Journal of Immigrant and Minority Health最新文献

In 2021, following the Taliban's control of Afghanistan, Aotearoa New Zealand (NZ) welcomed over 1,700 Afghan nationals at risk due to their association with NZ agencies. The New Settlers Family and Community Trust (NFACT) was contracted to provide tailored resettlement support. This study evaluated NFACT's Afghan evacuee resettlement programme using a mixed-methods approach, including a cross-sectional survey, interviews, and focus groups with Afghan evacuees and NFACT staff. Of the 101 surveyed evacuees, most (93.1%) expressed satisfaction with the support they received, and almost all (97.0%) would recommend NFACT's programme to newcomers. Analysis across integration domains revealed consistently high ratings for services and support. Qualitative findings from Afghan evacuees (n = 12) highlighted the challenges of adjusting to new systems, the crucial guidance provided by NFACT, and the need for ongoing, tailored support to foster their dreams and sense of purpose. NFACT staff (n = 11) emphasised their dedication to support evacuees beyond contractual obligations, how limited resourcing constrained their efforts, and how their shared values and experiences underpinned the success of the programme. The findings underscore the need for comprehensive, culturally sensitive, and sustainable resettlement programmes. These findings have implications for governments to strengthen support for humanitarian evacuation responses within the evolving geopolitical landscape.

This study evaluated the effectiveness of a culturally- and linguistically-adapted, patient navigator-led telehealth model in expanding mental health access and reducing depression and anxiety symptoms among Afghan refugees resettled across several U.S. states. We conducted a retrospective chart review of electronic medical records from 679 Afghan patients, assessing changes in PHQ-9 and GAD-7 scores using paired samples t-tests. Additionally, we explored which patients benefited most, analyzing variations in outcomes based on treatment plans, age, and gender. We observed statistically significant reductions in depression and anxiety symptoms between baseline and follow-up for all treatment groups (p < .001), with large effect sizes ranging from d = 0.80 to 1.06. For example, high-need patients showed a mean PHQ-9 reduction of 4.44 points (d = 1.05) and a GAD-7 reduction of 3.70 points (d = 0.94). The model was equally effective across genders and age groups. This patient navigator-led model demonstrates a promising strategy for improving mental health outcomes among Afghan newcomers. Its success highlights the potential for scalable mental health care solutions to address both clinical symptoms and structural barriers to care.

Immigrants constitute a substantial portion of the United States population and represent a significant minoritized group whose health is impacted by the country's migration policies as social determinants of health. This qualitative study used a phenomenological approach to document and explore the lived experiences of highly educated Iranian immigrants and International Students within the context of U.S. migration policies while considering the Social Determinants of Health framework. In-depth semi-structured interviews were conducted with 23 participants. Reflexive thematic analysis of the data revealed four major themes (1) entry and reentry visa restrictions for Iranians; (2) the emotional and social impact of the U.S. Travel Ban; (3) family separation and emotional distress; and (4) mental health impacts of immigration uncertainty. Findings highlight significant challenges faced by this population, including extended family separations, career uncertainties, and psychological distress. Participants reported heightened anxiety, insomnia, and feelings of isolation, aligning with research on migration-related mental health disparities. This research contributes to the limited literature on the experiences of Iranian immigrants in the U.S. and has implications for minoritized population health and policy reforms aimed at mitigating the adverse effects of immigration-related stress.

Refugee women face unique challenges in accessing preventive healthcare services upon resettlement, particularly for cervical cancer screening and HPV vaccination. Despite national efforts to reduce cervical cancer incidence, uptake remains disproportionately low among newly arrived refugee populations. Emerging research suggests that trust in healthcare systems and providers plays a pivotal role in shaping engagement with these services, yet little is known about how trust is built or broken in the early resettlement period. This study explores how trust and medical mistrust shape cervical cancer prevention behaviors among newly arrived refugee women in the United States, with attention to the multilevel relational and contextual factors that influence screening and vaccination. We conducted in-depth, semi-structured interviews with 17 refugee women resettled within the past two years in a Mid-western City, recruited through a community-based organization. Interviews were conducted in participants' preferred languages and lasted approximately 60 min. Data were thematically analyzed using Braun and Clarke's six-step framework, supported by Dedoose software. A codebook was developed through double coding and refined via consensus meetings. Themes were reviewed collaboratively and verified through member checking to enhance analytical rigor. Participants (n = 17) ranged in age from 21 to 56 and represented five countries, with the majority from Rwanda and Congo. Most had less than a high school education, and nearly all reported limited or no prior knowledge of cervical cancer, Pap smears, or HPV vaccination. Some confused HPV with other illnesses, while others attributed cervical cancer to unrelated factors such as stress or diet. Four themes emerged: trust as a precondition for engagement; provider trust shaped by cultural concordance, communication, and respect; systemic mistrust shaped by health literacy, practical/access issues and social influences; and the importance of community-based relationships in rebuilding trust and supporting preventive care engagement. Refugee women's engagement with cervical cancer prevention is shaped not only by knowledge but also by cultural safety, provider concordance, and systemic trust. Interventions must prioritize community-rooted education, gender-concordant care, and culturally responsive communication to improve prevention outcomes.

In the United States (U.S.), the number of asylum seekers has increased sixfold in the past decade. Limited research has explored the impact of social determinants of health on asylum seekers. To document evidence of torture and trauma, clinicians in medical-legal asylum clinics conduct Forensic Medical Evaluations (FMEs) according to the standardized United Nations Istanbul Protocol. These evaluations represent an uncommon encounter with the U.S. health system during the multi-year asylum process, during which applicants may not otherwise engage with health systems. This study aimed to determine post-migration factors that influence risk for negative health outcomes in U.S. asylum applicants and to categorize risk factors within the U.S. Department of Health and Human Services' social determinants of health framework. We performed a qualitative, retrospective study of a representative, purposive sample of forensic medical evaluations from 2010 to 2020 from the Weill Cornell Center for Human Rights' database. We identified major themes pertaining to post-migration risk and protective factors organized across social determinant domains. The 58 FMEs represented 29 asylum seekers in the U.S. The mean age was 30 years. Of the participants, 55% were female and 45% were male. The sample represented a global population, with origins from the Americas (41%), Africa (45%), and Asia (14%). Our analysis additionally identified the prolonged asylum process as a novel, unique structural barrier and identified protective factors, including community support. Given numerous barriers to accessing care experienced during the asylum process, this study identified a unique opportunity to utilize forensic medical evaluations to screen for social determinants of health.

Digital health services can facilitate patients' access to healthcare. However, access to reliable internet and utilization of digital healthcare are patterned by race, ethnicity, and class in the United States. We assessed willingness, use, and challenges accessing digital healthcare platforms among farmworkers arriving in North Carolina on temporary H-2A work visas (n = 327). We fielded a survey on digital healthcare access in English and Spanish at a central arrival hub for H-2A visa holders in 2024. We calculated descriptive statistics and assessed associations between willingness to use and uptake of digital healthcare and demographic variables. Most participants were interested in utilizing telehealth and patient portals, but few had ever used these services. Among participants who had used telehealth, 50% reported needing assistance. Older participants were less likely to utilize patient portals than younger participants. Future interventions should consider the unique context of migrant farmworkers in building digital health service models and provide digital skills training.

Arab Americans are at risk for disproportionately high use of commercial tobacco products, including among women, for whom waterpipe (shisha) smoking is increasingly normative. Culturally- and gender-responsive interventions, however, are scarce. We developed and tested Commit to Quit (CtQ), a novel community-driven tobacco intervention designed for Arab American women in Northern California. The program mobilized Arab American community women to support tobacco cessation and prevention within their community. Immigrant Arab American women participated in biweekly virtual sessions conducted in Arabicto learn about tobacco risks, cultural smoking norms, and prevention and cessation strategies and then support friends and relatives to quit through a peer-to-peer brief intervention. Pre- and post-program assessments measured changes in tobacco use behaviors, self-efficacy, and community engagement. Compared to a comparison group (n = 190), CtQ participants (n = 28) were significantly more likely to engage in cessation efforts, utilize various quitting methods, and promote smoke-free environments. Participants demonstrated increased self-efficacy incommunity activism and leadership. By centering Arab American women in tobacco interventions through culturally and linguistically accessible programming that addressed social smoking norms, CtQ facilitated increased community awareness and mobilized women to act as change agents to improve their own and their community's health. Community-driven interventions that are gender-responsive may reduce tobacco-related health disparities in underserved populations.

Afghan refugees in the United States experience high rates of individual trauma, resulting in poor mental health outcomes. Decades of war and displacement have also produced extensive collective trauma, a construct that is rarely investigated in forced migration literature. This study aimed to increase understanding of the concept of collective trauma among Afghan refugees and examine its association with mental health outcomes. A transformative explanatory mixed-method design was used, incorporating community-based participatory research methods. Quantitative analysis included regression models to test the role of collective trauma as both an independent variable and a moderating variable between individual trauma and mental health outcomes. Qualitative data were collected to contextualize and deepen understanding of the quantitative findings. Regression analyses demonstrated that collective trauma was a significant predictor of mental health outcomes and significantly moderated the relationship between individual trauma and mental health. Specifically, the effect of individual trauma on mental health worsened at higher levels of collective trauma. Qualitative findings supported these results, with participants describing collective trauma experiences such as the loss of culture, land, and language, as well as concerns over the integration of their children. These findings highlight the significant impact of collective trauma on Afghan refugees' mental health and underscore the need to consider collective trauma as an important factor in mental health research and interventions for forced migrant populations. Future research should further explore this construct to enhance understanding of collective trauma across diverse forced migrant groups.