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PubMed2006

Acceptance of repeat esophagogastroduodenoscopy to detect gastric cancer in a Chinese immigrant cohort.

GOAL: To study the feasibility of using repeat esophagogastroduodenoscopy (EGD) to screen for Helicobacter pylori infection and gastric cancer in an Asian immigrant cohort. BACKGROUND: Immigrants in the United States (US) from countries with high per capita rates of gastric cancer remain at higher risk for gastric cancer. The existence of the possibly modifiable risk factor of H. pylori infection and the poor outcomes associated with late-stage disease make screening higher-risk groups with EGD an appealing possibility. It is unknown whether Asian immigrants in the US would accept an EGD-based strategy for gastric cancer screening. STUDY: Cross-sectional study of adult Chinese immigrants in New York City with dyspepsia who underwent EGD in an earlier gastric cancer detection study, who were offered a second EGD four years later. Our main outcome measure was acceptance or refusal of repeat EGD. RESULTS: Seventy-three of the 115 Chinese participants in the earlier study were successfully contacted for this current study. Twenty-three of 73 (32%) underwent repeat EGD. Leading reasons given for declining were lack of symptoms and lack of time. Significantly associated with acceptance of repeat EGD was the belief that EGD will find stomach cancer "nearly always" in someone who has it (P=0.0054; odds ratio=14.0, 2.1 to 94.2 95% confidence interval). CONCLUSIONS: Acceptance of repeat EGD for gastric cancer detection in a cohort of Chinese immigrants was relatively low despite the mitigation of cost and language factors, 2 major barriers to healthcare access. Relocation seemed to be a factor as well. In this population, perceptions of the benefits of EGD may influence acceptance of testing for cancer detection purposes.

Aged↗

PubMed1993

Blood pressure, glucose, insulin and lipids of young Ethiopian recent immigrants to Israel and in those resident for 2 years.

OBJECTIVES: To determine influence of residence in Israel on blood pressure, glucose, insulin and lipids levels in recent and resident young Ethiopian immigrants, and to compare them with Israeli students. DESIGN: Young male Ethiopians, resident in Israel for < 3 months and residing in boarding schools, were compared, in a cross-sectional study, with those who had been living under the same conditions for 2 years. The food for both groups was provided from the same kitchen. A group of Israeli students served as an additional comparison group. METHODS: Body mass index, triceps skinfold width, sitting blood pressure and fasting glucose insulin, lipids and fructosamine levels were measured and a standard oral glucose tolerance test was performed, with glucose and insulin levels being measured 60 and 120 min after the load. RESULTS: Body mass index did not differ by much between the two Ethiopian groups, but was significantly lower in the Ethiopian groups than in the Israeli student group. Systolic (SBP) and diastolic blood pressure (DBP) were significantly higher in the resident immigrants than in the students, but the high-density lipoprotein-cholesterol, triglycerides, fructosamine and insulin response to oral glucose loading were all significantly lower, whereas the blood glucose response was actually higher. Resident immigrants had a significantly higher prevalence of hypertension. SBP and DBP correlated weakly (r = 0.25 and 0.24, respectively) with the sum of insulin after loading among the Ethiopian immigrants but not among the students. CONCLUSION: After 2 years' residence in Israel, young male Ethiopian immigrants acquire in parallel a rise in blood pressure and an increase in lipidaemia, insulinaemia and glucose response. However, the hypertensive subjects are not hyperinsulinaemic, with increases in insulinaemia accounting for only approximately 6% of blood pressure variability. The increase in the prevalence of hypertension therefore cannot be explained by dietary-induced insulinaemia alone.

Adult↗

PubMed1990

Immigration, stress, and depressive symptoms in a Mexican-American community.

This study assessed levels of depressive symptomatology in a household probability sample of Mexico-born (N = 706) and U.S.-born (N = 538) Mexican Americans. We hypothesized that immigration status differences in acculturation, strain, social resources, and social conflict, as well as differences in the associations of these variables with depression, would account for differences in depression between U.S.-born and Mexico-born respondents. U.S.-born Mexican Americans had higher depression scores than those born in Mexico. When cultural and social psychological variables were controlled in a multiple regression analysis, the immigrant status difference persisted. Tests of interaction terms suggested greater vulnerability to the effects of low acculturation and low educational attainment among the U.S.-born relative to those born in Mexico; however, the immigrant status difference persisted after controlling for these interactions. Unmeasured variables such as selective migration of persons with better coping skills, selective return of depressed immigrants, or generational differences in social comparison processes may account for the immigration status difference.

Acculturation↗

PubMed1998

HIV incidence in Ethiopian immigrants to Israel.

The HIV incidence in recent adult Ethiopian immigrants to Israel is estimated through the use of snapshot estimators based on percentage of CD4 progression with time since infection, whereas the preimmigration incidence experienced by this population is estimated using an epidemic model applied to HIV prevalence data obtained from immigrants on arrival in Israel. The snapshot estimators place incidence in adult Ethiopian immigrants in Israel between 3 and 11 infections/1000 uninfected persons/year around May 1995. In contrast, the epidemic model suggests that the incidence experienced by this population before immigration was between 12 and 22 infections/1000 uninfected persons/year. Although the drop in incidence postimmigration is good news, in the aggregate, we estimate that between 50 and 190 new infections have occurred annually in adult Ethiopians who have immigrated to Israel.

Adolescent↗

PubMed2006

Follow-up care after a diagnosis of Helicobacter pylori infection in an Asian immigrant cohort.

GOAL: To study the rate at which Helicobacter pylori infection is treated in an immigrant cohort after diagnosis by esophagogastroduodenoscopy (EGD). BACKGROUND: Gastric cancer is the second leading cause of cancer death worldwide, and is especially prevalent in East Asia; immigrants from this part of the world remain at higher risk. Infection with H. pylori is a known risk factor for gastric cancer. There have been no studies of completion of H. pylori treatment in immigrant populations. STUDY: Prospective cohort study of East Asian immigrants diagnosed with H. pylori infection who underwent EGD in a gastric cancer screening protocol. Our primary outcome was self-report or chart evidence of completion of treatment of H. pylori. RESULTS: Sixty-eight of the 126 participants (54%) tested positive for H. pylori infection on EGD. Forty-nine (72%) were seen for a follow-up visit at one of the clinics involved in the study. According to clinic records, 39 of these 49 participants (57% of all H. pylori-positive participants) were prescribed treatment. Only 31 participants (46%) completed treatment. Of possible explanatory factors, only having a "regular doctor" was significantly associated with treatment completion (odds ratio=5.6; 95% confidence interval, 1.2-25.0). CONCLUSIONS: In a sample of Asian immigrants, the rate of treatment of H. pylori infection, a potentially modifiable risk factor, was lower than expected. Having a "regular doctor" appeared to increase the likelihood of receiving appropriate follow-up care.

Aged↗

PubMed2004

Premigration exposure to political violence among independent immigrants and its association with emotional distress.

Although the distinction between independent immigrants and refugees has an impact on policy, services, and public opinion because it implies differences in resettlement needs, few recent studies have documented the validity of this assumption. In this population-based survey of recent migrants in Quebec (N = 1871), immigration status (refugee, independent, or sponsored immigrant) is examined in relation to premigration exposure to political violence and refugees' emotional distress, assessed with the SCL-25. A higher percentage of refugees reported exposure to political violence in their homeland, but the percentages of exposed independent (48%) and sponsored (42%) immigrants were unexpectedly high. Emotional distress was significantly higher among Chinese respondents who had witnessed acts of violence and in subjects from Arab countries who reported persecution. These results suggest that service providers and policy makers should not assume that independent immigrants have not been exposed to political violence before their migration.

Adolescent↗

PubMed2005

Drinking pattern among adolescents with immigrant and Norwegian backgrounds: a two-way influence?

AIMS: To assess the association between drinking behaviour among adolescents with both immigrant and native backgrounds with aspects of acculturation. DESIGN: Cross-sectional school survey among 15-16 year olds. SETTING AND PARTICIPANTS: All students, a total of 8361, in 10th grade during spring 2000 and 2001 in Oslo, Norway with response rate 88.3%. The sample consisted of 1213 students with an immigrant background and 4627 students with a Norwegian background. MEASUREMENTS: Indicators of the length of the acculturation process were assessed as first versus second generation and in terms of length of stay in Norway. The proportion of Muslim students in school was an indicator of social environment 'dryness'. Drinking behaviour was assessed as drinking alcohol ever, drinking frequency and intoxication frequency. FINDINGS: A smaller proportion of immigrant students were current drinkers, frequent drinkers and drank to intoxication compared with adolescents with a Norwegian background. Adjusted two-level analyses showed that alcohol drinking was less common among immigrant students with a short stay in Norway and with a large proportion of Muslim students in school. In those with a Norwegian background there was a larger proportion of abstainers, and those who drank did so less frequently and were less frequently intoxicated the larger the proportion of Muslim students there was in their school. CONCLUSION: Drinking behaviour among adolescents in a multicultural and heterogeneous society seems to reflect a bi-directional acculturation process where the majority population tend to adapt to the behaviours of the immigrant population which in turn, to a varying degree, tends to adapt to the behaviour of the majority population.

Acculturation↗

PubMed1979

Asthma in Asian immigrants.

Adult Asian immigrants to the United Kingdom attending an asthma clinic have been compared with a control group of non-immigrant Caucasian asthmatic patients of similar age distribution. The Asian immigrants had a later age of onset of asthma than their non-immigrant controls. Comparison with studies of asthmatic patients in India suggests that this may be an intrinsic ethnic difference but an effect of migration in early adult life is not excluded. Despite a later age of onset, the frequency of positive skin prick tests to common allergens was similar in the immigrant and control groups and 71% of the Asians had positive reactions to the house dust mite. Most other clinical features, the variability of airways obstruction and the requirements for treatment showed no significant differences between the two groups.

Adolescent↗

PubMed2006

Help seeking and barriers to utilisation of medical and health social work services among ageing immigrants to Israel from the former Soviet Union.

The study aimed to examine utilisation of medical and health social work services among ageing recent and long-term immigrants, to identify barriers to service utilisation, and to examine factors related to utilisation. Participants (n = 402) recruited from a random community sample of immigrants from the former Soviet Union in Israel, aged 55 and over, residing in urban areas throughout the country were interviewed by telephone. Using an expanded framework of Andersen's behavioural model, the independent variables included predisposing, enabling and need variables, and additional variables--barriers to utilisation or difficulties encountered during utilisation of services. For multivariate analyses of the dependent variables, a linear multiple regression model was employed for utilisation of medical services and a logistic regression model for utilisation of social work services. The main findings show that utilisation rates were high for medical services, but low for social work services. Recent immigrants had similar utilisation rates of medical services but utilised more social work services than long-term immigrants. There were few barriers but numerous difficulties in utilisation of medical services, while there were barriers but negligible difficulties in utilisation of social work services. Predisposing and need variables explained utilisation of medical services, whereas a combination of predisposing, enabling and need variables explained utilisation of social work services. The findings suggest that different factors are associated with the use of non-discretionary versus discretionary (social work) services. There is a need to reduce difficulties in utilisation of medical services and to enhance awareness about health social work services among the immigrants.

Aged↗

PubMed1992

Middle-Eastern immigrant parents' social networks and help-seeking for child health care.

The purpose of this research was to describe: (a) Arab-American immigrant parents' perceptions of their social networks, including social support; and (b) Arab-American immigrant parents' perceptions of their help-seeking related to child health care. Seventy-three immigrant parents who were Egyptian-American (n = 17), Palestinian-American (n = 44) and Yemeni-American (n = 12) completed the Norbeck Social Support Questionnaire, four Supplementary Social Support Questions, a Support System Map and a Child Health Interview Guide. Family and relatives were perceived as the major source of support and comprised the highest percentage of social network members. Compared with published scores of a normative American sample, the immigrant parents' scores were lower (P less than 0.01) on all social network and social support variables. There was a moderate negative correlation (r = 0.47) between parents' number of years of residence in the USA and percentage of network members living outside the USA (P less than 0.01) and a weak positive correlation (r = 0.36) between number of years in the USA and percentage of network members living close to the parent (P less than 0.01). Parents' help-seeking for child health care involved use of a variety of resources, with reliance on some long-distance support from family in the Middle-East. This descriptive research provides a basis for further research on patterns of support and help-seeking in immigrant parents.

Adolescent↗

PubMed2006

Understanding the increased risk of neural tube defect-affected pregnancies among Mexico-born women in California: immigration and anthropometric factors.

Mexico-born women in the United States have an unexplained twofold increased risk of neural tube defect (NTD)-affected pregnancies. We examined whether immigration characteristics were associated with the NTD risk and whether anthropometric factors contributed to the increased risk among Mexico-born women. Data were derived from a large population-based case-control study in California. In-person interviews were conducted with mothers of 538 (88% of eligible) NTD-affected fetuses/infants and mothers of 539 (88%) randomly selected non-malformed control infants. The crude odds ratio (OR) for NTDs among all Mexico-born women, women residing <2 years in the US, and women >16 years old at immigration compared with non-Hispanic white women was 2.4 [95% confidence interval (CI) = 1.8, 3.3], 7.2 [95% CI = 3.7, 14.0] and 3.0 [95% CI = 2.0, 4.4], respectively. Risk for second- or third-generation Mexican-Americans was similar to that of white women. The crude OR for all Mexico-born women was reduced from 2.4 to 2.0 [95% CI = 1.3, 3.0] and for those residing <2 years in the US from 8.4 to 7.1 [95% CI = 3.2, 15.3] after adjustment for maternal body mass index (BMI), height, compromised diet, diabetes, and other known risk factors. In term pregnancies, additional adjustment for pregnancy weight gain reduced the OR in all Mexico-born women and recent immigrants by 16% and 25%, respectively. Low pregnancy weight gain (<10 vs. 10-14 kg) was particularly associated with increased NTD risk among Mexico-born women (OR(ADJ) = 5.8; 95% CI = 2.1, 15.8). Findings indicate that recent Mexican immigrants have a sevenfold increased risk for NTDs. Maternal BMI and height contributed very little, and inadequate weight gain contributed modestly to the NTD risk disparity for Mexican immigrants.

Adolescent↗

PubMed1992

Immigration and citizenship debates: reflections of ten common themes.

"This article begins with the view that access to citizenship and to citizenship rights has become the principal object of struggle between immigrants and the rest of society in Western Europe.... In examining ten recurring themes of current debates on immigration and citizenship, the author hopes to summarise and critically examine the main arguments. The article also tries to show that arguments against the extension of rights to immigrants generally give priority to collective rather than individual rights. In this way, human rights violations towards immigrants are sanctioned (and sometimes even recommended) by socialist and conservative writers alike.... This article concentrates on themes relating to the acquisition of citizenship in the metropolitan state by immigrants from the former colonies." (SUMMARY IN FRE AND SPA)

Attitude↗

PubMed1993

Immigration and economic welfare: resource and environmental aspects.

"The relation between immigration and the economic welfare of residents is analyzed for resource-rich economies (such as Australia) both under competitive conditions and when various distortions are present. Immigration provides efficiency gains for residents under distortion-free competition for standard 'gains from trade' reasons. Such reasons, however, tend to be ignored by immigration and 'optimal population' theorists who raise the issue of restricting immigration without explicitly referring to the distortions. In situations where distortions and externalities are present, we argue that it is generally preferable to devise policies which specifically target the distortions than to restrict immigration."

Australia↗

PubMed2005

Welfare reform and health insurance of immigrants.

OBJECTIVE: To investigate the effect of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) on the health insurance coverage of foreign- and U.S.-born families headed by low-educated women. DATA SOURCE: Secondary data from the March series of the Current Population Surveys for 1994-2001. STUDY DESIGN: Multivariate regression methods and a pre- and post-test with comparison group research design (difference-in-differences) are used to estimate the effect of welfare reform on the health insurance coverage of low-educated, foreign- and U.S.-born unmarried women and their children. Heterogeneous responses by states to create substitute Temporary Aid to Needy Families or Medicaid programs for newly arrived immigrants are used to investigate whether the estimated effect of PRWORA on newly arrived immigrants is related to the actual provisions of the law, or the result of fears engendered by the law. PRINCIPAL FINDINGS: PRWORA increased the proportion of uninsured among low-educated, foreign-born, unmarried women by 9.9-10.7 percentage points. In contrast, the effect of PRWORA on the health insurance coverage of similar U.S.-born women is negligible. PRWORA also increased the proportion of uninsured among foreign-born children living with low-educated, single mothers by 13.5 percentage points. Again, the policy had little effect on the health insurance coverage of the children of U.S.-born, low-educated single mothers. There is some evidence that the fear and uncertainty engendered by the law had an effect on immigrant health insurance coverage. CONCLUSIONS: This research demonstrates that PRWORA adversely affected the health insurance of low-educated, unmarried, immigrant women and their children. In the case of unmarried women, it may be partly because the jobs that they obtained in response to PRWORA were less likely to provide health insurance. The research also suggests that PRWORA may have engendered fear among immigrants and dampened their enrollment in safety net programs.

Adolescent↗

PubMed1997

Changing patterns of distress during the adjustment of recent immigrants: a 1-year follow-up study.

A sample of 419 recent immigrants from the former Soviet Union to Israel was assessed, with a 1-year follow-up of 199 of these subjects. The Immigration Related Stressors Scale, Talbieh Brief Distress Inventory and Multidimensional Scale of Perceived Social Support were employed to measure the level and sources of distress, as well as the sources of social support. Three major patterns of change in distress level were distinguished, and their 1-year prevalence rates were established. In total, 44% of the respondents demonstrated the 'normal' pattern, with a permanent low distress level, 33% displayed the 'positive' pattern, with either persistent moderate or decreasing distress, and 23% displayed the 'negative' pattern, with either persistent high or increasing distress. Among the immigrants who demonstrated the positive pattern of change in distress, rates of stressors such as 'anxiety about the future', 'uncertainty in the present', 'depressive state', 'insufficient knowledge of Hebrew' and 'malevolence of Israelis' decreased during the study period. In those who showed the negative pattern, rates of stressors such as 'personality characteristics' and 'lack of acceptance of the host culture/mentality' have increased. Immigrants who showed the normal and positive patterns had greater total social support than those who showed the negative pattern. The level of family support tended be higher among immigrants with the normal pattern, while support by friends tended to be greater among those with the positive pattern of change in distress.

Adaptation, Psychological↗

PubMed2005

Are immigrants at a disadvantage in psychiatric in-patient care?

OBJECTIVE: To assess the utilization of psychiatric in-patient care among immigrants, and to compare immigrants and natives with respect to sociodemographic and clinical characteristics. METHOD: Analysing a sample of 23 377 consecutive referrals to psychiatric hospitals of a catchment area in 1995-2001. RESULTS: Within this sample, 20% were foreign nationals. Rates of psychotic disorders were similar in immigrants and natives. Regarding other diagnoses, sociodemographic and clinical measures, there were significant differences. Most immigrant groups had higher rates of compulsory admission, were more likely to be admitted with lower illness severity and not to be readmitted, and spent significantly shorter time in hospital, compared with Swiss in-patients. Some of these differences were clearly gender-specific. CONCLUSION: Service utilization and psychiatric treatment decisions are not explained merely by illness-related aspects in immigrants. Social and cultural factors have to be recognized in order to prevent disadvantages in psychiatric care.

Adolescent↗

PubMed1985

Immigrants and a public oral health care service for children in Denmark.

The present study was conducted to compare level of dental caries, treatment pattern and contact patterns with the Child Oral Health Care System of children of immigrants. The study comprised 239 Turkish, 117 Pakistani and 91 other immigrants and a control group of 359 Danish children. Data were extracted from the dental records in the clinic where they were treated. All groups of immigrants showed more caries in the primary dentition and less caries in the permanent dentition than Danish children of comparable age. For preschool children a higher number of broken appointments were found for the immigrants as well as a higher number of appointments which were interrupted due to management problems. The consequences for planning preventive and restorative programs for children of immigrants are discussed.

Adolescent↗

PubMed1999

Clinicoepidemiological study of imported malaria in travelers and immigrants to Madrid.

BACKGROUND: The number of Spanish travelers visiting malaria endemic areas, and the number of immigrants from malarial countries arriving in Spain are continuously increasing. However, little information about imported cases in Spain is available. METHODS: A prospective clinicoepidemiological study of imported cases of malaria diagnosed at a referral teaching hospital in Madrid, Spain. RESULTS: Of the 160 patients, sixty (37.5%) were immigrants and 100 (62.5%) Spanish nationals. Malaria was acquired in Africa by 98.3% of immigrants and in 83.0% of travelers. Falciparum malaria accounted for 71.8% of the cases, P. vivax for 11.9%, P. ovale for 10.6% and P. malarie for 5. 0%. Eleven (6.9%) patients, all immigrants, were asymptomatic. Severe complications were recorded in 17 (10.6%): 7, severe anemia; 3, cerebral malaria; 2, renal failure; 1, spontaneous splenic rupture; 1, acute pulmonary edema; 1, sepsis; 1, acute cerebrovascular accident; and 1, disseminated intravascular coagulation. There were no fatal cases. Among the 100 Spanish nationals, 44% did not follow any prophylaxis, 29% followed a correct prophylaxis, 27% were considered defaulters, and 39% took self-treatment without cure. CONCLUSIONS: There is a changing pattern of imported malaria in Madrid, with one third occurring in immigrants and two thirds in nationals. This data provides information about the reemergence of imported malaria to Europe.

Adolescent↗