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PubMed1998

Reported health, lifestyles, and use of health care of first generation immigrants in The Netherlands: do socioeconomic factors explain their adverse position?

OBJECTIVE: Differences in health, lifestyles, and use of health care between groups of varying ethnic origin can have important implications for preventive and curative health care. This paper studies whether socioeconomic factors explain ethnic differences in these outcomes. DESIGN: Data on health status, lifestyles, and use of health care were obtained from interviews with 3296 people aged 16-64 years (response: 60.6%), among whom were 848 first generation immigrants. Ethnic differences in these outcomes were examined with and without adjustment for socioeconomic factors, using logistic regression. SETTING: General population of Amsterdam, the Netherlands. MAIN OUTCOME MEASURES: Health status (self rated health, General Health Questionnaire, functional limitations), lifestyles (smoking, alcohol), and use of health care (general practice, pharmaceuticals, hospitalisations). MAIN RESULTS: Immigrants from Turkey, Morocco and (former) Dutch colonies report a poorer health and a higher use of health care, especially primary health care among the elderly. An adverse socioeconomic position partially explains the poor health of these immigrants. In turn, their poor health explains most of their higher use of health care. CONCLUSIONS: Cultural factors and poor living conditions seem to contribute to the poor health of immigrants, besides an adverse socioeconomic position. The pressure on various health services will increase in future because of the relatively high increase in immigrants' needs at older ages and their presently low mean age.

Adolescent↗

PubMed2001

Immigrants in the Netherlands: equal access for equal needs?

OBJECTIVE: This paper examines whether equal utilisation of health care services for first generation immigrant groups has been achieved in the Netherlands. DESIGN: Survey data were linked to an insurance register concerning people aged 16-64. Ethnic differences in the use of a broad range of health care services were examined in this group, with and without adjustment for health status and socioeconomic status, using logistic regression. SETTING: Publicly insured population in Amsterdam, the Netherlands. PARTICIPANTS: 1422 people from the indigenous population, and 378 people from the four largest immigrant groups in the Netherlands-that is, the Surinamese, the Netherlands Antilleans, and the Turkish and Moroccan. MAIN OUTCOME MEASURES: General practitioner service use (past two months), prescription drug use (past three months), outpatient specialist contact (past two months), hospital admission (past year), physiotherapist contact (past two months) and contact with other paramedics (past year). MAIN RESULTS: Ethnicity was found to be associated with the use of health care after controlling for health status as an indicator for need. The use of general practitioner care and the use of prescribed drugs was increased among people from Surinam, Turkey and Morocco as compared with the indigenous population. Compared with the indigenous group with corresponding health status, the use of all other more specialised services was relatively low among Turkish and Moroccan people. Among the Surinamese population, the use of more specialised care was highly similar to that found in the Dutch population after differences in need were controlled for. Among people from the Netherlands Antilles, we observed a relatively high use of hospital services in combination with underuse of general practitioner services. The lower socioeconomic status of immigrant groups explained most of the increased use of the general practitioner and prescribed drugs, but could not account for the lower use of the more specialised services. CONCLUSIONS: The results indicate that the utilisation of more specialised health care is lower for immigrant groups in the Netherlands, particularly for Turkish and Moroccan people and to a lesser extent, people from the Netherlands Antilles. Although underuse of more specialised services is also present among the lower socioeconomic groups in the Netherlands, the analyses indicate that this only partly explains the lower utilisation of these services among immigrant groups. This suggests that ethnic background in itself may account for patterns of consumption, potentially because of limited access.

Adolescent↗

PubMed2006

Smoking in immigrants: do socioeconomic gradients follow the pattern expected from the tobacco epidemic?

OBJECTIVES: Although socioeconomic patterns of smoking across the different stages of the tobacco epidemic have been well researched, less is known about these patterns among immigrant populations. This paper aims to assess the smoking prevalence and its socioeconomic gradients among three immigrant populations. METHODS: Three cross-sectional studies, using structured face-to-face interviews, were conducted in three representative (for socioeconomic status) samples of 385 Turkish, 316 Moroccan, and 1072 Surinamese first-generation immigrants aged 35-60 years in Amsterdam, The Netherlands. Information gathered included information about smoking behaviour, educational level and background characteristics. The associations between educational level and smoking rates were assessed using logistic regression analyses stratified by age and sex, for each ethnic group separately. RESULTS: The prevalence of smoking differed per group, being highest among Turkish and Surinamese men (63% and 55%, respectively), followed by Moroccan men and Turkish and Surinamese women (30%, 32% and 27%, respectively). Higher smoking rates were found among women with higher educational levels, except for Surinamese women aged 35-44 years. However, among Turkish and Moroccan men aged 35-44 years and Surinamese men, smoking rates were higher in lower socioeconomic groups. CONCLUSIONS: The prevalence figures and educational associations suggest that the socioeconomic gradient changes in earlier stages of the epidemic in immigrant populations than in the Western host populations, particularly in men. This provides indications to suggest that smoking prevention measures in male immigrant groups need to be tailored to lower socioeconomic groups in particular throughout the tobacco epidemic, and to higher socioeconomic groups among women.

Adult↗

PubMed2004

Assuring the health of immigrants: what the leading health indicators tell us.

Over the past 20 years, the United States has experienced one of the largest waves of immigration in its history. Understanding the health status and needs of immigrants is important because of their growing numbers and their contribution to the health of the nation, but it is challenging because of gaps in national databases, the heterogeneity of immigrant populations, and uncertainty about how migration affects health. Healthy People 2010 outlines the nation's public health objectives for the current decade. It includes ten leading health indicators (LHIs) chosen because of their importance as public health issues, their ability to motivate action, and the availability of data to measure their progress. In this paper, we discuss the health of immigrants from the perspective of these LHIs, as they provide a framework for anticipating some of the future health needs of immigrants and help define priority areas for research and action.

Emigration and Immigration↗

PubMed2005

[Depressive syndromes in the immigrant population].

Migrations are currently one of the most important sociocultural and political phenomena. As a rule, immigrants are in good health, although the immigration is by itself a mental health risk factor. This population shows common specific problems as adaptation processes, depressive syndromes, or other psychiatric problems. "Ulises' syndrome", depression, and dysthymia are the most common mental health conditions among unlawful non-european community immigrants cared in specific facilities. Similarly to the spanish indigenous population, anxiety disorders and readjustment disorders are the most common diagnoses among legal immigrants cared by Mental Health Services (MHS). Given the impact of sociocultural aspects in the development and clinical manifestations of mental health problems, it is necessary to know the demands of the immigrant population and to adjust current facilities for their care.

Depression↗

PubMed2001

Tuberculosis in the foreign-born population of Tarrant county, Texas by immigration status.

The epidemiology of tuberculosis is changing in the United States as a result of immigration, yet the extent to which different classes of immigrants contribute to overall morbidity is unknown. Tuberculosis in nonimmigrant visitors is of particular interest as they are currently exempt from screening requirements. We conducted a prospective survey of all culture-positive tuberculosis patients in Tarrant County, Texas from 1/98 to 12/00. Immigration status of foreign-born patients was classified as permanent residents, undocumented, or nonimmigrant visitors. Of 274 eligible participants, 114 (42%) were foreign-born; of these, 67 (59%) were permanent residents, 28 (25%) were undocumented, and 19 (17%) were nonimmigrant visitors. Among the foreign-born, we observed significant differences by immigration status in multidrug resistance (p = 0.02), human immunodeficiency virus (HIV) infection (p = 0.0007), and hospitalization (p = 0.03 for ever/never, 0.01 for duration). Compared with other immigrants, more nonimmigrant visitors were multi-drug-resistant (16 % versus 11% of undocumented residents and 1% of permanent residents), were HIV-positive (32% versus 0% of undocumented and 5% of permanent residents), were hospitalized (47% versus 36% of undocumented and 19% of permanent residents), and had lengthy hospitalizations (median [midspread] days = 87 [25 to 153] versus 8.5 [4 to 28] for undocumented and 10 [7 to 24 d] for permanent residents). We found nonimmigrant visitors to be an important source of tuberculosis morbidity in Tarrant County. Further studies in other regions of the U.S. are needed to determine if screening and treatment recommendations of persons who spend extended periods in the U.S. should be raised to the standards set for permanent residents.

Adult↗

PubMed2000

Somatization in an immigrant population in Israel: a community survey of prevalence, risk factors, and help-seeking behavior.

OBJECTIVE: Knowledge about the frequency, severity, and risk factors of somatization (somatic manifestations of psychological distress) among immigrants is limited. The authors examined somatic distress in an immigrant population in Israel, explored its relationship with psychological distress symptoms and health-care-seeking behavior, and determined its correlation with the length of residence in Israel. METHOD: Two reliable and validated self-report questionnaires, the Brief Symptom Inventory and the Demographic Psychosocial Inventory, were administered in a cross-sectional community survey of 966 Jewish immigrants from the former Soviet Union who had arrived in Israel within the previous 30 months. RESULTS: The 6-month prevalence rate for somatization was 21.9% and for psychological distress, 55.3%. The current rate of co-occurrence of somatization and psychological distress was 20.4%. The most common physical complaints were heart or chest pain, feelings of weakness in different parts of the body, and nausea. Somatization was positively correlated with the intensity of psychological distress and with help-seeking behavior during the 6 months preceding the survey. Women reported significantly more somatic and other distress symptoms than men. Older and divorced or widowed individuals were more likely to meet the criteria for somatization. Within the first 30 months after resettlement, longer length of residence was associated with higher levels of somatization symptoms. CONCLUSIONS: Somatization is a prevalent problem among individuals in cross-cultural transition and is associated with psychological distress; demographic characteristics such as gender, age, marital status, and duration of immigration; self-reported health problems; and immigrants' help-seeking behavior.

Adolescent↗

PubMed2002

Ødegaard's selection hypothesis revisited: schizophrenia in Surinamese immigrants to The Netherlands.

OBJECTIVE: The incidence of schizophrenia among Surinamese immigrants to the Netherlands is high. The authors tested Ødegaard's hypothesis that this phenomenon is explained by selective migration. METHOD: The authors imagined that migration from Surinam to the Netherlands subsumed the entire population of Surinam and not solely individuals at risk for schizophrenia. They compared the risk of a first admission to a Dutch mental hospital for schizophrenia from 1983 to 1992 for Surinamese-born immigrants to the risk for Dutch-born individuals, using the Surinamese-born population in the Netherlands and the population of Surinam combined as the denominator for the immigrants. RESULTS: The age- and sex-adjusted relative risk of schizophrenia for the Surinamese-born immigrants was 1.46. CONCLUSIONS: Selective migration cannot solely explain the higher incidence of schizophrenia in Surinamese immigrants to the Netherlands.

Adolescent↗

PubMed1996

Suicide among immigrants from the Indian subcontinent: a review.

OBJECTIVE: Studies of suicide among immigrants from the Indian subcontinent (India, Pakistan, Bangladesh, and Sri Lanka) were examined to increase awareness of suicide risk and to better understand social and psychological factors contributing to suicide in this group. METHODS: An online search was conducted of MEDLINE for the years 1966 to 1994 and Psychological Abstracts for the years 1974 to 1994, and all references on completed suicides in the target population were selected for review. RESULTS: Suicide rates of young women immigrants from the Indian subcontinent are consistently higher than those of their male counterparts and of young women in the indigenous populations of the countries to which they immigrate. Suicide rates among older men in this immigrant group have been reported to be low, although reports are less consistent. Use of violent methods such as hanging, burning, and poisoning is common among both men and women. A disproportionately higher number of immigrant Hindus commit suicide. Family conflict appears to be a precipitating factor in many suicides, whereas mental illness is rarely cited as a cause. Depression, anxiety, and domestic violence may contribute to the high rates. Affective disorders may be underdiagnosed in this population. CONCLUSIONS: More research is needed on the epidemiology of psychiatric illnesses and their contribution to suicide in this group.

Adult↗

PubMed2006

Psychological distress among recent Russian immigrants in the United States.

BACKGROUND: The purpose of this study was to examine the psychological status of Russian immigrants who have recently come to the United States. AIMS: The project included creation of a Russian version of the Hopkins Symptom Checklist-25 (HSCL-25) in order to identify anxiety and depression in members of the Russian-speaking immigrant population. METHODS: Translation and adaptation included (a) cross-cultural adaptation; (b) translation; (c) pre-testing; and (d) analysis of validity, reliability and internal consistency. Seventeen Russian-speaking patients at a Russian psychiatric clinic were recruited for the study and were compared with a sample of 42 Russian-speaking members of the community. RESULTS: The instrument showed internal consistency when evaluated with coefficient alpha. Clinic patients had significantly higher anxiety and depression symptom scores than community subjects. Russian immigrants' scores on the anxiety and depression scales were less than comparative data for the United States and notably less than similar measures for Russian immigrants to Israel. CONCLUSIONS: Recent Russian immigrants to the United States appear to have low prevalences of anxiety and depression.

Adolescent↗

PubMed1986

A time series analysis of international immigration and suicide mortality in Canada.

A neglected topic concerning suicide as a sociological phenomenon is the relationship between international immigration and suicide mortality. This study examines the association between these variables using time series data for the period 1950 to 1982 in Canada. The central hypothesis, derived from the Durkheimian theory of social integration and suicide, is that the higher the immigration rate, the higher the rate of suicide. Two statistical controls, the unemployment rate and age composition, drawn from the "economic anomie" and "social demographic" perspectives respectively were introduced into a multiple regression model involving immigration and suicide. While some of the results in the initial stages of the analysis appear to contradict the established literature concerning the relevance of immigration and unemployment in predicting suicide, more refined breakdowns which allow for the separate investigation of male and female suicide propensities, generally support the social integration and economic anomie theories. It is concluded that the 15-34 male cohort is highly sensitive to changes in their economic prospects and in their immigration experience and therefore, have higher suicide rates than women in the same age group.

Adolescent↗

PubMed1995

Use of the Brief Symptom Inventory to assess psychological distress in three immigrant groups.

This paper examined the internal consistency reliability of two newly developed alternate language versions of the Brief Symptom Inventory (BSI) (This is not the Bradford Somatic Inventory, which is also known as the BSI) when used with Polish and Filipino immigrants and the original versions of the BSI and its parent instrument, the Symptom Checklist 90 (SCL-90) when used with Irish immigrants; and, the theoretical and criterion related validity of the Psychoticism subscale of the BSI for Polish, Filipino, and Irish immigrants. Internal consistency estimates and triangulation of individual BSI global and subscale scores with verbal self-reports and clinical assessments demonstrated that the BSI is a relatively reliable and valid cross-cultural measure of psychological distress. However, problems with the Psychoticism subscale occurred across all three immigrant groups, which suggested that this subscale should be interpreted with caution when used with immigrants.

Acculturation↗

PubMed1998

Psychological distress among Ethiopian and Russian Jewish immigrants to Israel: a cross-cultural study.

A community survey was conducted examining the differences in levels of psychological distress and its symptomatology, comparing 110 Ethiopian-Jewish and 400 Russian-Jewish immigrants to Israel. Psychological distress was measured by the Talbieh Brief Distress Inventory. Russian immigrants were found to be more distressed than their Ethiopian counterparts and this between-group difference can be attributed to the greater relative number of females, older immigrants and those with longer duration of stay in Israel in the Russian sample. The highest levels of distress were observed for paranoid ideation in the Ethiopian sample and anxiety and hostility in the Russian sample. These symptoms were independent of gender and time since immigration. Russians with longer duration of stay demonstrated higher scores signifying adjustment difficulties than their Ethiopian counterparts. These results suggest that the differences in levels and symptom expression of psychological distress are determined, to a considerable extent, by demographic factors (sex, age) and the differing cultural backgrounds of the two immigrant groups.

Acculturation↗

PubMed1998

Predicting psychological distress among former Soviet immigrants.

This study investigated whether age, gender, marital status, education, employment, length of time in the U.S. and immigration demands (novelty, occupation, language, discrimination, loss, and not feeling at home) were predictors of psychological distress in a sample of 1,647 former Soviet immigrants. Multiple regression analysis indicated that the combined model of demographic and demand of immigration variables was significant. Results indicated that women, older immigrants, those with less than a college education, and those with greater immigration demands related to novelty, language, discrimination, loss, and not feeling at home were most distressed.

Adult↗

PubMed1999

Psychological distress through immigration: the two-phase temporal pattern?

A large community sample, cross-sectional and in part longitudinal design, and comparison groups was used to determine the timing of psychological distress among immigrants. A total of 2,378 adult immigrants from the former Soviet Union to Israel completed the self-administered questionnaire Talbieh Brief Distress Inventory. The aggregate levels of distress and six psychological symptoms--obsessiveness, hostility, interpersonal sensitivity, depression, anxiety, and paranoid ideation--were compared at 20 intervals covering 1 to 60 months after resettlement. The level of psychological distress was significantly higher in the immigrants than that of Israeli natives but not in the potential immigrant controls. A two-phase temporal pattern of development of psychological distress was revealed consisting of escalation and reduction phases. The escalation phase was characterized by an increase in distress levels until the 27th month after arrival (a peak) and the reduction phase led to a decline returning to normal levels. The 1-month prevalence rate was 15.6% for the total sample, and for highly distressed subjects it reached 24% at the 27th month after arrival, and it declined to 4% at the 44th month. The time pattern of distress shared males and females, married and divorced/widowed (but not singles), as well as subjects of all age groups (except for immigrants in their forties). The two-phase pattern of distress obtained according to cross-sectional data was indirectly confirmed through a longitudinal way. Claims of early euphoric or distress-free period followed by mental health crisis frequently referred to in the literature on migration was not supported by this study.

Adult↗

PubMed2006

Health and the education of children from racial/ethnic minority and immigrant families.

Building on a conceptual model of the transition to elementary school, this study explored the role of health in the early cognitive achievement of children from various racial/ethnic minority and immigrant families by applying multilevel modeling to data from a nationally representative sample of American kindergarteners. Whites tended to have the best physical health before transitioning to first grade. Children from immigrant Latino/a and Asian families had the worst physical health but the best mental health. Compared to white children from native families, these health differentials partially explained the lower math achievement and achievement growth of black children (whether from native or immigrant families) in first grade as well as the lower math achievement of children from Latino/a immigrant families and the lower achievement growth of children from Asian immigrant families during this period.

Child↗

PubMedDate not supplied

Pap smear rates among Haitian immigrant women in eastern Massachusetts.

OBJECTIVE: Given limited prior evidence of high rates of cervical cancer in Haitian immigrant women in the U.S., this study was designed to examine self-reported Pap smear screening rates for Haitian immigrant women and compare them to rates for women of other ethnicities. METHODS: Multi-ethnic women at least 40 years of age living in neighborhoods with large Haitian immigrant populations in eastern Massachusetts were surveyed in 2000-2002. Multivariate logistic regression analyses were used to examine the effect of demographic and health care characteristics on Pap smear rates. RESULTS: Overall, 81% (95% confidence interval 79%, 84%) of women in the study sample reported having had a Pap smear within three years. In unadjusted analyses, Pap smear rates differed by ethnicity (p=0.003), with women identified as Haitian having a lower crude Pap smear rate (78%) than women identified as African American (87%), English-speaking Caribbean (88%), or Latina (92%). Women identified as Haitian had a higher rate than women identified as non-Hispanic white (74%). Adjustment for differences in demographic factors known to predict Pap smear acquisition (age, marital status, education level, and household income) only partially accounted for the observed difference in Pap smear rates. However, adjustment for these variables as well as those related to health care access (single site for primary care, health insurance status, and physician gender) eliminated the ethnic difference in Pap smear rates. CONCLUSIONS: The lower crude Pap smear rate for Haitian immigrants relative to other women of color was in part due to differences in (1) utilization of a single source for primary care, (2) health insurance, and (3) care provided by female physicians. Public health programs, such as the cancer prevention programs currently utilized in eastern Massachusetts, may influence these factors. Thus, the relatively high Pap rate among women in this study may reflect the success of these programs. Public health and elected officials will need to consider closely how implementing or withdrawing these programs may impact immigrant and minority communities.

Adult↗

PubMed1993

Nutrition-related diseases and dietary change among Third World immigrants in northern Europe.

Immigrants from the third world are more prone to acquire nutritional deficiency diseases, such as rickets, osteomalacia and iron deficiency anemia than the rest of the population in the recipient countries. Lately, evidence is also emerging that some immigrant groups are particularly susceptible to diseases related to overnutrition, such as coronary heart disease and non-insulin dependent diabetes. The purpose of this review article is to give a holistic view of the nutrition related diseases and disorders among immigrants. It deals with the prevalence of these diseases among immigrants in Northern European countries, and looks into some of the hypotheses, which have been put forward to explain why immigrant groups are more prone to acquire these diseases than the rest of the population. The focus of this part of the paper is the process of dietary change after migration. The practical implications of the findings from the literature review are then discussed.

Adolescent↗