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Screening immigrants for tuberculosis in Newcastle upon Tyne.

BACKGROUND: Successive national guidelines on the control of tuberculosis in the United Kingdom have included recommendations for screening immigrants coming from countries with a high prevalence of tuberculosis. As there has been only one other study on the process and outcome of screening immigrants at a district level the aim of this study was to assess the contribution of screening immigrants to the control of tuberculosis in Newcastle. METHODS: The Port of Arrival (POA) forms were used to identify all new immigrants for screening in Newcastle during 1993. The Family Health Services Authority (FHSA) register was used to identify additional new immigrants from the Indian sub-continent. For all new immigrants identified by the POA forms and FHSA register, hospital and practice records were reviewed for evidence of screening and its outcome up to the end of 1994. RESULTS: There were 252 POA forms in 1993, 100 of which were for immigrants from the Indian sub-continent. This represents less than a third of all new immigrants from the Indian sub-continent. Of all immigrants identified by POA forms, 99 (39 per cent) had been screened. This resulted in the detection of one active case of tuberculosis. CONCLUSIONS: The POA system alone is inadequate for identifying immigrants for screening. The published evidence on screening immigrants for tuberculosis suggests that the system does not work well and the yield of new cases is low. To assess the effectiveness of screening immigrants a national audit is needed.

Emigration and Immigration↗

Making it in America: social mobility in the immigrant population.

In his survey of research on social mobility and U.S. immigration, George Borjas underscores two insights. First, most immigrants are at a sizable earnings disadvantage, relative to native-born workers. Second, the earnings of different groups of immigrants vary widely. The children of immigrants "catch up" to native-born workers slowly. The jump in relative wages between the first and second generations is somewhere between 5 and 10 percentage points. Of particular concern is that the age-adjusted relative wage of both immigrants and second-generation workers has been falling--a trend with bleak implications for the children of immigrants. The wide ethnic variation in the earnings of immigrants has equally important implications. National origin groups from advanced economies, such as Canada, do much better in the U.S. labor market than those from poorer countries, such as Mexico. And the initial ethnic differences tend to persist. In rough terms, about half of the difference in relative economic status persists from one generation to the next. Thus a 20 percentage point wage gap among ethnic groups in the immigrant generation implies a 10 point gap among second-generation groups and a 5 point gap among third-generation groups. Again in rough terms, Borjas attributes about half of that persistence to the ethnic environment in which children are raised. Borjas cautions that the rate of social mobility that immigrants enjoyed over much of the twentieth century may not continue in the future. The employment sectors seeking immigrants today are unlikely to provide the same growth opportunities as did the rapidly expanding manufacturing sector a century ago. And in contrast to the many and diverse ethnic groups that made up early twentieth-century immigrants, the large ethnic groups of immigrants today may develop separate economies and social structures, in effect hindering their social mobility.

Achievement↗

Asthma, allergy and atopy in Asian immigrants in Melbourne.

OBJECTIVES: To compare the prevalence of asthma, hay fever and atopy in Asian immigrants in Melbourne with that in Australian-born non-Asians and Australian-born Asians, and to investigate the association of these conditions with atopic status, length of stay in Australia and IgE levels in Asian immigrants. DESIGN: We performed a cross-sectional study by telephone interviews, using standard questionnaire items on respiratory and allergic symptoms. A random sample of 636 recent Asian immigrants of ethnic Chinese origin, 109 Australian-born Asians and 424 Australian-born non-Asians were selected from the 1991 Melbourne Telephone Directory, using a presumptive surname list. Skin tests to determine atopic status were performed on 269 Asian immigrants and 167 of these also had serum levels of total and specific IgE estimated. RESULTS: In the under 20 years age group the prevalence of wheeze or asthma ever was higher in Australian-born non-Asians and Australian-born Asians than in Asian immigrants (P < 0.001), and the prevalence of hay fever was higher in Asian immigrants and Australian-born Asians than in Australian-born non-Asians. In those older than 20 years, hay fever was almost twice as common in Asian immigrants as in Australian-born non-Asians (P < 0.001 for 20-40 years age group; P < 0.01 for > 40 years). The prevalence of hay fever and, to a lesser degree, asthma in Asian immigrants increased significantly with length of stay in Australia, independent of age at arrival, sex and atopic status (trend test: P < 0.001 for hay fever; P = 0.05 for asthma). Atopy was more common in Asian immigrants and Australian-born Asians than in Australian-born non-Asians (P < 0.001) and was very strongly associated with both hay fever and asthma, irrespective of length of stay. Pollen and mite sensitivities were more common in Asian subjects (twice as common for Asian-born and 1.5 times for Australian-born) than non-Asian subjects (P < 0.01). Among Asian immigrants, elevated total IgE level (> 100 IU/mL) was strongly associated with a history of hay fever (P < 0.01) and wheeze or asthma ever (P < 0.05), atopy (P < 0.001) and the presence of specific IgE antibodies to grass pollen, dust mite, cockroach and Ascaris antigens (P < 0.05 for all). CONCLUSION: We found substantial differences in the prevalence of asthma, hay fever and atopy between Asian immigrants, Australian-born Asians and non-Asians. The prevalence of hay fever and asthma in Asian immigrants was strongly associated with length of stay in Australia, suggesting that environmental factors are important in the pathogenesis of these diseases.

Adolescent↗

Is immigration associated with an increase in risk factors and mortality among coronary artery disease patients? A cohort study of 13,742 patients.

BACKGROUND: Clinical studies showing an association between immigration and increased prevalence of coronary risk factors or mortality rate in patients with coronary artery disease are scarce. OBJECTIVES: To compare the risk profile and mortality of coronary patients born in Israel with those who immigrated to Israel, and to determine whether recent immigration is associated with greater risk among immigrants from the Soviet Union. METHODS: Demographic, clinical, and laboratory data were collected on chronic coronary artery disease patients from 18 Israeli medical centers during the screening period of the Bezafibrate Infarction Prevention Study in the early 1990s. Data on mortality after a mean 7.7 year follow-up were obtained from the Israel Population Registry. RESULTS: While significant differences in mortality (14.7% vs. 18.5%, P < 0.001) were observed between Israeli-born patients and immigrants respectively, the mortality in these groups was similar when compared within specific age groups. Immigrants suffered more from hypertension and angina pectoris, and their New York Heart Association functional limitation class was higher, as compared to their Israeli-born counterparts. A multivariate analysis of mortality comparing patients from the Soviet Union who immigrated after 1970 with those who immigrated before 1970 showed an increased risk for newer immigrants, with a hazard ratio of 1.69 (95% confidence interval 1.19-2.40) for those immigrating between 1970 and 1984, and 1.68 (95% CI 1.01-2.28) for those immigrating between 1985 and 1991. CONCLUSION: The worse profile and prognosis observed among patients who recently emigrated from the Soviet Union cannot be explained by traditional risk factors for CAD such as smoking, diabetes, hypertension, and lipid disorders. Further investigation, including variables such as psychological stress to which immigrants are more exposed than others, is needed.

Aged↗

Canadian and immigrant international medical graduates.

OBJECTIVE: To compare the demographic and educational characteristics of Canadian international medical graduates (IMGs) and immigrant IMGs who applied to the second iteration of the Canadian Resident Matching Service (CaRMS) match in 2002. DESIGN: Web-based questionnaire survey. SETTING: The study was conducted during the second-iteration CaRMS match in Canada. PARTICIPANTS: The sampling frame included the entire population of IMG registrants for the 2002 CaRMS match in Canada who expressed interest in applying for a ministry-funded residency position in the 13 English-speaking Canadian medical schools. Those who immigrated to Canada with medical degrees were categorized as immigrant IMGs. Canadian citizens and landed immigrants or permanent residents who left Canada to obtain a medical degree in another country were defined as Canadian IMGs. MAIN OUTCOME MEASURES: Demographic characteristics, education and training outside Canada, examinations taken, previous applications for a residency position, preferred type of practice, and barriers and supports were compared. RESULTS: Out of 446 respondents who indicated their immigration status and education, 396 (88.8%) were immigrant IMGs and 50 (11.2%) were Canadian IMGs. Immigrant IMGs tended to be older, be married, and have dependent children. Immigrant IMGs most frequently obtained their medical education in Asia, Eastern Europe, the Middle East, or Africa, whereas Canadian IMGs most frequently obtained their medical degrees in Asia, the Caribbean, or Europe. Immigrant IMGs tended to have more years of postgraduate training and clinical experience. A significantly greater proportion of immigrant IMGs had perceived that there were insufficient opportunities for assessment, financial barriers to training, and licensing barriers to practice. Nearly half (45.5%) of all IMGs selected family medicine as their first choice of clinical discipline to practise in Canada. There were no significant differences between Canadian and immigrant IMGs in terms of first choice of clinical discipline (family medicine vs specialty). There were no significant differences between the groups in the number of times they applied to CaRMS in the past, but a relatively greater proportion of Canadian IMGs obtained residency positions. CONCLUSION: There are notable similarities and some significant differences between Canadian and immigrant IMGs seeking to practise medicine in Canada.

Adult↗

Race, region and the territorial politics of immigration in the US.

Zelinsky and Lee recently unveiled a model of the sociospatial process of immigrant settlement designed to augment and possibly supplant the well-known theories of assimilation and pluralism. Although in some ways new, their work continues a tradition in social science that treats the settlement geography of immigrants as a measure of their more general fit into American society. The authors question the prevailing assumption that immigrant settlement patterns represent a barometer of their adaptation, or lack thereof, to a host society. This critique of the concepts of assimilation, pluralism and Zelinsky and Lee's alternative "heterolocal" model of immigrant settlement pivots around the issues of spatial scale and race. The authors argue that the contestations over immigration and how well immigrants fit into society are increasingly constructed at the regional scale. The authors also assert that questions race infuse almost all aspects of these debates. The transformation of America's largest city-regions into places of non-White immigrants, and the shifting political balance of power to states like California through immigration-driven reapportionment, are touchstones for anti-immigration initiatives and associated local and national debate. Fear of racial regional changes underpins an increasingly powerful response to immigration. The reactions elicited by these settlement geographies fall under the heading the authors call the "territorial politics of immigration".

Acculturation↗

Cancer risks in first-generation immigrants to Sweden.

We used the nationwide Swedish Family-Cancer Database to analyse cancer risks in 613,000 adult immigrants to Sweden. All the immigrants had become parents in Sweden and their median age at immigration was 24 years for men and 22 years for women. We calculated standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) for 18 cancer sites using native Swedes as a reference. Data were also available from compatriot marriages. All cancer was decreased by 5% and 8% for immigrant men and women, respectively. However, most of the male increase was due to lung cancer for which male immigrants showed a 41% excess. Among individual cancer sites and immigrant countries, 110 comparisons were significant, 62 showing protection and 48 an increased risk. Most of the differences between the rates in immigrants and Swedes could be ascribed to the variation of cancer incidence in the indigenous populations. Some high immigrant SIRs were 5.05 (n = 6, 95% CI 1.82-11.06) for stomach cancer in Rumanian women and 2.41 (41, 1.73-3.27) for lung cancer in Dutch men. At some sites, such as testis, prostate, skin (melanoma), kidney, cervix and nervous system, the SIRs for immigrants were decreased; in some groups of immigrants SIRs were about 0.20. The highest rates for testicular cancer were noted for Danes and Chileans. Women from Yugoslavia and Turkey had an excess of thyroid tumours. All immigrant groups showed breast, endometrial and ovarian cancers at or below the Swedish level but the differences were no more than 2-fold.

Adult↗

Overcoming the odds: access to care for immigrant children in working poor families in California.

OBJECTIVES: To explore the extent to which, among working poor families, uninsured immigrant children experience more barriers to care than uninsured nonimmigrants, and compare these differences to those of insured children. METHODS: We used data from the 2001 California Health Interview Survey, a randomized, population-based telephone survey conducted from November 2000 through September 2001. Financial and nonfinancial access to health care and utilization of health services were examined for 3,978 nonimmigrant and 462 immigrant children and adolescents under the age of 18 years. We compared differences in crude rates across four subgroups (insured immigrants, uninsured immigrants, insured nonimmigrants, uninsured nonimmigrants) and in adjusted models controlling for socioeconomic and immigration characteristics, parental language, health status, and other demographic factors. RESULTS: More immigrant than nonimmigrant children lacked health insurance at the time of the interview (44% vs. 17%, p < 0.0001). Among the uninsured, immigrants had higher odds of perceiving discrimination (11% vs. 5%, p < 0.05) and postponing emergency room (ER) (16% vs. 7%, p < 0.05) and dental care (40% vs. 30%, p < 0.05) after controlling for covariates. Among the insured, immigrants fared worse on almost every access and utilization outcome. Among insured immigrants, child and parent undocumented status and having a non-English-speaking parent contributed to missed physician and ER visits. CONCLUSIONS: Disparities in access and use remain for immigrant poor children despite public insurance eligibility expansions. Insurance does not guarantee equitable health care access and use for undocumented children. Financial and nonfinancial barriers to health care for immigrant children must be removed if we are to address disparities among minority children.

Adolescent↗

Health insurance coverage of the children of immigrants in the United States.

OBJECTIVES: This study assesses the health insurance coverage of children of immigrants in the United States and variations among immigrant groups. METHOD: The study uses data from the March supplements of the 1994 and 1996 Current Population Survey to compare health insurance coverage of children who report foreign parentage. Separate logistic regressions are conducted to estimate the likelihood of being covered by any insurance, public insurance, and private insurance. RESULTS: 27.3% of all children of immigrants are without health insurance, 34.1% are on public insurance, and 44.3% have private insurance. Foreign-born children who have not yet become U.S. citizens are the most likely to be without health insurance (38.0%). Many of these children are not covered because their parents are unable to find jobs that provide coverage and Medicaid fails to enroll as many of them as possible. Overall, the children's chances of being covered by any health insurance vary little according to when their parents came to this country. However, children of recent immigrants are more likely to rely on public health insurance (40.1% vs. 24.8%) and less likely to be covered through private sources (36.8% vs. 60.6%) than those of established immigrants. Among immigrant groups, children of Haitian (48.4%) and Korean (45.3%) immigrants are at the highest risks of being uninsured. Both children of the Dominican Republic (65.9%) and Laos (83.3%) report high rates of public insurance coverage. CONCLUSIONS: Greater disparity in health insurance coverage among children of immigrants is expected once the new welfare reform bills take effect. In particular, noncitizen children, children of recent immigrants, illegal immigrants, and Dominican Republican immigrants will be affected most. Efforts aimed at reducing the harm should target these vulnerable groups.

Animals↗

Teacher-reported problem behaviour in Turkish immigrant and Dutch children: a cross-cultural comparison.

OBJECTIVE: To compare problem behaviour in Turkish immigrant children living in the Netherlands versus problem behaviour in Dutch children from the general population as reported by teachers. METHOD: Teacher's Report Forms (TRF) were filled out by Dutch teachers, and for a subsample also by Turkish immigrant teachers, concerning 524 Turkish immigrant children selected randomly from the immigrant population in two large cities in the Netherlands. TRFs completed for Turkish immigrant children were compared with TRFs filled out for 1625 children selected randomly from the Dutch general population. RESULTS: No significant differences were revealed between children from both cultures on the TRF total problems, internalizing, externalizing and specific syndrome scales. Turkish immigrant teachers, however, reported higher total problems, internalizing and anxious/depressed scores for immigrant children than did Dutch teachers for the same immigrant children. CONCLUSION: No significant differences were found in the levels of behavioural and emotional problems reported by Dutch teachers for Turkish immigrant versus Dutch children. However, Turkish immigrant teachers reported high levels of anxiety and depression in immigrant children which go largely undetected by their Dutch teachers.

Adolescent↗

Absorption of nursing students: new immigrants in the general academic nursing programme in Israel.

Two years after upgrading its nursing programme to university level, Israel experienced a massive wave of immigration from the former Soviet Union. Previous studies have shown that Russian immigrants in general, and in nursing in particular, have several unique characteristics that need to be taken into consideration in planning curricula and absorption programmes. The aim of the present work was to update these data, focusing on the reasons new immigrants choose nursing as a career, their image of the profession and their satisfaction with it. The study population consisted of 302 students attending five major academic schools of nursing in Israel. Students were divided into two groups: new immigrants (less than 4 years in Israel) and long-time Israelis (more than 4 years in Israel). All completed a 30-item questionnaire of proven validity and reliability. Findings were analysed by length of time in Israel and year of study. Using a series of statistical tests, we found that compared with the long-time Israelis, the new immigrants came from a higher socio-economic/professional stratum (in their mother country), had a less 'technical' perception of nursing, and were attracted to the profession primarily for extrinsic reasons ('close to medicine', economics). Both groups showed highest satisfaction in the clinical domain; however, the difference was significant only in the long-time Israeli group, even though the new immigrants had rated this domain highest in importance. The new immigrants showed least satisfaction in the academic domain. These results could be explained by several factors: the financial and housing problems that accompany immigration; the higher proportion of married students in the new immigrant group; and especially language difficulties, which are multiplied in Israel, where mastery in both Hebrew and English is necessary. Of particular interest was the fact that many of the immigrant students had already begun or completed medical school in their old country but were forced to compromise their dreams on immigration. This affected both their image of nursing and their reasons for choosing it as a career. We believe these findings will help nurse educators identify areas in which they can help ease the absorption process for maximal benefit to both the students and the profession.

Adolescent↗

Immigrant women family caregivers in Canada: implications for policies and programmes in health and social sectors.

Migration has become a profound global phenomenon in this century. In Canada, uncoordinated policies, including those related to immigration, resettlement, employment, and government funding for health and social services, present barriers to immigrant women caregivers. The purpose of this paper is to share relevant insights from individual and group interviews with immigrant women family caregivers, service providers and policy influencers, and discuss these in relation to immigration, health and social policy, and programme trends in Canada. The present authors conducted individual interviews with immigrant women family caregivers (n = 29) in phase 1, followed by two group interviews with women family caregivers (n = 7), and two group interviews with service providers and policy-makers (n = 15) in phase 2. Using an inductive approach, the authors employed thematic content data analysis. Immigrant women experienced barriers to health and social services similar to Canadian-born family caregivers, particularly those who have low incomes, jobs with limited flexibility and heavy caregiving demands. These immigrant women family caregivers avoided certain formal services for a variety of reasons, including lack of cultural sensitivity. However, their challenges were compounded by language, immigration and separation from family in the home country. The identified barriers to support reinforce the importance of modifying and expanding policies and programmes affecting immigrant women's ability to care for family members with illnesses or disabilities within the context of Canadian society. Participants recommended changes to policies and programmes to deal with information, transportation, language, attitudinal and network barriers. The various barriers to services and programmes which were experienced by immigrant women caregivers underscore the importance of reviewing policies affecting immigration, caregiving, and access to health and social services. Intersectoral collaboration among agencies is essential to reduce the barriers identified in the present study, and to establish services which are linguistically and culturally appropriate.

Asian People↗

[Prevalence of diabetes mellitus in young Asian Indian immigrants in Santa Coloma de Gramenet (Spain)].

BACKGROUND AND OBJECTIVE: There is a general agreement to consider Asian Indian subjects, specially those who immigrated to Western countries, as a high-risk population to develop type 2 diabetes mellitus (DM2). This could be mainly explained by reasons based on the immigration changes, particularly the metabolic impact of a westernized diet (environmental hypothesis) or reasons based in the presence of tissue resistance to insulin (genetic hypothesis). The aim of the study was to estimate the prevalence of DM2 in 3 populations of Asian Indian immigrants, non-Asian Indian immigrants and autochthonous subjects. POPULATION AND METHOD: An observational multicenter study was performed in 3 primary care centers from Santa Coloma de Gramenet (Barcelona, Spain). Subjects from Asian Indian, non-Asian Indian and autochthonous origin born between 1948-73 were compared. Their DM2 prevalence as well as sociodemographic and clinical data among diabetic patients were analyzed. RESULTS: The overall prevalence of DM2 was 4.6 %. The prevalence of DM2 was higher among Asian Indian immigrants (20.9%, 95% CI, 12.1-29.1) compared with autochthonous (3.6%; 95% CI, 2.9-9.3; p < 0.001) and non-Asian Indian immigrants (9.7%; 95% CI, 5.3-14.1; p = 0.013). Nevertheless, differences between autochthonous and non-Asian Indian immigrants were found (p < 0.001). Asian Indians subjects had an earlier diagnosis age, especially those younger than 44 years, than those of non-Asian Indian immigrants and autochthonous groups (p < 0.002 and p < 0.006, respectively). CONCLUSIONS: Taken together, these results suggest that young immigrant populations have a higher prevalence of DM2 compared with autochthonous ones. Indeed, the prevalence of DM2 among immigrant Asian Indians represents the highest reported in the European Union so far and shows differences with non-Asian Indian immigrants. In spite of this, these differences are not totally conclusive in statistical terms; further studies are needed to compare both populations.

Adult↗

Greek immigrant children in southern Sweden in comparison with Greek and Swedish children. I. General living conditions.

Greek immigrant children belonging to the second generation of immigrants in Sweden have been compared with Swedish children and Greek children in Greece regarding general living conditions. Interviews were performed in the homes of all participants. The parents in the two Greek groups had the lowest educational level. The yearly salary of immigrant families was similar to that of the Swedish families. Immigrant and Swedish parents worked outside their homes to the same extent, Greek immigrant mothers fulltime, Swedish mothers mostly part time. For economical reasons the immigrant parents looked after their children within the family while the Swedish families almost always utilized community day care facilities. The immigrant families had fewer children than the Swedish and Greek rural families and their dwellings were smaller. Corporal punishment was a common method of upbringing in Greece and among the immigrants. The immigrant families had extremely few contacts with Swedish families. A majority of the immigrant families were unsure about their future in Sweden, whether or not to stay. In conclusion, the Greek immigrant group in many respects had adapted to Swedish customs but they had also at the same time retained much of the Greek cultural characteristics.

Acculturation↗

Are there differences in all-cause and coronary heart disease mortality between immigrants in Sweden and in their country of birth? A follow-up study of total populations.

BACKGROUND: Mortality from cardiovascular diseases is higher among immigrants than native Swedes. It is not clear whether the high mortality persists from the country of birth or is a result of migration. The purpose of the present study was to analyse whether all-cause and coronary heart disease mortality differ between immigrants in Sweden and in the country of birth. METHODS: Two cohorts including the total population from Swedish national registers and WHO were defined. All-cause and CHD mortality are presented as age-adjusted incidence rates and incidence density ratios (IDR) in eight immigrant groups in Sweden and in their country of birth. The data were analysed using Poisson regression. RESULTS: The all-cause mortality risk was lower among seven of eight male immigrant groups (IDR 0.39-0.97) and among six of eight female immigrant groups (IDR 0.42-0.81) than in their country of birth. The CHD mortality risk was significantly lower in male immigrants from Norway (IDR = 0.84), Finland (IDR = 0.91), Germany (IDR = 0.84) and Hungary (IDR = 0.59) and among female immigrants from Germany (IDR = 0.66) and Hungary (IDR = 0.54) than in their country of birth. In contrast, there was a significantly higher CHD mortality risk in male immigrants from Southern Europe (IDR = 1.23) than in their country of birth. CONCLUSION: The all-cause mortality risk was lower in the majority of immigrant groups in Sweden than in their country of birth. The differences in CHD mortality risks were more complex. For countries with high CHD mortality, such as Finland and Hungary, the risk was lower among immigrants in Sweden than in their country of birth. For low-risk countries in South Europe, the risk was higher in immigrants in Sweden than in South Europe.

Age Distribution↗

Immigration and the American century.

The full impact of immigration on American society is obscured in policy and academic analyses that focus on the short-term problems of immigrant adjustment. With a longer-term perspective, which includes the socioeconomic roles of the children of immigrants, immigration appears as one of the defining characteristics of twentieth-century America. Major waves of immigration create population diversity with new languages and cultures, but over time, while immigrants and their descendants become more "American," the character of American society and culture is transformed. In the early decades of the twentieth century, immigrants and their children were the majority of the workforce in many of the largest industrial cities; in recent decades, the arrival of immigrants and their families has slowed the demographic and economic decline of some American cities. The presence of immigrants probably creates as many jobs for native-born workers as are lost through displacement. Immigrants and their children played an important role in twentieth-century American politics and were influential in the development of American popular culture during the middle decades of the twentieth century. Intermarriage between the descendants of immigrants and old-stock Americans fosters a national identity based on civic participation rather than ancestry.

Age Distribution↗

Health, life expectancy, and mortality patterns among immigrant populations in the United States.

BACKGROUND: The US immigrant population has grown considerably in the last three decades, from 9.6 million in 1970 to 32.5 million in 2002. However, this unprecedented population rise has not been accompanied by increased immigrant health monitoring. In this study, we examined the extent to which US- and foreign-born blacks, whites, Asians, and Hispanics differ in their health, life expectancy, and mortality patterns across the life course. METHODS: We used National Vital Statistics System (1986-2000) and National Health Interview Survey (1992-1995) data to examine nativity differentials in health outcomes. Logistic regression and age-adjusted death rates were used to examine differentials. RESULTS: Male and female immigrants had, respectively, 3.4 and 2.5 years longer life expectancy than the US-born. Compared to their US-born counterparts, black immigrant men and women had, respectively, 9.4 and 7.8 years longer life expectancy, but Chinese, Japanese, and Filipino immigrants had lower life expectancy. Most immigrant groups had lower risks of infant mortality and low birthweight than the US-born. Consistent with the acculturation hypothesis, immigrants' risks of disability and chronic disease morbidity increased with increasing length of residence. Cancer and other chronic disease mortality patterns for immigrants and natives varied considerably, with Asian Immigrants experiencing substantially higher stomach, liver and cervical cancer mortality than the US-born. Immigrants, however, had significantly lower mortality from lung, colorectal, breast, prostate and esophageal cancer, cardiovascular disease, cirrhosis, diabetes, respiratory diseases, HIV/AIDS, and suicide. INTERPRETATION: Migration selectivity, social support, socio-economic, and behavioural characteristics may account for health differentials between immigrants and the US-born.

Databases, Factual↗

[Utilization of preventive dental services by recent immigrants in Quebec].

OBJECTIVES: Studies conducted in Canada show that recent immigrants tend to under-utilize preventive services provided by the health care system. The objective of our study was to learn whether this phenomenon also applies to dental care. METHODS: Our sample was composed of 5,795 women who live in Quebec and are between 30 and 44 years old. These women filled out a self-administered questionnaire regarding their immigration status and their habits concerning dental visits. In our analyses, we compared the use of dental services of recent immigrants (10 years or less in Canada), long-term immigrants (more than 10 years), and non-immigrants (Canadians of origin). RESULTS: 55% of recent immigrants are preventive service users compared to 69% of long-term immigrants and 76% of non-immigrants. The financial barrier partly explains this result: immigrants often have a modest income and rarely benefit from dental coverage. However, having private dental insurance does not in itself explain the gap between these groups. This suggests that there is a cultural barrier in dental services access. CONCLUSIONS: Under-use of preventive services by immigrants is not limited to the medical field, it extends to dental services as well. In order to facilitate immigrants' adaptation to the health system, we recommend that the government provide them with free dental services that respect their culture.

Adult↗