Journal of Immigrant and Minority Health最新文献

Xenophobia among healthcare professionals can significantly impact the quality of care provided to immigrant and refugee populations, particularly in countries with high influxes such as Türkiye. This study evaluated xenophobia among resident physicians at Pamukkale University Hospital and identified factors influencing these attitudes. This cross-sectional study involving 271 resident physicians at Pamukkale University Hospital was conducted between August 1 and August 20, 2022. The participants were randomly selected and stratified by department. Data were collected via a 38-item questionnaire, including the 11-item Xenophobia Scale. Descriptive statistics, the Mann‒Whitney U test, the Kruskal‒Wallis test, and multiple linear regression analysis were used for data analysis. The mean xenophobia scale score among participants was 57.53 (SD = 7.82), indicating high levels of xenophobic attitudes. The significant factors associated with higher xenophobia scores included being from a surgical department (B = 0.571, p < 0.001) and lacking foreign nationals in their close environment (B = 0.724, p < 0.001). Additionally, 58.7% of the resident physicians opposed providing free healthcare services to refugees, and 10.0% indicated that they might delay providing health services to these patients because of their status. Additionally, 7.7% of the resident physicians admitted to discriminating against migrant/refugee patients. The study reveals pervasive xenophobic attitudes among resident physicians in Türkiye, which are influenced by departmental affiliation and the social environment. These findings underscore the need for targeted interventions to address xenophobia in healthcare settings, including cultural competence training and policy changes, to ensure equitable healthcare access for all patients.

Immigration policy, particularly regarding migrants crossing the US-Mexico border, has been a highly debated topic for years. There is a continued debate on how to maintain national security while protecting the health and dignity of migrants. In this commentary, we argue that the Biden Administration's "Proclamation on Securing the Border" issued on June 4, 2024, alongside the Department of Homeland Security (DHS) and Department of Justice's (DOJ) Interim Final Rule, poses a significant threat to the health of migrants seeking asylum at the US-Mexico border by forcing more migrants to wait in encampments in border towns. Specifically, migrants are more likely to face increased exposure to disease, mental health effects, and violence as a result of this proclamation. We call for structural policy reform and propose several alternative policies that can be enacted at the regional and national levels to help maintain the health and dignity of migrants while still prioritizing border security.

Diverse social ties are critical facilitators of well-being among older adults. Social ties might be especially important for aging immigrants who face multiple social and economic vulnerabilities over the life course. We investigated social ties (e.g., partners, children, other family, and friends) by immigrant status among older adults in the United States (U.S.). Data come from the 2018 Health and Retirement Study (N = 4,006), a national sample of older adults in the U.S. We used multivariable logistic regression to compare social ties (e.g., partners, children, other family, and friends) by immigrant status. We further explored interactions with sex and race/ethnicity. Older immigrants are more likely to report that they can rely a lot on their partners (aOR = 1.84, 95% CI 1.27, 2.68) but less likely to rely on friends (aOR = 0.72, 95% CI, 0.55, 0.94) compared to non-immigrants. Older immigrants are also less likely to meet frequently with friends (aOR = 0.66, 95% CI, 0.51, 0.86) and with other family (aOR = 0.71, 95%, CI, 0.55, 0.91) compared to non-immigrants. Lastly, older immigrant men are significantly less likely to meet with friends compared to non-immigrant men (aOR = 0.48, 95% CI, 0.32, 0.73). As the older population in the U.S. continues to diversify and immigrant older adults navigate their support options, older immigrants-especially men-may be at risk for less variation in their social support options, particularly from extended family members and friends.

Research suggests that stress due to racism may underlie the disproportionately high rates of adverse pregnancy outcomes experienced by Black women in the US. Study objectives: (1) Identify forms of systemic racism affecting pregnancy outcomes and (2) increase understanding about the role of racism in adverse pregnancy outcomes for Black women. A systematic review was conducted to explore the relationship between systemic racism and pregnancy outcomes for Black women. Searches were performed using EBSCO Academic Search Complete, CINAHL Complete, and Consumer Health Complete first between January to April 2021 and subsequently between November 2023 to January 2024. Included studies were observational, written in English, had full-text availability, examined at least one form of systemic racism and pregnancy outcome, and reported results for Black women. A meta-analysis was performed using a random effects model, summary effect estimates were pooled by pregnancy outcome. The I² statistic was used to measure heterogeneity between studies. A total of 32 studies were included in the review. Significant pooled effects of exposure to systemic racism were observed for preterm birth 0.30 (95% CI 0.12-0.48), small for gestational age 0.31 (95% CI 0.05-0.58), and low birth weight 0.24 (95% CI 0.11-0.37). Among studies that compared results by race, exposure to systemic racism had a significant and rather large effect on preterm birth for Black women (d_s = 0.62; 95% CI 0.06-0.41). Exposure to systemic racism has a significant effect on preterm birth, small for gestational age, and low birth weight for Black women. Having knowledge of how racism contributes to stress and poor pregnancy outcomes can help health professionals improve delivery of quality care to Black women. Future research should continue identifying forms of racism positively related to adverse pregnancy outcomes.

Although there is recent growing attention on mental health and mental well-being across the globe, supports in this area of healthcare can be a challenge for immigrant and racialized groups with experiences of hardship across several domains. This study aimed to gather perspectives from immigrants and racialized community members on strategies central to support their mental health and well-being, with the aim of addressing research to practice gaps. The study was co-designed in collaboration with a Community Action Table in Markham, Ontario, a setting with 93% of residents self-identifying as visible minorities. Using a community-focused mixed methods Concept Mapping approach, 68 residents, service providers, and policymakers were engaged through three phases of brainstorming, sorting and rating, and interpretation. Their brainstorming led to 68 statements which they sorted into groups and rated for importance and feasibility to act in next six months. Further analysis led to a 9-cluster concept map comprising of Family Wellness, Awareness & Education, Cultural Sensitivity, Social Service Access, Community Building, Socioeconomic, Food Security, Healthcare Access, and Housing Stability. These clusters are important in advancing knowledge on ways to support and prioritize mental health and well-being of immigrants and racialized communities. Overall, participants viewed mental health and well-being as being closely tied to their living and working conditions while also focusing on family wellness and intergenerational dynamics. Novel insights from this project are important for the planning of mental health and well-being supports for immigrant groups in Canada and can help improve foci across sectors through service implementation.

The COVID-19 pandemic disproportionately affected African, Caribbean, and Black (ACB) people in Canada. Despite higher SARS-CoV-2 exposure risks, likelihood of being quarantined, and risk of severe disease outcomes, little is known about the pandemic's effects on this community's mental health. This study aims to identify factors associated with changes in ACB Canadians' mental health during the pandemic and provide guidance for improved access to mental health resources. Data was collected from May to July 2021 using a cross-sectional, national, online survey. Eligible participants for this community-based study were ACB adults residing in Canada. Survey measures included demographics, pandemic-related experiences, mental health status, and access to mental health services. Bivariate analyses and multinomial logistic regression examined associations between variables. Among the 1,556 participants, 25.4% reported improved mental health and 33.1% reported worsened mental health since the pandemic's onset. Improved mental health was associated with younger age, receiving at least one pandemic-related benefit, and living in a home that became safer. In contrast, worsened mental health was associated with younger age, working less, the pandemic having a major impact on ability to pay bills, not receiving pandemic-related benefits, home becoming less safe, and increased substance use. Barriers to accessing mental health services included difficulty getting an appointment, cost, pandemic measures, and lack of culturally competent care. These insights underscore the positive impact of pandemic-related emergency relief, the challenges in accessing mental health services, and the gaps in culturally competent mental health care.

Little is known about differences in child developmental vulnerability before school entry according to maternal birthplace and sex. Official immigration records were linked with the Early Development Instrument assessments among children in kindergarten in the province of Manitoba, Canada (2005-2017). Logistic regression was used to estimate odds ratios of vulnerability in five developmental domains associated with maternal birthplace and child sex. Children of immigrant mothers from most birthplaces had higher adjusted odds of developmental vulnerability than non-immigrants in domains related to language and communication skills, except those of the rest of North America & Oceania. Children of Sub-Saharan African mothers were more vulnerable in four domains. Boys were consistently more vulnerable than girls across domains and maternal birthplaces. Children of immigrant mothers exhibited higher developmental vulnerability than non-immigrants in domains related to language and communication skills, potentially reflecting exposure to English and French as second languages.

Asylum medicine clinics that train clinicians to conduct forensic medical and mental health evaluations (FME) have proliferated in the United States, but there is still significant unmet need in training. We created a 12-week curriculum to develop the core skills needed to conduct effective, trauma-informed FME. Our course used a "flipped classroom" model; participants reviewed didactics in advance from a national, peer-reviewed training program, the Asylum Medicine Training Initiative, and used in-class time for case-based practice as experiential learning. Participants completed feedback surveys after each session in addition to pre-and post-course assessments. Sixteen clinicians with diverse geographic, professional, and demographic backgrounds participated in the course from January-March 2023. The three key themes that emerged from qualitative feedback were high participant satisfaction with the course model; participant desire for additional opportunities for practice; and participant desire for community-building. Post-course surveys showed that most participants felt only "somewhat comfortable" with the core skills emphasized in the course. Taken together, these findings suggest that curricula in asylum medicine should focus on experiential learning, skills practice, and building longitudinal mentorship. This curriculum is an innovative educational model that differs from the traditional didactic training that has been the mainstay in asylum medicine education. The curriculum is replicable and can be tailored to local environments or broad virtual communities.

In the United States, it is estimated that 15% of Latinos will experience a depressive or anxiety disorder during their lifetime. Education, prevention programming, and health interventions around topics such as stress, nutrition, mental health, and health maintenance for Latino immigrants are lacking, inadequate, or nonexistent. This type of programming may be protective against depression and anxiety. A total of 19 Latina women completed a five-week, group-based intervention to learn about stress, stress management, nutrition, mental health, and healthy behaviors in a culturally sensitive environment taught by native Spanish speakers. Program evaluation occurred through in-depth interviews and changes in anxiety and depression scores via the Generalized Anxiety Scale and the Patient Health Questionnaire, respectively. The team saw statistically significant decreases in the GAD-7 scores pre- and post-intervention (8.00 versus 5.08, p<0.05), but no differences in the PSS or the PHQ-2 scores. Group-based intervention and education taught by native Spanish speakers may be an acceptable and feasible approach to addressing anxiety in Latina immigrants.

Healthcare providers (HCPs) play a critical role in the care of women with experience of FGM/C although there is limited research on knowledge about FGM/C among HCPs in Canada and USA. Research evidence suggests that many women with experience of FGM/C have negative care experiences. We sought to investigate the knowledge, attitudes, and practices of Canadian and USA HCPs regarding FGM/C, along with women's healthcare experiences with FGM/C in both countries. We conducted a scoping review guided by Arksey & O'Malley's framework. We exported 4054 peer-reviewed records from Embase, Global Health PubMed, Medline, and Scopus databases. After screening titles, abstracts and full texts using inclusion criteria such as publication between 2000 and 2023, a focus on FGM/C and studies conducted in USA and Canada, we included 13 articles in the final review. Care provider studies revealed that HCPs reported a desire for more knowledge and training to enable them to provide high-quality care for women with FGM/C. Majority of the studies have revealed reliance of HCPs on informal learning channels to gain knowledge on FGM/C. Findings reveal that many women with experiences of FGM/C have reported insensitive comments from HCPs including some nurses' unsympathetic behavior toward FGM/C related postpartum discomfort. In some studies, majority of the women felt their doctors were unable to care for them while other women noted that shame and discomfort deterred them from further care seeking. HCPs play an important role in caring for FGM/C patients. Nonetheless HCPs often receive no training or training that is inadequate (insufficient to make providers feel confident to provide care) on how to provide high-quality, culturally competent care leading to poor experiences for women. This necessitates concerted efforts to provide high-quality training of HCPs for better care for women with FGM/C.