Journal of Immigrant and Minority Health最新文献

Hepatitis C virus (HCV) infection is increasingly reported among Rohingya refugees in Cox's Bazar, with active infection rates in adults reaching 20% by 2023. The risk of liver disease progression and hepatocellular carcinoma (HCC) may be amplified by coexisting factors such as chronic malnutrition, coinfections, aflatoxin exposure, metabolic disorders, and environmental toxins. Despite WHO-led efforts, data on these risk factors remain fragmented, and access to care is limited. This study underscores the need for comprehensive surveillance, epidemiological research, and long-term prevention strategies to reduce HCV-related morbidity and the future burden of HCC in displaced Rohingya populations.

Domestic Abuse [DA] is a pattern of behavior that is used to gain or maintain power and control over a partner or family member. Despite the prevalence of DA in African communities across Canada, little is known about their level of DA knowledge, or the causes and perceptions about DA in these communities. Our study sought to investigate the level of DA knowledge held by African communities in Canada, and identify what they believe to be the causes and solutions to DA. A cross-sectional survey was conducted with members of African communities in Alberta Canada. Participants were recruited using convenience and snowball sampling. A pilot tested survey questionnaire was used for data collection. Using Slovin's formula, the minimum sample size was determined to be 385 participants. Out of 478 participants, 370 (77.4%) had high DA knowledge. The association between sociodemographic variables and knowledge of DA-related behaviors was not statistically significant. Involvement of community and faith leaders was most popular for raising DA awareness, and DA education was most popular for preventing DA. Economic and cultural factors were deemed the main causes of DA, while counselling was most popular for DA intervention. The findings suggest a knowledge-attitude gap in DA awareness, emphasizing the need for education that addresses deeper sociocultural and systemic contributors to abuse. Applying a socio-ecological lens, interventions should target multiple levels of influence to be culturally relevant and effective.

African-born Black women living in the US experience markedly higher rates of HIV diagnosis than their US-born counterparts, with condom use and PrEP remaining underutilized despite their effectiveness. Existing HIV prevention interventions for African-born Black women are limited in scope; some lack cultural tailoring, linguistic appropriateness, and most not do include PrEP. Using the ADAPT-ITT model, we culturally adapted two evidence-based interventions for US Black women-Sister-to-Sister and Sisters Informing Sisters about Topics on AIDS (SISTA)-to increase condom use and PrEP uptake among African-born Black women through community stakeholder input. DADA, which was adapted from SISTA, consists of two 3-hour peer-led, group-level intervention and Dada kwa Dada (DKD), adapted from Sister-to-Sister, is a 1-hour individual-level intervention. To test feasibility and acceptability, 29 African-born women without HIV were recruited from social media groups and community partner listservs in Massachusetts and New York; 17 were randomized to DKD and 12 to DADA. Participants completed risk assessments at baseline and provided post-intervention feedback interviews and surveys. Both adapted interventions demonstrated high feasibility and acceptability, with participants expressing positive qualitative and quantitative feedback regarding their culturally appropriateness, and relevance. This study addresses critical gaps in tailored HIV prevention approaches for African-born Black women and paves the way for future trials to improve condom use and PrEP in this population. Next steps are to conduct a fully-powered comparative effectiveness trial to assess the relative impact of both interventions on increased condom use and uptake of PrEP.

Various systematic reviews underscore the relevance of social support for resilience among refugees. This meta-analysis aims to determine the quantitative assessment of social support and resilience among refugees and the extent of the associations between social support and resilience among refugees. After a systematic literature search, we included twenty-three studies, and performed random-effects meta-regressions. Studies on resilience and social support among refugees very heterogeneously operationalize both constructs. While increases in social support among refugees accompany higher resilience in numerous studies, these associations are not significant. In contrast to previous reviews' conclusions, the current data cannot confirm a relationship between resilience and social support among refugees. Substantiated conclusions about the relationship between resilience and social support among refugees might be reached by a population-specific clear conceptualization and operationalization of the constructs, the content differentiation of the constructs, representative samples, and longitudinal and intervention studies.

Immigrants in the United States may experience varying levels of exposure to perfluoroalkyl substances (PFAS) depending on their duration of residency and their region of origin. PFAS are persistent environmental pollutants linked to adverse health outcomes, yet little is known about exposure levels among immigrant populations. This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) 2003-2018 to assess serum PFAS concentrations among adults by length of U.S. residency and race/ethnicity (used as proxy for origin). Several PFAS compounds were analyzed using ANCOVA and general linear models. U.S.-born adults represented 74.9% (n = 8,272) of the sample. Overall, PFAS levels increased with time in the U.S., converging towards levels observed in U.S.-born individuals-, consistent with the long biological half-lives of certain PFAS compounds. Significant differences in ∑PFAS were found for immigrants residing less than 5 years (geometric mean ratio [GMR]: 0.73, 95% CI: 0.64-0.84, P < 0.0001), with smaller differences in those residing 5-10 years (GMR: 0.84, 95% CI: 0.77-0.91, P < 0.0001) or 10-15 years (GMR: 0.84, 95% CI: 0.77-0.93, P = 0.0004), compared to U.S.-born. The pace of convergence varied by race/ethnicity, reflecting both environmental exposure in the U.S. and likely differences in exposure prior to migration. These results emphasize the need to consider duration of residency and background when evaluating chemical exposure disparities. The study highlights the need for public health interventions to address PFAS exposure among immigrants, especially those newly arrived, considering their potential differential exposure risks.

The increasing immigrant population in the U.S. faces unique challenges in navigating the healthcare system, including language and cultural barriers, and knowledge of services. Immigrant parents may face additional challenges as they attempt to navigate the healthcare system on behalf of their children. This study investigated associations between parents' immigrant status and their perceptions of shared decision-making (SDM) in their child's healthcare. Participants included 27,082 parent respondents from U.S. households in the 2021-22 National Survey of Children's Health. Measures included parents' immigrant status and reports of shared decision-making in their child's healthcare. Potential moderators of the association between immigrant status and SDM included time spent providing or arranging children's healthcare, household economic strain, parenting support, needing extra help to arrange care, and household language. Logistic regression analyses showed that compared to U.S.-born parents, immigrant parents were more likely to report lower levels of SDM. Immigrant parents who reported needing extra help coordinating or arranging healthcare services for their child had significantly higher odds of low SDM compared to their counterparts. To improve child health outcomes, immigrant families may benefit from increased SDM and support in coordinating their children's healthcare services.

South and East Asian immigrants represent a growing population in Canada. Despite the availability of Canadian mental healthcare services, utilization rates among these populations remain lower. Cultural differences, communication barriers, mental health literacy, and systemic challenges significantly hinder accessibility. Addressing these factors is crucial for achieving equitable access to mental healthcare. This study aimed to investigate the factors influencing access to mental healthcare services among South and East Asian immigrants in Canada. This scoping review followed Arksey and O'Malley's five-stage framework. Four databases (MEDLINE, EMBASE, PsycINFO, and CINAHL) were searched for studies published from 2000 onwards. The inclusion criteria were peer-reviewed articles in English that examined access to mental health services in Canada for South and East Asian immigrants aged 18 years or older. Eighteen studies were included in the final review, following the screening of 278 papers. Multiple researchers conducted data extraction to resolve any conflicts through discussion and debate. Three key factors associated with barriers to accessing Canadian mental healthcare services were identified: communication, cultural, and systemic factors. These factors intersect with stigma as a crosscutting theme influencing access to mental health services. This study identified three key factors influenced by stigma, illustrating the barriers faced by South and East Asian immigrants in accessing mental health services. Future research should focus on enhancing facilitators and reducing barriers to improve access to mental healthcare in Canada for these populations.

The increasing global nursing shortage has led to a rise in the migration of African-educated nurses (AENs) to the United States. Despite being essential to the U.S. healthcare workforce, AENs face significant challenges during their transition, including cultural, professional, and emotional adjustments. This study aimed to explore the lived experiences of AENs transitioning into the American healthcare system and to identify the specific support needs required for their successful integration. A phenomenological approach guided by Ricoeur's interpretive phenomenology framework and Afaf Meleis's transitions theory was used. A combination of purposive and convenience sampling was employed to select 19 AENs who were trained in Africa but are currently working in various U.S. health institutions, and they participated in in-depth, unstructured interviews. Data were analyzed thematically to capture the essence of participants' experiences. Five main themes emerged: (1) Navigating an Unfamiliar Ground, including culture shock, language barriers, and differences in patient care standards; (2) Developing a Thriving Mindset, highlighting resilience, determination, and the importance of social support; (3) Institutional Factors Affecting Transitioning, such as the role of mentorship programs and perceived racial biases; (4) Heavy Performance Demands, reflecting the need for constant skill demonstration and managing high workloads; and (5) Leveraging Opportunities for Growth, focusing on career progression, financial benefits, and access to advanced healthcare technologies. AENs experience a complex transition into the U.S. healthcare system characterized by significant challenges and growth opportunities. Targeted support interventions, including cultural competence training, mentorship, and institutional support systems, are essential to facilitate their successful integration and enhance their contributions to patient care.

Healthcare provided by bilingual providers or with assistance from qualified interpreters is intended to improve patient-provider communication. Despite federal laws requiring healthcare facilities to provide access to appropriate interpretation language assistance services for patients not proficient in English, many Spanish-preferring patients receive primary care from providers not fluent in Spanish or who regularly use formal interpreters. Partnering with two urban SafetyNet providers in Southern California, we conducted focus groups in Spanish with Spanish-preferring patients who received care from providers who: (1) were Spanish-qualified, (2) used formal interpreters, and (3) used informal interpreters or other communication strategies. We coded transcripts to identify themes and compared patient experiences across provider types. Our study included 62 adult Spanish-preferring primary care patients. Spanish-preferring patients reported preference for continuity with their English-speaking providers despite language barriers because of established rapport. Patients receiving care from Spanish-language-qualified providers reported greater trust, more comprehensive care (i.e., covered more issues with minimal detail), yet with many interactions rushed. Formal interpreters facilitated better understanding and professional communication, however, impersonalized some patient-provider interactions. Informal interpreters or ad-hoc strategies led to mixed experiences, often dependent on patient or provider ability to accurately convey medical information. Overall, Spanish-preferring patient experiences highlighted the necessity for healthcare systems to support robust language and interpretation services that enhance direct communication, ensure interpreter quality, and maintain long-term patient-provider relationships. Improvements in policy and practice are needed to optimize healthcare communication for Spanish-preferring patients, since patient-provider communication is critical for high-quality health outcomes and experiences in multilingual settings.