Information is limited on alcohol use among Arab Americans. The purpose of this study was to describe and analyze the alcohol use pattern among Arab Americans by reviewing existing surveys using an acculturation model. Secondary data analysis. Nationally, English-speaking immigrant Arab Americans reported lower rates of lifetime alcohol use (50.8%), past month use (26.4%) and binge drinking (10%) than the White majority group. In a state survey, self-identified English-speaking Arab Americans were less likely to report past month use (45.6%) than the White majority group but reported similar rate of binge drinking (17.0%). Locally, lifetime drinking was reported by 46.2% of the immigrants but only 13.4% of refugees fleeing war. Few databases are available to estimate alcohol use pattern among Arab Americans; the limited data suggest a drinking pattern consistent with acculturation. However, the potential influence of other factors is unknown and needs to be investigated.
Arab Americans; Alcohol; Refugees; Acculturation
English as a Second Language programs serve large foreign-born
populations in the US with elevated risks of tuberculosis (TB), yet little is
known about TB perceptions in these settings. Using a community-based
participatory research approach, we elicited perceptions about TB among
immigrant and refugee learners and staff at a diverse adult education center.
Community partners were trained in focus groups moderation. Ten focus groups
were conducted with 83 learners and staff. Multi-level, team-based qualitative
analysis was conducted to develop themes that informed a model of TB perceptions
among participants. Multiple challenges with TB control and prevention were
identified. There were a variety of mis-perceptions about transmission of TB,
and a lack of knowledge about latent TB. Feelings and perceptions related to TB
included secrecy, shame, fear, and isolation. Barriers to TB testing include low
awareness, lack of knowledge about latent TB, and the practical considerations
of transportation, cost, and work schedule conflicts. Barriers to medication use
include suspicion of generic medications and perceived side effects. We posit
adult education centers with large immigrant and refugee populations as
excellent venues for TB prevention, and propose several recommendations for
conducting these programs. Content should dispel the most compelling
misperceptions about TB transmission while clarifying the difference between
active and latent disease. Learners should be educated about TB in the US and
that it is curable. Finally, TB programs that include learners and staff in
their design and implementation provide greater opportunity for overcoming
previously unrecognized barriers.
Tuberculosis; Community-based participatory research; Focus groups; Adult education; Immigrants; Refugees
Smoking may be a coping mechanism for psychosocial stress caused by discrimination.
We conducted a cross-sectional survey of rural-to-urban migrant women working as restaurant/hotel workers (RHWs) and those working as sex workers (FSWs) in 10 Chinese cities to investigate whether perceived discrimination is associated with smoking. We interviewed RHWs at medical examination clinics and FSWs at entertainment venues. Modified Poisson regression was used to estimate prevalence ratios.
Of the 1696 RHWs and 532 FSWs enrolled, 155 (9.1%) and 63 (11.8%) reported perceived discrimination, respectively. Perceived discrimination was independently associated with ever tried smoking (prevalence ratio [PR], 1.71; 95% confidence interval [CI], 1.31–2.23) and current smoking (PR, 2.52; 95% CI, 1.32–4.79) among RHWs and ever tried smoking (PR, 1.36; 95% CI, 1.16–1.61) and current smoking (PR, 1.63; 95% CI, 1.28–2.06) among FSWs.
Perceived discrimination is associated with higher prevalence of smoking among rural-to-urban migrant women in China.
health disparities; migrant health; smoking; tobacco control; women’s health
This qualitative study examines help-seeking pathways to depression care of low-income Latinos with diabetes and major depression. A purposive sample (N = 19) of Spanish-speaking, immigrant, low-income Latinos was selected from a randomized clinical trial targeting Latinos with diabetes and major depression. Four focus groups followed by 10 in-depth qualitative interviews were conducted. Narratives were analyzed using the constant comparative method informed by grounded theory. Need for formal care was described in relation to acute somatic symptoms, functional impairment, and mood changes. Treatment initiation occurred through family members and primary care physicians who encouraged or inhibited help-seeking. Adherence to depression care focused on interpersonal aspects of care, evaluated symptom relief, and improved functioning. Help-seeking barriers included self-reliance, language barriers, stigma, competing health demands, and structural barriers. Findings from this study highlight potential points of intervention for developing culturally-appropriate collaborative care approaches for low-income Latinos with diabetes and major depression.
Diabetes; Latinos; Depression; Help-seeking
Although numerous studies have looked at cancer incidence and survival in Asian Indian-American (AIA) patients, there is a paucity of data regarding clinicopathologic presentation of cancer in this ethnically diverse population. After receiving IRB approval, AIA patients of Indian and Pakistani descent who presented with Stage 0, I, & II breast cancer to our facility were identified. Charts were extracted for clinical and pathologic variables in addition to outcomes data. Standard statistical analyses were performed using SAS (v 9.1). The population (n = 50) consisted of 86% Indian (n = 43) and 14% Pakistani (n = 7). The median age at diagnosis was 52 (range 25–79). Sixty-three percent of tumors were detected after discovery of a palpable mass while 36% had a mammographically detected mass. Stage 0, I & II distribution was 14, 42 and 44%, respectively. The median tumor size was 1.5 cm (range 0.2–4.5 cm). ER, PR, and HER2 were positive in 69, 67, and 24% of AIA patients, respectively; 21% were triple-negative. Treatment data shows that 60% underwent lumpectomy (n = 29), 39% underwent mastectomy (n = 19), 74% received hormonal therapy (n = 26) and 55% received chemotherapy (n = 30). To our knowledge, this is the first detailed report of the clinicopathologic presentation of Asian-Indian American women with breast cancer at a single institution. Of note, AIA women were more likely to present with palpable masses and at a younger age. This differs from Caucasian women and may indicate a social or cultural barrier to routine screening mammograms and possibly a biologically more aggressive tumor.
Asian-Indian American; Ethnic disparity; Early stage breast cancer; Radiation therapy (RT); Breast conserving therapy (BCT)
Disparities in incarceration rates and in prison-based TB/HIV testing may contribute to health disparities in the communities most affected by incarceration. We analyzed Bureau of Justice Statistics surveys of federal and state prison inmates to assess TB and HIV screening rates for US-born Hispanics, foreign-born Hispanics, non-Hispanic blacks, and non-Hispanic whites. Screening rates were high overall but foreign-born Hispanic inmates had significantly lower odds of being tested for TB in both state (AOR 0.55) and federal prisons (AOR 0.31) compared to white inmates. Foreign-born Hispanics also had lower odds of being tested for HIV in state prisons and Hispanics had lower odds of being tested for HIV in federal prisons compared to white inmates. Screening for infectious diseases in state and federal prisons is high but Hispanics have higher odds of going untested; this has important consequences for prevention of further transmission in the communities to which they return.
Incarceration; Prisons; Hispanics; Disparities; HIV; TB
Qualitative data was collected from Mexican-American (MA) and Puerto Rican (PR) breast cancer survivors to gain their perspectives on the relevant issues surrounding breast cancer survivorship and exercise. Six focus groups, a total of 31 participants were convened (three in Puerto Rico and three in Texas). Responses were analyzed and compared between the Mexican-American and Puerto Rican groups. Follow-up sessions were conducted at the sites to review the initial results and to validate a culturally adapted exercise intervention trial. A total of 900 responses were catalogued into 27 codes. Both groups had similar descriptions of exercise and barriers to exercise. Both groups expressed lack of information regarding their exercise capabilities. The groups differed in their responses to perceived safety in their community and how to deliver a culturally adapted exercise intervention in their community. We found important cultural differences and similarities in relevant factors of exercise and breast cancer survivorship.
Hispanic; breast cancer; cultural adaptation; exercise; survivorship
The family and home environment are important in shaping the dietary patterns of children, yet research among low-income, minority groups is limited. We examined ethnic differences in the home food environment and parental practices among 706 low-income, African-American and Hispanic families of preschoolers. Questionnaires measured the access and availability of various foods in the home, parental practices, and meal consumption behaviors. Mixed model logistic regression and ANCOVA were used to assess ethnic differences. Unhealthy foods were available for both groups. Hispanic families were more likely to have fresh vegetables (AOR = 2.9, P = 0.001), fruit (AOR = 2.0, P = 0.004), and soda available (AOR = 1.40, P = 0.001) compared to African-Americans. African-Americans families were more likely to restrict (AOR = 0.63, P = 0.001) and reward with dessert (AOR = 0.69, P = 0.001). Hispanic families consumed more family meals together (P = 0.003) and less meals in front of the television (P = 0.006). Health promotion interventions should consider the behavioral differences between ethnicities.
Early childhood; family health; nutrition; obesity; minority populations
Little research exists on the need for, barriers to, and acceptability and effectiveness of psychosocial support services among Latinas with breast cancer, despite their increased risks of psychosocial distress. This formative research study identifies barriers to and benefits and components of an effective peer support counselor intervention for Spanish-speaking Latinas recently diagnosed with breast cancer. Analysis was based on interviews of 89 Latino cancer patients referred to psychosocial services; 29 Spanish-speaking survivors of breast cancer; and 17 culturally competent advocates for Latinos with cancer. Results indicate that interventions should begin close to diagnosis; build self-care skills; be culturally competent and emotionally supportive; provide language appropriate cancer information; encourage self-expression; and address lack of access to and knowledge of services. Creating such psychosocial programs with input from survivors and advocates who have similar self-identities to patients would improve quality of life in diverse and underserved populations.
Breast cancer; Latinos; peer counselors; psychosocial support; mixed methods
This study aims to describe the utilization of curative and preventive care among Mexican immigrant women in the country of origin versus the US, and to identify factors associated with preventive and curative care utilization. A cross-sectional sample of 185 Mexican immigrant women living in Birmingham, AL between 2004 and 2005 were included in this study. Fisher’s Exact tests showed that there was a statistically significant difference between seeking curative care (p < 0.0001) and preventive care (p < 0.0001) in country of origin versus the US. Differences in the reasons for lack of utilization of both curative and preventive care were also observed in the US and the country of origin. These findings suggest that difference in healthcare-seeking behaviors and utilization among Mexican immigrant women between the US and their country of origin may be useful in the development of interventions aimed at increasing the use of preventive and curative care services to this immigrant population in the US.
Mexican Immigrants; Latina; Health care utilization; Health care seeking behaviors
This study used focus group methodology to examine perceptions of obesity and weight management among Latina immigrant women in Alabama.
Four focus groups (N=25) were conducted in Spanish as part of a participatory intervention development process. Participants were obese/overweight Latina immigrant women (BMI >25) primarily recruited from a community hospital.
The majority of participants were from Mexico. Participants described obesity in the context of short-term effects such as physical symptoms and aesthetics. Perceived weight gain was related to lifestyle changes since moving to the U.S. Social isolation, depression, and stress were reported to contribute to weight gain. Participants expressed interest in weight loss but emphasized a desire for programs that preserve traditional foods and include family.
Weight-management programs designed for Latina immigrants should address their perceptions of obesity. This data also suggests that those interventions that preserve culture and incorporate family may have increased community buy-in.
obesity; focus groups; weight loss; women; Latino; Hispanic; knowledge; beliefs
Recent studies revealed a negative association between acculturation and sun-safe behaviors, possibly mediated by education level, health status, and social networks. We sought to elucidate this relationship by exploring the moderating effects of gender and health insurance on each mediated path. We used data from 496 Latino respondents to the 2005 Health Information National Trends Survey. Acculturation, assessed by a four-item index, was the primary predictor; use of sunscreen and protective clothing were the primary outcomes, assessed by frequency scales. Moderated mediation was tested with an established causal moderation method. The mediated association between acculturation, education level and sunscreen use might be stronger among women than men (P < 0.08). We found no evidence of moderated mediation for use of protective clothing. The findings suggest ways of refining the theoretical and empirical rationale for sun safety research and interventions with Latinos. Studies should replicate these models with longitudinal data.
Acculturation; Sun-safe behaviors; Latinos; Moderated mediation; Sociodemographic factors
Prevalence of hepatitis B among Asian Americans is higher than for any other ethnic group in the United States. Since more than 50% of liver cancer is hepatitis B related, the burden of morbidity and mortality is extremely high among Asian Americans, highlighting the need for culturally appropriate interventions. We conducted focus groups (n = 8) with a total of 58 Korean, Vietnamese, and Chinese immigrants in Maryland to explore knowledge, awareness and perceived barriers toward hepatitis B screening and vaccinations. Thematic analysis uncovered generally low levels of knowledge and awareness of hepatitis B risks, screening, and vaccination; inter-generational differences; and barriers to prevention. Some differences arose across ethnic groups, particularly toward perceived orientation to preventive activities and the role of religious groups. High rates of hepatitis B infection among Asian Americans highlight the need for tailored interventions. These findings may assist policy strategists in implementing interventions that will facilitate the integration and scale-up of hepatitis B education, screening, and vaccination campaigns.
Hepatitis B risk; HBV screening and vaccinations; Asian Americans; Qualitative; Immigrant health
This analysis assessed the prevalence of excess body weight, physical inactivity and alcohol and tobacco use in Asian American subgroups. Using 2005 California Health Interview Survey data, we estimated the prevalence of body mass index (BMI) categories using both standard and World Health Organization-proposed Asian-specific categories, physical inactivity, and alcohol and tobacco use for Chinese (n=1285), Japanese (n=421), Korean (n=620), Filipino (n=659) and Vietnamese (n=480) Americans in California. About 80% of Japanese and Filipino American men and 70% of Korean American men were “increased/high risk” by Asian-specific BMI categories. Most Asian American subgroups were more likely to walk for transportation than non-Hispanic whites, but less likely to report other physical activities. Highest smoking and binge drinking prevalences were among Korean, Vietnamese and Filipino American men and Japanese and Korean American women. These results suggest risk profiles for each Asian American subgroup to consider when setting priorities for health promotion programs.
Asian American subgroups; California Health Interview Survey; Body Mass Index; Health risk behaviors
We distinguish between selection and true migration effects on weight and body fat for Vietnamese immigrants; and examine the role of acculturation on these outcomes.
Data (n=703) were collected among three population-based samples of working-age Vietnamese immigrants, repatriated emigrants and never-migrated Vietnamese nationals. This allows for a decomposition exercise to separate the effects of migration effects from selection effects on body mass index (BMI) and waist-hip ratio (WHR).
Immigrants are more likely to be overweight and to have high WHR, relative to both never-leavers and returnees, a pattern reflecting the importance of migration over selection. Among immigrants, coming to the US at a younger age is associated with higher BMI and WHR levels. And longer length of residence in the US is related to higher BMI. While higher Vietnamese language proficiency is related to a lower BMI level, being bilingual (proficient in both English and Vietnamese) is associated with lower risks for being overweight.
The distinct pattern of results suggests that more problematic weight status and fat distribution among Vietnamese immigrants relative to Vietnamese nationals are not artifacts of the types of persons choosing to emigrate, but rather are due to acculturation to American diet and lifestyles. While efforts to promote and maintain traditional patterns of diet and lifestyle are likely to help Vietnamese and other immigrants avoid the perils of American patterns, facilitating a bi-cultural orientation is perhaps the most realistic approach for preserving protective features of the culture of origin with regard to body weight and fat distribution.
immigrant health; obesity; selection effect; migration; acculturation; Vietnamese Americans
To examine the use of complementary and alternative medicine (CAM) for weight loss among Mexican-American women.
Cross-sectional survey of different CAM modalities, including traditional Mexican medicine therapies.
The sample was drawn from women participating in a weight-loss program in Portland, Oregon.
Sample consisted of 31 adult Mexican-American women.
Most respondents reported using some form of CAM for weight loss, with most reporting using herbs and teas (70%), home remedies (61%) and massage (55%).
Mexican-American women report using a wide range of CAM therapies for weight loss. Understanding their patterns of use will enhance cultural competence of health care professionals and help address their medical needs.
Obesity; Hispanics; Traditional Medicine; Women; Complementary Alternative Medicine
The “Latina epidemiologic paradox” refers to the observation that despite socioeconomic disadvantages, Latina mothers in the United States (US) have a similar or lower risk for delivering an infant with low birth weight (LBW) compared to non-Latina White mothers. An analogous paradox may exist between foreign-born (FB) and US-born (USB) Latinas. Our goal was to assess differences in LBW in USB Latinas, FB Latinas, and non-Latina Whites in Los Angeles County in 2003 using birth records and survey data. Using logistic regression, we estimated associations between LBW and birthplace/ethnicity in a birth cohort and nested survey responder group and between LBW and acculturation in responders to a follow-up survey. USB Latinas and FB Latinas had a higher prevalence of LBW infants compared to Whites (odds ratio [OR] = 1.34, 95% confidence interval [CI] = (1.17, 1.53) and OR = 1.32, 95% CI = (1.18, 1.49), respectively); when we adjusted for additional maternal risk factors these point estimates were attenuated, and interval estimates were consistent with a modest positive or inverse association. Among Latinas only, LBW was more common for high-acculturated FB and USB Latinas compared to low-acculturated FB Latinas, and there was limited evidence that environmental or behavior risk factors had less impact in low-acculturated Latinas. In summary, adjusting only for demographics, Latinas in our study were more likely to have LBW infants compared to Whites, in contrast to the Latina paradox hypothesis. Furthermore, adjusting for environmental or behavioral factors attenuated the positive association, but there was little evidence that Latinas had a lower prevalence of LBW regardless of the variables included in the models. Finally, among Latinas, there was limited evidence that associations between known risk factors and LBW were modified by acculturation.
Low birth weight; Latina; Hispanic; US-born; foreign-born; Acculturation; Two-phase analysis
Theories of acculturation predict that discrepancies in cultural orientation between adolescents and their parents will increase the adolescents’ risk for behavior problems such as substance use. This study evaluated this hypothesis in a sample of 1772 Hispanic 9th grade students in Southern California. Parent–child discrepancy in U.S. orientation (defined as the difference between the child’s U.S. orientation and the child’s perception of the parents’ U.S. orientation) was a risk factor for past-month smoking, lifetime and past-month alcohol use, and lifetime and past-month marijuana use. Parent–child discrepancy in Hispanic orientation (defined as the difference between the child’s Hispanic orientation and the child’s perception of the parents’ Hispanic orientation) was a risk factor for lifetime and past-month alcohol and marijuana use. The adolescents’ own Hispanic orientation was protective against lifetime and past-month smoking and marijuana use, but not alcohol use. In an analysis of mediation, U.S. acculturation discrepancy was associated with lower levels of family cohesion, which in turn was associated with higher levels of substance use. Results suggest that family-based interventions for acculturating and bicultural Hispanic families may be useful in decreasing the likelihood of substance use among Hispanic adolescents.
Acculturation; Hispanic; Adolescence; Tobacco; Alcohol; Drugs
Racial/ethnic minorities are disproportionately affected by barriers to health care access and utilization. The primary objective was to test for an independent association between household food insecurity and health care access/utilization. In this cross-sectional survey, 211 Latinos (predominantly, Puerto-Ricans) with type 2 diabetes (T2D) were interviewed at their homes. Factor analyses identified four barriers for health care access/utilization: enabling factor, doctor access, medication access and forgetfulness. Multivariate logistic regression models examined the association between each of the barrier factors and food insecurity controlling for sociodemographic, cultural, psychosocial, and diabetes self-care variables. Higher food insecurity score was a risk factor for experiencing enabling factor (OR = 1.46; 95% CI = 1.17–1.82), medication access (OR = 1.26; 95 CI% = 1.06–1.50), and forgetfulness (OR = 1.22; 95 CI% = 1.04–1.43) barriers. Higher diabetes management self-efficacy was protective against all four barriers. Other variables associated with one or more barriers were health insurance, perceived health, depression, blood glucose, age and education. Findings suggest that addressing barriers such as food insecurity, low self-efficacy, lack of health insurance, and depression could potentially result in better health care access and utilization among low income Puerto-Ricans with T2D.
Puerto-Ricans; Type 2 diabetes; Health care access barriers; Food insecurity; Self-efficacy
In the US, HIV disproportionately affects Latinos who often present late in the disease. Baltimore has seen a recent rapid growth in its Latino population paralleled by an increasing impact of HIV/AIDS among Latinos. From 2009 to 2010, we performed a cross-sectional survey of Latinos accessing the Baltimore City Health Department (BCHD) Latino Outreach services to assess self-report of previous HIV testing, with particular attention to migration history and risk behaviors. Of 247 Latinos (46% male) accessing BCHD outreach services, 96% were foreign-born. Self-perceived HIV risk was not associated with actual risk behaviors or HIV testing. In multivariate models, previous HIV testing was correlated with knowledge of HIV transmission modes and knowing that a person with HIV can appear healthy. Consistent with CDC recommendations, HIV screening among Latino immigrants should not be limited to individuals with self-perceived risk for HIV. Promoting key pieces of HIV knowledge may improve HIV testing behaviors.
HIV/AIDS; Prevention; Hispanic; Latino; Condom; HIV knowledge; HIV testing
The number of African-born residents living in the United States (US) increased by more than 750 % between 1980 and 2009. HIV diagnosis rates in this population are six times higher than estimated incidence in the general US population. African-immigrants with HIV are also diagnosed at later stages of infection than US-born residents, but they paradoxically have lower mortality after diagnosis. There are higher rates of HIV among women, higher rates of heterosexual transmission, and lower rates of injection-drug-use-associated transmission among African-born residents in the US relative to the general US population. Despite this distinct epidemiologic profile, surveillance reports often group African-born residents with US-born Blacks. The high rates of HIV among African-born residents in the US combined with increasing immigration and incomplete surveillance data highlight the need for more accurate epidemiologic data along with appropriate HIV service programs.
HIV; AIDS; African; Immigrants
This study assessed the feasibility of a culturally-appropriate weight-loss intervention targeting obese Spanish-speaking Mexican women.
This 12-month weight-loss program was based on behavioral interventions previously used successfully with English-speaking participants. Cultural adaptations included: female interventionists, minimal written materials, emphasis on group activities, focus on Mexican traditions and beliefs, and skill-building approach to food measurement. All sessions were conducted in Spanish. The study had few exclusionary criteria, which allowed participation of women with a wide range of literacy levels.
Recruitment exceeded expectations, with 47 participants enrolling in the program. Not counting participants who became pregnant during the study, attendance at 6 and 12 months was 62% and 50% respectively. Mean weight loss at 6 and 12 months was 5.3 kg and 7.2 kg, respectively, with a mean reduction in BMI of 4.0 kg/m2 and 5.5 kg/m2 from baseline to 6 and 12 months, respectively.
This pilot study shows that it is feasible to develop and implement culturally-appropriate behavioral lifestyle interventions for obesity treatment in Mexican-American women.
Obesity; Hispanics; Women; Weight-loss Intervention; Cultural Adaptation