Journal of Immigrant and Minority Health最新文献

Among Hispanic/Latino immigrants, substance abuse, intimate partner violence, HIV, and mental health form a syndemic that exacerbates health inequities. Promotoras (community health workers) play a critical role in reaching these vulnerable populations by providing culturally relevant healthcare connections. This study examines the feasibility, acceptability, and effects of an intervention by promotoras addressing acculturative stress and resilience among Hispanic/Latino immigrants to the US. The intervention consisted of four virtual sessions- two one-on-one and two group sessions- delivered by Latino/a community health workers, known as promotoras, using motivational interviewing and group coaching strategies to enhance resilience and reduce health risk behaviors. Feasibility and acceptability were assessed through study logs and post-intervention participant feedback, while a pre-post assessment measured intervention effects. A single-group, longitudinal pilot intervention design was employed. Participants included 30 young adult (18-44 years) immigrants from Latin America or the Caribbean residing in the US for ≥ 1 year. Measured variables included acculturative stress, depressive symptoms, emotional and instrumental support, pandemic stress, COVID-19 knowledge, and COVID-19 risk behaviors. Multiple analytic methods (paired sample t-test, Wilcoxon signed-rank test, McNemar's test) were applied to assess the feasibility, acceptability, and effects of the intervention. Findings indicate high intervention satisfaction, with participants recommending increased social engagement for enhanced impact. Acculturative stress (p = .041), depressive symptoms (p = .005), and risk behaviors (p = .021) showed significant reductions, while COVID-19 knowledge and pandemic stress remained unchanged. This study supports the feasibility and scalability of the intervention in addressing syndemic behavioral and mental health conditions, with broader implications for reducing health inequities among Hispanic/Latino immigrants. Clinical Trial Registration: NCT03527654.

Early identification of hearing loss through screening, such as pure-tone audiometry, is a crucial aspect of preventive pediatric care that helps minimize negative developmental outcomes. However, non-native English-speaking (NNES) children, often immigrants or children of immigrant families, encounter systemic barriers in healthcare that limit their access to recommended screenings. This study is the first to investigate the differences in audiometric screening adherence and outcomes between NNES and native English-speaking (NES) children. Using a retrospective cohort analysis, demographic and audiometric screening data were collected from 176 patients (88 NNES and 88 NES) during well-child checks (WCC) at ages four, five, six, and eight at an academic outpatient pediatric clinic in the United States. Statistical analyses compared adherence to recommended hearing screenings between the two groups. Both NNES and NES groups had a mean age of 10.8 years (p = 0.83), shared similar insurance coverage, and had a balanced sex distribution. The non-English languages represented included Nepali (40%), Mai-Mai (11%), and Swahili (8%). Our findings showed that NNES children had lower audiometric screening rates at the four-year WCC (p = 0.04) and the six-year WCC (p = 0.04). No disparities were found in screening failure rates or referral rates to audiologists or pediatric otolaryngologists. Implementing targeted cultural competency interventions could help reduce implicit provider bias and improve hearing screening practices. The variability in adherence to hearing screening during attended WCC visits and test frequencies used underscores the necessity for more standardized and universally adopted guidelines for pediatric hearing screens at pediatric clinics.

To describe asylum-seeking women's perspectives on and lived experiences of obstetric violence, including how it is shaped by structural contexts related to stigma, discrimination, and migration policies and systems. We conducted a qualitative study involving thematic analysis of in-depth interviews conducted July 2022-April 2023 with pregnant and postpartum asylum-seeking women at the Mexico-U.S. border (N = 38). Asylum-seeking pregnant and postpartum women faced obstetric violence across the migration process and within both health and immigration systems. This was experienced in hospitals, immigration detention, and other clinical and non-clinical settings and included denial of timely and responsive care; discriminatory, disrespectful and dehumanizing treatment; physical and verbal abuse; and lack of informed consent for procedures. Women described obstetric violence as frequent, with some attributing this to intersectional stigma and discrimination. Obstetric violence represents a severe violation of the human and reproductive rights of pregnant and postpartum asylum-seekers which requires urgent policy action and intersectoral interventions. Culturally-appropriate, trauma-informed reproductive healthcare, provider sensitivity trainings, changes to immigration policies, and anti-discrimination interventions within and beyond the health system are recommended.

This Brief Report discusses implementation strategies used to increase equity and access to research study participation among forcibly displaced migrants. Common barriers to research participation for this population (e.g. language access, informed consent) limit the perspective of migrants within immigrant and refugee health scholarship, reducing the applicability of findings to diverse populations. We aimed to characterize barriers and our responses to migrants' participation in research. Study participants included forcibly displaced migrant patients at the largest safety net hospital in New England. Two researchers analyzed field notes, reflexivity notes, and standard operating procedure adaptations. Four themes emerged including challenges of conducting qualitative interviews with interpreters, technology literacy, reimbursement woes, and role of the researcher. The goal of the study was to uplift the experience of migrant research participants, describe challenges in the research process, and present recommendations to migrant participation in research. We provide lessons learned for immigrant and refugee health scholars.

This study examined Asian and Latino immigrants' recent exclusionary experiences with immigration policy, such as knowing someone deported, being racially profiled, or being denied health insurance, and their relationship with health care access and health status. The 2018-2020 Research on Immigrant Health and State Policy survey asked adult Asian and Latino immigrants (N = 2,010, Asian n = 1,004, Latino n = 1,006) if they had experienced any of sixteen immigration policy exclusions ever and in the last 12 months. Regression models tested relationships between the number of exclusionary experiences and mental and physical health outcomes for all respondents and only respondents with any lifetime exclusionary experience. Each additional recent exclusionary experience was associated with 40% higher odds of delaying care, 21% lower odds of better self-rated health, and 24% higher odds of mental illness. Results held when limiting the sample to only respondents with any lifetime exclusionary experience. Recent exclusionary experiences with immigration policy likely have immediate consequences for health care access and health status. Findings underscore the need for early intervention to reduce the impact of immigration policy exclusions.

Latino youth experience significant healthcare disparities, particularly in juvenile detention facilities, where access to appropriate medical care is often limited. These disparities can contribute to a range of negative health outcomes, largely influenced by systemic factors such as socioeconomic status, cultural barriers, and inadequate health services tailored to their specific needs. Using logistic regression analyses, we examine individual and situational factors influencing healthcare access and outcomes among 377 detained youth. Specifically, we assess the likelihood of visiting a doctor in the past six months, being diagnosed with a chronic medical illness, and receiving treatment for such illnesses, with a focus on racial/ethnic and gender disparities. Results revealed that visiting a doctor significantly increased the likelihood of diagnosis and treatment for chronic illnesses. Girls were more likely to seek medical care than boys, while Latino youth were less likely than their non-Latino counterparts to access healthcare services. Mental health status and pre-incarceration living conditions also emerged as meaningful factors for chronic illness diagnosis and treatment. These findings highlight the urgent need for better healthcare interventions to address the barriers faced by Latino youth and the challenges of mental health issues and unstable living conditions in detention settings.

The rapid expansion of digital health during COVID-19 transformed healthcare delivery, offering new opportunities for remote care. However, health access remains inequitable, with barriers such as technology access, language barriers, and financial constraints disproportionately affecting immigrants and marginalized populations. This study applied an intersectional approach to examine digital health utilization trends by immigration status and key sociodemographic factors. This study analyzed nationally representative data from the 2021-2023 National Health Interview Survey (NHIS) for adults (N = 83,116). Immigration status was cross-classified with race/ethnicity, gender, marital status, education, income, health insurance, chronic conditions, and rural residency. Weighted logistic regression models examined disparities and moderation effects. While digital health utilization generally declined post-pandemic with increased access to in-person care, disparities across populations persisted. While naturalized immigrants had similar odds of digital health use compared to U.S.-born individuals, noncitizen immigrants had significantly lower odds. The findings also reveal noncitizen immigrants, particularly those with lower income, no insurance, and living in rural areas, face significant barriers in accessing digital health services. These disparities highlight the need for targeted policies to ensure equitable access to digital health resources for immigrant populations.

Health literacy is essential for navigating healthcare systems and making informed decisions. Migrant and minority ethnic populations often face barriers that impact their health literacy and access to care. This study explored the health literacy profiles and lived experiences of African and Latin American communities in England. A mixed-methods study was conducted using Phase 1 of the Ophelia (Optimising Health Literacy and Access) process. Sixty-five participants completed the Health Literacy Questionnaire (HLQ), and hierarchical cluster analysis identified distinct health literacy profiles. Two focus groups (n = 7 each) were held to explore participants' experiences in greater depth. Qualitative data were analysed using thematic analysis. While participants demonstrated strengths in accessing and understanding health information, significant disparities emerged in areas requiring institutional engagement, trust in healthcare providers, and emotional support. Key barriers included digital exclusion, limited interpreter availability, fear of immigration consequences, and experiences of being dismissed or misunderstood in clinical settings. These challenges disproportionately affected asylum seekers and those with insecure immigration status, reflecting structural vulnerability and institutional racism. The study highlights the limitations of individual-level interventions and calls for system-wide changes to address the relational and structural barriers that undermine health equity. Improving health literacy among migrant populations requires more than accessible information. Equity-focused, co-designed interventions that confront institutional racism, invest in culturally safe communication, and prioritise emotional safety are essential to reducing racial and ethnic health disparities.