffering from psychopathology. The subjects were interviewed with a diagnostic instrument, the CIDI-S, an abbreviated version of the CIDI. Prevalence and incidence rates of depression and anxiety were calculated separately for two age groups (those below age 65 and those aged 65 and above). RESULTS: Before immigration, incidence rates were lower among the elderly than among younger adults, a finding consistent with the literature. However, after immigration, the reverse was found, with higher prevalence and incidence rates among elderly immigrants. CONCLUSION: The data suggest that immigration contributes to an increase of psychopathology which is particularly pronounced among the elderly.

Adult↗

Comparison of self-reported emotional and behavioral problems in Turkish immigrant, Dutch and Turkish adolescents.

OBJECTIVE: The aim of this study was to compare self-reported emotional and behavioral problems for Turkish immigrant, native Dutch and native Turkish adolescents. METHOD: A total of 379 Turkish immigrant adolescents living in the Netherlands, and 1039 Dutch adolescents from the general population completed the Dutch translation of the Youth Self-Report (YSR); 2151 Turkish adolescents from the general population completed the Turkish translation of the YSR; parents of Turkish immigrant adolescents filled in the Turkish translation of the Child Behavior Checklist (CBCL/4-18). RESULTS: Turkish immigrant adolescents scored themselves significantly higher than Dutch adolescents on five of the 11 YSR syndromes, most markedly on the Anxious/Depressed, Withdrawn and Internalizing scales. Dutch adolescents scored themselves higher than immigrant adolescents on the Somatic Complaints and Delinquent Behavior scales. Turkish immigrant adolescents scored themselves higher than Turkish adolescents on five of the 11 scales, most markedly on the Delinquent Behavior scale. Total problems scores for Turkish immigrant adolescents were higher than for Dutch and Turkish adolescents. Turkish immigrant adolescents scored themselves higher than their parents assessed them on seven of the 11 scales. CONCLUSION: Turkish immigrant adolescents reported more problems in comparison to their Dutch and native Turkish peers. Different patterns of parent-child interaction, family values and delay of Dutch language skills are considered to be responsible for these differences in scores.

Adolescent↗

Immigration and HIV/AIDS in the New York Metropolitan Area.

Because the HIV pandemic undergoes continual change in its locations and affected populations, it is crucial to study HIV risk behaviors among mobile and immigrant groups within and across borders. The impact of cross-cultural migrations and the importance of studying that impact in terms of demographic characteristics as well as cultural and environmental factors has not received adequate attention in public health research. This collaborative analysis utilizes data from three studies of immigrant groups in New York to describe and compare these factors that provide the context for risk and prevention of HIVAIDS and other health challenges. Data discussed were obtained utilizing multi-method approaches to identify and describe HIV risks among both new and more established immigrant populations within the urban settings of North America, with NYC as a central focus. Demographic and epidemiological data situate the analysis within the larger contexts of US migration and the HIV/AIDS epidemic in NYC. The authors identify risk and protective factors embedded to varying degrees in immigrants' multiple cultures and sub-cultures. The three populations studied include: 1) new Hispanic immigrants from the Dominican Republic, Mexico and Central America; 2) West Indian (Caribbean) immigrants from Jamaica, Trinidad/Tobago and other anglophone Caribbean nations; and 3) South Asian immigrants from India (Indian Americans). The paper seeks differences and commonalities, focusing on the social, attitudinal and behavioral factors that contribute to increased HIV/AIDS vulnerability among these populations. The data presented also identify some of the attitudes and behaviors of individuals and groups, as well as other facilitators and obstacles to transmission for immigrants as they adapt to new environments. Topics addressed include factors affecting HIV/AIDS vulnerability of immigrant groups, goals and expectations, health and mental heath issues, gender role change, sexual risk, alcohol and other drug use, perception of HIV/AIDS risk and implications for prevention.

Acquired Immunodeficiency Syndrome↗

Why are immigrants at increased risk for psychosis? Vitamin D insufficiency, epigenetic mechanisms, or both?

European researchers have observed that schizophrenia is 3 times more frequent in immigrants than in native-born subjects. This increased risk is even higher in dark-skinned immigrants, and the second generation is more affected than the first one. Immigrant status is an important environmental risk factor not only for schizophrenia but also for other psychoses. The explanations proposed to date have been mainly related to epidemiological biases and psychological reasons, such as racism or social defeat, but no biological hypotheses have been tested so far. This article proposes two biological hypotheses related to changes in sun exposure, changes in diet, and stress associated with immigration, which would explain the increased risk for psychosis associated with immigrant status. (1) Vitamin D insufficiency has been proposed as a risk factor for schizophrenia. The main source of vitamin D is through photosynthesis by sun exposure, and dark skins need more sun exposure to maintain adequate blood levels. Vitamin D insufficiency in adulthood could explain why dark-skinned immigrants develop psychosis when moving to high latitude countries, and its insufficiency during pregnancy could explain why the observed risk is higher in the second generation. (2) The second hypothesis is that of epigenetics, with psychosis resulting from modifications in gene expression caused by changes in diet and/or stress related to immigration. The role of homocysteine and the vitamin B-complex, especially folic acid, in these changes in DNA transcription would vary according to the polymorphism of the methylenetetrahydrofolate reductase gene. The vitamin D insufficiency and epigenetics hypotheses are consistent with yet unexplained findings well known in the epidemiology of schizophrenia, such as the increased risk in the urban environment, the excess of winter births, the excess of schizophrenia births after maternal famine, and the shorter interbirth period before a schizophrenia birth. In order to test these hypotheses, epidemiological studies of psychosis and immigration should include objective measures of skin color, which is predicted to be a more important risk factor than ethnicity. They should measure vitamin D, homocysteine and vitamin B-complex status and assess the polymorphisms of the vitamin D receptors and the methylenetetrahydrofolate reductase gene. If confirmed, these hypotheses would lead to effective and inexpensive preventive measures which would markedly decrease the rates of psychosis and schizophrenia, as well as the burden and stigma of these diseases, and greatly improve the mental health of immigrants.

Emigration and Immigration↗

Arab immigrants: a new case for ethnicity and health?

Community-based studies of Arab Americans point to significant health problems among the immigrants, a finding that runs contrary to theories of immigrant selectivity. This study is the first to use nationally representative data to test this question. Using new questions that identify region of birth in the 2000 and 2001 National Health Interview Surveys, we compare the self-rated health and activity limitation of Arab immigrants to US-born white Americans and test the extent to which social, demographic, and immigrant characteristics account for observed disparities. The results find that Arab immigrants do not significantly differ from US-born whites in their self-rated health and are less likely to report limitations in activity. Length of time in the US has no composite effect on health; however, US citizenship does. Compared to the most recent immigrant arrivals, Arab immigrants who are citizens report worse health while their peers who are not officially American (non-citizens) do not, regardless of their duration of US residency. Contrary to prior studies on Arab health, we find that Arab immigrants are not uniformly disadvantaged in their health outcomes and that their health profile is more diverse than currently documented. The results also suggest that controlling for years of US residency may be insufficient for capturing the cumulative effects of acculturation on immigrant health. We conclude by suggesting avenues of future research for capturing heterogeneity among emergent ethnic populations such as Arab Americans.

Adolescent↗

[Travelling immigrants].

OBJECTIVES: To characterise travelling immigrants and the international movements they undertake. To identify the risk journeys that this population makes and to assess the international preventive activities for them compared with those for autochthonous travellers. DESIGN: Retrospective, observational study. SETTING: Unit of International Health (UIH) Santa Coloma de Gramenet (Barcelona), in the Barcelonès Nord i Maresme Health Area, Primary Care Division of the Catalan Institute of Health. PARTICIPANTS: Patients seen between June 1999 and June 2002 (n=1163) at the UIH. They were divided into two groups, depending on their origins: those born inside (autochthonous group; no=1019) or outside (immigrant group; n1=144) the European Union. MAIN MEASUREMENTS: Age, country of origin, length of residence in Spain, interval between consultation and journey, reason for journey, destination, duration of the journey, kind of journey, stay in rural or isolated area, exposure to malaria, vaccinations and anti-malaria chemoprophylaxis prescribed, and overall risk of journey. RESULTS: Immigrants spent more time abroad than autochthonous people (mean 43.5 days; 95% CI, 37.9-49.1; and 15.8 days, 95% CI, 14.9-16.7, respectively; P<.0001). Periods between the journey and the consultation at the UIH were generally similar in the two groups (mean of 26.8 days for immigrants and 30.41 days for autochthonous people; ns), although the immigrants consulted more often in periods of less than 15 and 7 days (P<.005). 31.9% of immigrants stayed in areas of high malaria transmission (95% CI, 24.4%-39.6%) vs 21.3% (95% CI, 18.8%-23.8%) of autochthonous people (P=.04). Overall, immigrants made more risk journeys than autochthonous people (54.8% vs 43.1%; P<.01). No significant differences between the two groups were found in terms of quality in the administration of the international vaccinations prescribed. Compliance with the guidelines for anti-malaria chemoprophylaxis was less in the immigrant group than in the autochthonous one (36% vs 84%; P<.005). CONCLUSIONS: The immigrant group in our environment needs to be thought of as a risk group for catching and importing tropical diseases during their international movements. They form a population for whom international preventive measures should be prioritized.

Adolescent↗

Health status and Canada's immigrant population.

Given the framework of the 1984 Canada Health Act, the health status of immigrants should be similar to average levels within whole of Canada. Yet, assuming equality of health status between immigrant and non-immigrants, or between immigrant groups is likely an unrealistic and simplistic assumption, given unseen barriers affecting accessibility, the restructuring of the Canadian health care system, and problems with the provision of health care resources to the immigrant population. Using the National Population Health Survey, this paper focuses upon the health status of the immigrant population relative to that of non-immigrants within Canada, with reference to diagnosed conditions, self-assessed health, and the Health Utilities Index Mark 3. Findings indicate that, with the exception of the most recent arrivals, immigrants experience worse health status across most dimensions relative to non-immigrants. Multivariate analysis reveals that age, income adequacy, gender, and home ownership are dimensions upon which health status differs between the two groups.

Adolescent↗

[Immigration and tuberculosis. Five year experience].

Immigrants are a tuberculosis risk group. In Portugal, in 2000, they had an incidence rate 3.6 times higher than the global incidence, and were native, predominantly, from Angola and Cabo Verde. Being the Chest Disease Center of Venda Nova located in a residential area with a great number of immigrants, most of them living in slums, we decided to evaluate the tuberculosis cases in this group, between 1996/2000, comparing the data obtained with some data of the tuberculosis cases in the non-immigrants. Immigrants with tuberculosis corresponded to 24.5% of all cases, 71.4% male, 93.9% black and mostly native from Cabo Verde and Angola. 73% lived in Portugal for more than 5 years, 86.7% were new cases and 13.3% relapses. 174 were pulmonary forms, 70.7% of which were D+ and 81% confirmed (against 75% in the non-immigrants). Of the 91 drug susceptibility tests done in the pulmonary forms, 9.9% revealed multidrug resistance, against 5% in the non-immigrants. Twenty six point six percent had AIDS against 18% in the non-immigrants. Some conclusions: important percentage of immigrants with tuberculosis in the Chest Disease Center of Venda Nova; immigrants have a higher confirmation rate of pulmonary tuberculosis, more multidrug resistance and AIDS cases.

Adolescent↗

Onset of allergy and asthma symptoms in extra-European immigrants to Milan, Italy: possible role of environmental factors.

BACKGROUND: Allergy and asthma are typical disorders of the affluent societies. Migrants from developing to industrialized countries seem to be at increased risk of allergy and asthma development. OBJECTIVE: To evaluate time of onset, spectrum of sensitization and clinical features in a population of extra-European immigrants to Milan, Italy, complaining of allergy and asthma symptoms. METHODS: Data regarding 243 extra-European immigrants checked at an allergy clinic from 1994 to 2000 were collected retrospectively. The demographic data were compared with those of the extra-European immigrants living in Milan at the end of 1999. RESULTS: The patients were complaining of asthma (63.7%), rhinoconjunctivitis (56.7%), rhinitis alone (21%) or urticaria (3%). One hundred and eighty-seven out of 222 patients (84.3%) declared they were healthy before migrating and allergy/asthma symptoms started to appear after their arrival in Italy, namely after an average period of 4 years and 7 months. The proportion of male patients was lower than the proportion of men in the extra-European immigrant population (48% vs. 55%), suggesting that in adult immigrants allergy and asthma are more common in women than in men. Furthermore, there was an over-representation of Central-South Americans attending the clinic, which seemed to be due to a genetic predisposition to allergy/asthma development. When data were analysed for single countries, a trend towards an increased risk of allergy and asthma was found in immigrants from all Central-South American countries. A skin test positivity for at least one inhalant allergen was found in 196 out of 232 patients (81%), and the spectrum of allergic sensitization was similar to that of the Italian population living in the North of Italy. CONCLUSION: Most extra-European immigrants declared that they were healthy at home and that allergy and asthma symptoms had appeared after immigration to Milan; lifestyle and environmental factors in a western industrialized city seem indeed to facilitate allergy/asthma onset in immigrants from developing countries. Allergy/asthma risk seems to be different in different ethnic groups.

Adult↗

Global drug-resistance patterns and the management of latent tuberculosis infection in immigrants to the United States.

BACKGROUND: In the United States, an increasingly disproportionate burden of tuberculosis among the foreign-born population has led to calls for improvements in the detection and treatment of latent infection in new immigrants. Current treatment guidelines do not take into account global differences in drug-resistance patterns or their implications for the treatment of immigrants. The use of multinational surveillance systems to guide the management of latent infection according to region-specific drug-resistance profiles could improve the efficiency of efforts to reduce the burden of tuberculosis in immigrants to the United States. METHODS: We constructed a decision-analysis model by using a hypothetical cohort of all documented immigrants entering the United States from developing nations. Region-specific drug-resistance profiles were derived from data on 30,388 cases of infection. The model examined the effectiveness and cost effectiveness of four strategies: no intervention or tuberculin skin testing followed by treatment with isoniazid, treatment with rifampin, or treatment with rifampin plus pyrazinamide for those with a positive test result. RESULTS: A strategy of detecting and treating latent tuberculosis infection was cost-saving among immigrants from Mexico, Haiti, sub-Saharan Africa, South Asia, and developing nations in East Asia and the Pacific. This strategy was highly cost effective among immigrants from other developing nations. Rifampin plus pyrazinamide was the preferred strategy for treating latent infection in immigrants from Vietnam, Haiti, and the Philippines. CONCLUSIONS: For new immigrants to the United States from developing nations, a strategy of detecting and treating latent tuberculosis infection would lead to substantial health and economic benefits. Because of the high prevalence of resistance to isoniazid, treatment with a rifampin-containing regimen should be strongly considered for immigrants from Vietnam, Haiti, and the Philippines.

Antitubercular Agents↗

Purity and passion: risk and morality in Latina immigrants' and physicians' beliefs about cervical cancer.

This paper examines how physicians' beliefs about risk factors for cervical cancer compare with Mexican and Salvadoran immigrant women's views (hereafter Latina immigrants). Between August 15, 1991 and August 15, 1992, we conducted ethnographic interviews with 39 Mexican immigrant women, 28 Salvadoran immigrant women, and 30 physicians in northern Orange County, California. Physicians and Latina immigrants converge on their beliefs that sexual behavior is a predominant risk factor for cervical cancer. They diverge, however, on their reasons. Latina immigrants' perceptions of health risks are embedded in a larger set of cultural values centering around gender relations, sexuality, and morality. Latina immigrants also emphasized men's behavior as risk factors. Physicians' views, on the other hand, are largely based on the epidemiology of cervical cancer risk factors. They emphasized beginning sexual relations at an early age, multiple sexual partners, and infection with sexually transmitted viruses. Some physicians, however, displayed moral interpretations of the sex-based risk factors for cervical cancer through the use of the culturally-loaded term "promiscuous" in place of "multiple sexual partners," through specific references to morality, and through characterizations of women at risk for cervical cancer. Both the physicians and the Latina immigrants in our study paid considerably less attention to socioeconomic factors. Our results have important implications for physicians who provide health care for Latina immigrants. Physicians should be clear to point out that women need not be "promiscuous" to get cervical cancer.

Adult↗

Differences in age of first hospitalization for schizophrenia among immigrants and nonimmigrants in a national case registry.

While previous studies have found an increased incidence of schizophrenia in some immigrant groups, differences in age of onset in these groups has not been examined. The purpose of this study was to compare age of first hospitalization of (1) native-born people versus immigrants, (2) immigrants from different countries of origin, and (3) first generation immigrants versus second generation immigrants; and to reexamine gender differences in age of first hospitalization. Data were extracted on all first hospital admissions nationally for the years 1978-1992 (n = 10,902) from the National Psychiatric Hospitalization Case Registry of the State of Israel Ministry of Health. Immigrants were older at time of first hospitalization than nonimmigrants, with considerable variations between different countries of origin. Second generation immigrants (i.e., born in Israel to immigrant parents) had ages of first hospitalization similar to people with native-born parents. Males had earlier ages at first hospitalization than females. The results suggest that immigration may have a delaying effect on age of first admission and support previous findings regarding gender difference in age of onset.

Adolescent↗

Immigrant policy: issues for social work practice.

Immigrants make up a significant segment of U.S. society. Immigration to the United States has been characterized by steady growth, dramatic changes in ethnic composition, and declining socioeconomic levels. The challenge for social work is to respond to the social services needs of immigrants by designing appropriate programs that will contribute to the social and economic integration of immigrants. This article provides an overview of the major policy issues relevant to social work practice with immigrants and describes the recent U.S. immigrant population. It discusses current federal policy that affects service provision to immigrants, defines immigrant eligibility for social services, outlines the major areas of need among immigrants, and considers implications for social work practice.

Cultural Diversity↗

Coronary heart disease risks in first- and second-generation immigrants in Sweden: a follow-up study.

OBJECTIVES: To analyse whether there is an association between country of birth in first-generation immigrants and first hospitalization for or death from coronary heart disease (CHD) and to analyse whether this association remains in second-generation immigrants. DESIGN: In this follow-up study, the MigMed database at the Karolinska Institute, Stockholm, was used to identify all hospital diagnoses of and deaths from incident CHD in first- and second-generation immigrants in Sweden between 1 January 1987 and 31 December 2001. Incidence ratios standardized by age, geographical region and socio-economic status were estimated by sex in first- and second-generation immigrants; the reference group was Swedish-born people whose parents were both born in Sweden. SUBJECTS: The total Swedish population aged 25-69 years. RESULTS: First-generation immigrants from Finland, central European countries, other eastern European countries and Turkey had higher rates of CHD than men or women in the reference group. First-generation immigrant women born in southern Europe, other western European countries and Baltic countries had lower CHD risks than the reference group. Sons of both male and female first-generation immigrants showed CHD risks similar to or slightly higher than those of their parents. Amongst second-generation women, only subjects with Finnish fathers or mothers had higher risks of developing CHD than the reference. CONCLUSIONS: Increased risks of CHD found in some first-generation immigrant groups often persist in second-generation immigrant men. Healthcare professionals and policy makers should take this into account when designing and undertaking measures to prevent CHD.

Adult↗

One-year prevalence and socio-cultural aspects of chronic headache in Turkish immigrants and German natives.

The aim of this research was to study the prevalence of chronic headache (CH) and associated socio-cultural factors in Turkish immigrants and native Germans. Five hundred and twenty-three Turkish and German company employees were screened using a standard questionnaire. Those who suffered from headaches were also examined by a neurologist. Complete data were available for 471 (90%) subjects. Thirty-four participants (7.2%) had CH. Two independent factors for association with CH could be identified: overuse of acute headache medication (OR = 72.5; 95% CI 25.9-202.9), and being a first-generation Turkish immigrant compared with native Germans (OR = 4.4; 95% CI 1.4-13.7). In contrast, the factor associated with chronic headache was not increased in second-generation Turkish immigrants. Medication overuse was significantly more frequent in first-generation Turkish immigrants (21.6%) compared with second-generation Turkish immigrants (3.3%) and native Germans (3.6%; chi(2) = 38.0, P < 0.001). First-generation Turkish immigrants did not contact headache specialists at all, compared with 2.8% of second-generation Turkish immigrants and 8.8% of native Germans (chi(2) = 118.4, P < 0.001). Likewise no first-generation Turkish immigrant suffering from CH received headache preventive treatment, compared with 6.6% of native Germans (chi(2) = 19.1, P = 0.014). The data from this cross-sectional study reveal a high prevalence of chronic headache as well as a very low utilization of adequate medical care in first-generation Turkish immigrants in Germany.

Adult↗

Longitudinal study of oral hygiene and dietary habits among immigrant children in Sweden.

Families immigrating to Sweden from Finland and Southern Europe (Greece, Yugoslavia, and Turkey), as well as Swedish control families of the same social class, were interviewed twice on their children's oral hygiene and dietary habits and on the parents' knowledge of oral health. The first interview was made on the immigrants' arrival in Sweden and the second one 30 months later. The material comprised 35 Finnish, 23 South-European and 54 Swedish families. During the observation period more immigrant than control children had complained about toothache. The frequency of toothbrushing was lower among the immigrants than among the Swedes at both interviews. The frequency of sweets consumption was significantly higher among the immigrants. Fewer immigrant than Swedish children had been examined or treated by a dentist before the first interview. There was no difference between the immigrants and the controls in channels of information about oral hygiene, the schools and the dentists being the foremost source of information for both groups. The Swedish parents had a more competent knowledge of oral hygiene than the parents of the immigrant children. It was concluded that Finnish and South-European immigrant children definitely have a great need of preventive dentistry.

Adolescent↗

Motor neurone disease and multiple sclerosis among immigrants to Britain.

Hospital discharge rates for various immigrant groups resident in Greater London and the West Midlands were studied to compare the incidence of two diseases of the nervous system-motor neurone disease (MND) and multiple sclerosis (MS). For both these conditions immigrants from Europe, Ireland, America and from the old commonwealth countries of Canada, Australia, and New Zealand had discharge rates that were similar to those for people born in the United Kingdom. In contrast, immigrants from the new commonwealth countries of Asia, Africa, America (including the West Indies), and Europe (Gibraltar, Malta, and Gozo) had a greatly reduced risk of MS but a very similar risk of MND compared with those born in the United Kingdom. MS but not MND was rare among immigrants of Asian or African ethnic origin and uncommon among immigrants from the West Indies. Deaths attributed to MS and MND have also been studied. During a three-year period there were no deaths reported for MS among immigrants of Asian and African ethnic origin and 14 were expected. There were two deaths from MND among these immigrants and five were expected. Among the immigrants from the West Indies two deaths were attributed to MS and 13 were expected, and there were three deaths attributed to MND and four were expected. The contrast between MND and MS in hospital morbidity and mortality confirms that MS among immigrants to Britain is rare in those of Asian and African ethnic origin.

Adolescent↗

[Prevalence of dental caries: comparison between immigrant and autochthonous children].

INTRODUCTION: Immigration to Spain has been high in recent years, especially in some autonomous communities. In both deciduous and permanent teeth, immigrant children have a higher number of dental caries and a lower number of restored teeth than autochthonous schoolchildren. Few studies have compared the prevalence of dental caries between immigrant and autochthonous children. OBJECTIVE: To determine the prevalence of dental caries in two groups of children: an immigrant group and an autochthonous group. MATERIAL AND METHOD: The study sample consisted of 600 children (235 immigrant children and 365 autochthonous children) aged between 6 and 10 years old who were living in the autonomous community of Valencia. The children were examined by two specialists, an odontologist and a pediatrician. RESULTS: The prevalence of dental caries was higher in immigrant children than in autochthonous children. In deciduous dentition, the prevalence of caries was 47.23 % and 32.05 % in immigrants and autochthonous children, respectively. In permanent dentition, the prevalence was 53.19 % and 35.34 %, respectively. CONCLUSIONS: The prevalence of dental caries was higher in immigrant children than in autochthonous children. Pediatricians and/or odontologists should aim to improve knowledge of good dental health care and habits among immigrant children and their parents.

Child↗