Immigration and Selected Indicators of Health Status and Healthcare Utilization among the Chinese

We examined indicators of health status and healthcare utilization according to immigration status to assess the ‘healthy immigrant effect’ for Chinese adults. Data for Chinese in Taiwan (n = 15,549) were from the 2001 Taiwan National Health Interview Survey (NHIS). Data for U.S.-born Chinese (n = 964) and Chinese Immigrants in the U.S. (n = 253) were from the 1998–2004 U.S. NHIS. We used multivariate logistic regression to estimate the adjusted odds of perceived poor health, having ever smoked, and past year emergency room visits according to immigration status. For Chinese immigrants, more years in the U.S. were associated with lower odds of reporting poor health (OR = 0.4; 95% CI = 0.2–0.8) and past-year emergency room use (OR = 0.5; 95% CI = 0.3–0.9). Compared with recent Chinese immigrants (<5 years in U.S.), Chinese in Taiwan had higher odds of reporting poor health (OR = 6.2; 95% CI = 3.2–12.1) and having ever smoked (OR = 1.6; 95% CI = 1.1–2.5). Our results suggest that those who migrate have better health profiles than those who do not migrate. However, recent Chinese immigrants were not significantly different than U.S.-born Chinese.     

“Automatic assumption of your gender,sexuality and sexual practices is also discrimination”: Exploring sexual healthcare experiences and recommendations among sexually and gender diverse persons in Arctic Canada

Sexual and mental health disparities are reported in Arctic Canada as in other Arctic regions that experience shared challenges of insufficient healthcare resources, limited transportation, and a scarcity of healthcare research. Lesbian, gay, bisexual, transgender, and queer persons (LGBTQ+) report sexual and mental health disparities in comparison with their heterosexual and cisgender counterparts, and these disparities may be exacerbated in rural versus urban settings. Yet limited research has explored sexual healthcare experiences among LGBTQ+ persons in the Arctic who are at the juncture of Arctic and LGBTQ+ health disparities. We conducted a qualitative study from May 2015 to October 2015 with LGBTQ+ persons in the Northwest Territories, Canada that involved in‐depth individual interviews with LGBTQ+ youth (n = 16), LGBTQ+ adults (n = 21), and key informants (e.g. coaches, teachers, nurses, social workers, and healthcare providers) (n = 14). We conducted thematic analysis, a theoretically flexible approach that integrates deductive and inductive approaches, to identify and map themes in the data. Findings reveal geographical, social, and healthcare factors converge to shape healthcare access. Specifically, the interplay between heterosexism and cisnormativity, intersectional forms of stigma, and place limited LGBTQ+ persons’ sexual healthcare access and produced negative experiences in sexual healthcare. Limited healthcare facilities in small communities resulted in confidentiality concerns. Heteronormativity and cisnormativity constrained the ability to access appropriate sexual healthcare. LGBTQ+ persons experienced LGBTQ+, HIV, and sexually transmitted infections stigma in healthcare. Participants also discussed healthcare provider recommendations to better serve LGBTQ+ persons: non‐judgment, knowledge of LGBTQ+ health issues, and gender inclusivity. Findings can inform multi‐level strategies to reduce intersecting stigma in communities and healthcare, transform healthcare education, and build LGBTQ+ persons’ healthcare navigation skills.     

NHS commissioning in probation in England – Still on a wing and a prayer

Policy reforms in England and Wales mean that all individuals released from prison will have some contact with probation services, either serving a community sentence, or being on licence post‐release. Despite often having complex health needs, including a higher prevalence of mental health problems, substance misuse problems and physical health problems than the general population, this socially excluded group of people often do not access healthcare until crisis point. This is partly due to service‐level barriers such as a lack of appropriate and accessible healthcare provision. We conducted a national survey of all Clinical Commissioning Groups (CCGs, n = 210) and Mental Health Trusts (MHTs, n = 56) in England to systematically map healthcare provision for this group. We compared findings with similar surveys conducted in 2013 and 2014. We had excellent response rates, with the data analysed here representing responses from 75% of CCGs and 52% of MHTs in England. We found that just 4.5% (n = 7) of CCG responses described commissioning a service specifically for probation service clients, and 7.6% (n = 12) described probation‐specific elements within their mainstream service provision. Responses from 19.7% of CCGs providing data (n = 31) incorrectly suggested that NHS England are responsible for commissioning healthcare for probation clients rather than CCGs. Responses from 69% (n = 20) of MHTs described providing services specifically for probation service clients, and 17.2% (n = 5) described probation‐specific elements within their mainstream service provision. This points to a need for an overarching health and justice strategy that emphasises organisational responsibilities in relation to commissioning healthcare for people in contact with probation services to ensure that there is appropriate healthcare provision for this group.     

The healthcare experiences of Koreans living in North Carolina: a mixed methods study

This study examined the healthcare experiences of Korean immigrants aged 40–64 living in the North Carolina Triangle area of the Southeastern United States. Using a mixed methods design, we collected quantitative data via a questionnaire from 125 participants and conducted a focus group with 10 interviewees from December 2010 to February 2011. The quantitative data were analysed using t‐tests and chi‐square tests, and a thematic analysis was used for the focus group study. Questionnaire findings showed that only 27.2% had sufficient English skills to communicate adequately. Participants with insurance were significantly more likely to be employed (P < 0.001), had higher incomes (P = 0.011) and higher education (P < 0.001), and had greater English‐speaking ability (P = 0.011) than those without insurance. Participants who did not use healthcare services showed significantly less knowledge (P < 0.001) of and less satisfaction (P = 0.034) with the healthcare system than those using healthcare services. Sixty‐two participants (49.6%) reported having no health insurance for one or more of the following reasons: high costs (75.8%), medical tourism (22.6%) and lack of information or knowledge (6.5%). The following themes emerged from the data collected during the focus group: (i) barriers to utilisation of healthcare services; (ii) facilitators of utilisation of healthcare services; and (iii) social support seeking for health management. Our mixed methods study findings indicate that healthcare disparities exist among Korean immigrants and that a number of factors, including health literacy, may contribute to their poor health outcomes. Continued collaboration among community members, healthcare professionals and academicians is needed to discuss the community's health concerns and to develop sustainable programmes that will ensure meaningful access to care for those with limited English proficiency and medically underserved populations.     

Predictors of Obesity in Latino Children: Acculturation as a Moderator of the Relationship Between Food Insecurity and Body Mass Index Percentile

As Latino children acculturate to the United States, they are at risk for excess weight gain. Existing literature suggests that higher levels of food insecurity may predict obesity, but the role of acculturation is not well understood. Latino children ages 2–17 of both immigrant and non-immigrant parents (n = 63) were recruited from a primary care clinic serving low income families. Child anthropometric measures, and parent acculturation and food insecurity measures were collected via self-administered questionnaires. Over 63% of the patients were either overweight or obese according to criteria established by the Center for Disease Control and Prevention (CDC). Regression analysis revealed acculturation as a significant moderating variable between food insecurity and BMI percentile, F(5,12) = 4.836, P = .017, R ² = .707 in children of Latino immigrants. The identification of this relationship may serve to facilitate in the development of future weight-gain prevention interventions in primary care settings within Latino immigrant populations.     

Household Density among Undocumented Mexican Immigrants in New York City

Background High household density increases exposure to communicable diseases, psychological distress in adults, and poor long-term health in children. High residential density, which may be a mediator of poor health, is common among immigrants. Methods We used data from a pilot survey among Mexican immigrants in New York City. Respondents were recruited through venue-based sampling in neighborhoods with large Mexican populations. Results Among respondents that reported being undocumented (N = 404), the mean number of people per room (PPR) of residence was 2.2. In multivariate analyses, living in conditions of >2 PPR was positively associated with living with one’s children (OR = 2.3, 95% CI = 1.4–3.9), having experienced food insecurity in the past 6 months (OR = 2.0, 95% CI = 1.1–3.6), and language discrimination (OR = 2.3 compared to other forms of discrimination, 95% CI = 1.2–4.4). Conclusions Undocumented Mexican immigrants, particularly those who are linguistically marginalized and experience food insufficiency, live in conditions of marked household density in NYC.     

Access to healthcare among Chinese immigrants living in Seville,Spain

ObjectiveTo investigate the use of healthcare services and factors associated with accessing them among Chinese immigrants living in Southern Spain.MethodA mixed methodology was used. A cross-sectional survey was first administered to Chinese immigrants (n = 133), and they were asked about their visits to the doctor, use of emergency services, and hospitalization. A phenomenological approach was then used with key informants (n = 7). In the interviews, additional information, such as barriers and facilitators to improving accessibility, was explored.ResultsIn the previous year, 51% had visited a doctor and 34% had visited an Emergency Department. The main reasons for hospitalization were pregnancy (37.5%) and surgery (25%). At least 20% of the sample reported having never visited a doctor. Language difficulties and time constraints were identified as important barriers to accessibility. Sex differences were found among the reasons for lack of time, which, in men, were related to work (odds ratio [OR] = 7.7) and, in women, were related to childcare (OR = 12). The majority of Chinese immigrants preferred to use Traditional Chinese Medicine as their first treatment rather than visiting a doctor.ConclusionsA lower use of health services was found among Chinese immigrants in Spain compared to the native population. When using health services, they choose acute care settings. Communication and waiting times are highlighted as major barriers. Adapting these demands to the healthcare system may help immigrants to trust their healthcare providers, thus increasing their use of health services and improving their treatment.     

The Role of Social Support and Acculturative Stress in Health-Related Quality of Life Among Day Laborers in Northern San Diego

There is evidence to suggest that Latino day laborers experience higher levels of acculturative stress than Latinos in employment sectors in the US. Given the stress-buffering role that social support plays in minimizing the negative physical and mental health outcomes of stress, this study examined this relationship in a sample of 70 Latino Day laborers in the northern San Diego area (100% male, mean age = 27.7, SD = 9.1). Results from multivariate regression analyses showed that there was a significant interaction effect between social support and acculturative stress (P = 0.025) on physical health, indicating that higher levels of social support buffered the negative effects of acculturative stress on physical health. Acculturative stress and social support were not associated with mental health status. Overall, these findings suggest that fostering social support may be an essential strategy for promoting health among Latino male day laborers.     

Acceso a la atención sanitaria mediante seguros de salud comunitarios entre migrantes de Senegal

ObjectiveTo evaluate the determinants of healthcare access financing and the role of a particular class of informal financing known as tontine, a community-based health insurance among Senegalese immigrants.MethodData were retrieved through qualitative techniques, semi-structured interviews (n = 14) and discussion group (n = 10) in a population of Senegalese migrants residing in Granada between October and November 2019. Key participants were from a tontine.ResultsThe lack of work or economic resources, as well as the condition of undocumented immigrant constitute barriers to adherence to public and private health insurance. Participants consider that public health care does not take into account the importance of following treatment close to their relatives in their country of origin or having the alternative of traditional medicines. The tontine helps to protect the most vulnerable people such as undocumented immigrants and allows financing services of cultural importance.ConclusionsThis study was the first to provide an understanding of a financing mechanism typical of an immigrant community quite unknown to Spanish society. Tontines continue a long tradition whereby disadvantaged and vulnerable communities resist multiple sources of discrimination and inequality by self-help, trust and solidarity.     

Cultural competence in healthcare in the community: A concept analysis

This study aims to conduct a concept analysis on cultural competence in community healthcare. Clarification of the concept of cultural competence is needed to enable clarity in the definition and operation, research and theory development to assist healthcare providers to better understand this evolving concept. Rodgers’ evolutionary concept analysis method was used to clarify the concept's context, surrogate terms, antecedents, attributes and consequences and to determine implications for further research. Articles from 2004 to 2015 were sought from Medline, PubMed, CINAHL and Scopus using the terms “cultural competency” AND “health,” “cultural competence” OR “cultural safety” OR “cultural knowledge” OR “cultural awareness” OR cultural sensitivity OR “cultural skill” AND “Health.” Articles with antecedents, attributes and consequences of cultural competence in community health were included. The 26 articles selected included nursing (n = 8), health (n = 8), psychology (n = 2), social work (n = 1), mental health (n = 3), medicine (n = 3) and occupational therapy (n = 1). Findings identify cultural openness, awareness, desire, knowledge and sensitivity and encounter as antecedents of cultural competence. Defining attributes are respecting and tailoring care aligned with clients’ values, needs, practices and expectations, providing equitable and ethical care, and understanding. Consequences of cultural competence are satisfaction with care, the perception of quality healthcare, better adherence to treatments, effective interaction and improved health outcomes. An interesting finding is that the antecedents and attributes of cultural competence appear to represent a superficial level of understanding, sometimes only manifested through the need for social desirability. What is reported as critical in sustaining competence is the carers’ capacity for a higher level of moral reasoning attainable through formal education in cultural and ethics knowledge. Our conceptual analysis incorporates moral reasoning in the definition of cultural competence. Further research to underpin moral reasoning with antecedents, attributes and consequences could enhance its clarity and promote a sustainable enactment of cultural competence.     

NHS commissioning in probation in England – on a wing and a prayer

National guidance in England exhorts Clinical Commissioning Groups [groups of general practices established to organise delivery of National Health Service (NHS) care in their local area (CCGs)] to commission healthcare for those living in the community who are serving non‐custodial sentences called ‘community orders’. This includes ‘approved premises’ – accommodation providing enhanced supervision for offenders and individuals on bail who may present a high risk of harm to the public. In this national survey of CCGs in England, we compared the extent to which healthcare services were commissioned for probationers in 2014 with similar data we collected in 2013. A freedom of information (FOI) request was sent to all CCGs (n = 212) and Mental Health Trusts (organisations commissioned to provide health and social care services to individuals with mental health disorders) (n = 53) in England. Mental Health Trusts were included as they were known to fund mental health services for probation as part of their block funding allocations. A small number of basic questions were asked. The response rate was good with 65% of CCGs (n = 137) and 68% (n = 36) of Mental Health Trusts responding. The findings show that the proportion of CCGs commissioning healthcare for probation reduced from 7% to 1%, with 20% of CCGs stating that funding healthcare for this group was the responsibility of the NHS England Area Teams. There was also a reduction in the proportion of Mental Health Trusts funding healthcare for probation but from a much higher baseline, that is from 70% to 61%. The prevalence of mental health disorders in probation is high, so it was of concern that only 12% of Mental Health Trusts provided a service to support approved premises and just 32% provided clinics in probation. The results are discussed within the context of the NHS reforms and the government's plans in England to reform probation.     

Inter-professional practice in the prevention and management of child and adolescent self-harm: foster carers’ and residential carers’ negotiation of expertise and professional identity

Inter-professional collaboration remains a significant concern within healthcare and social care. However, there has been scant attention paid to practices at the interface of clinicians and carers, namely foster carers and residential carers. The present study considers child and adolescent self-harm management and prevention practices as a site of empirical interest due to reports that multi-agency teams are not effectively operating. Drawing upon a grounded theory approach, data were generated via semi-structured interviews and focus groups with residential carers (n = 15) and foster carers (n = 15) in Wales. Themes were developed through axial coding. The results present two central themes to explain the nature and perceived causes of inter-professional discord. First, there are clear contestations in expertise, with carers challenging clinicians’ propositional knowledge in favour of their own experiential expertise. However, participants simultaneously endorse medical dominance, which contributes to their sense of disempowerment and marginalisation. Second, is the preclusion of carers’ professional identity, primarily due to inadequate professionalisation procedures. Meanwhile, the privileging of their parenting role is perceived to support the perpetuation of courtesy stigma. Carers are then compelled to undertake the effortful labour of legitimisation. Together these thematic insights provide direction on mechanisms to improve inter-professional interactions, notably around training and accreditation.     

Australian homeless persons’ experiences of social connectedness,isolation and loneliness

Both loneliness and a lack of social integration are associated with serious physical and psychological health issues. One population highly susceptible to social isolation and loneliness are individuals who are homeless, who also experience high rates of mental disorder and relationship breakdown. Despite this, little research has explored how social networks, isolation and loneliness are experienced for those with a history of homelessness. In‐depth, semi‐structured interviews were used to get a nuanced understanding of how social networks and isolation are experienced and understood by individuals experiencing homelessness. Sixteen participants who were either homeless (n = 11) or previously homeless (n = 5) in Sydney, Australia, completed one‐off interviews that were audio‐recorded and transcribed. Data were analysed using thematic analysis. Participants constructed their social networks as being both constrained and enabled by marginalisation. They experienced rejection from the non‐homeless: the loss of critical network members, including rejection from family and a lack of companionship, and low quality and precarious relationships within the homeless community. These accounts were best conceptualised through loneliness theory. Participant's accounts signal that the homeless will likely continue feeling isolated if mainstream attitudes towards homelessness remain stigmatising and discriminatory.     

Factorial Invariance,Scale Reliability,and Construct Validity of the Job Control and Job Demands Scales for Immigrant Workers: The Multi-Ethnic Study of Atherosclerosis

Immigrants have a different social context from those who stay in their home country or those who were born to the country that immigrants now live. Cultural theory of risk perception suggests that social context influences one’s interpretation of questionnaire items. We examined psychometric properties of job control and job demand scales with US- and foreign-born workers who preferred English, Spanish, or Chinese (n = 3,114, mean age = 58.1). Across all groups, the job control scale had acceptable Cronbach’s alpha (0.78–0.83) and equivalent factor loadings (ΔCFI < 0.01). Immigrants had low alpha (0.42–0.65) for the job demands scale regardless of language, education, or age of migration. Two job-demand items had different factor loadings across groups. Among immigrants, both scales had inconsistent associations with perceived job stress and self-rated health. For a better understanding of immigrants’ job stress, the concept of job demands should be expanded and immigrants’ expectations for job control explored.     

Perceived Discrimination Among Three Groups of Refugees Resettled in the USA: Associations With Language, Time in the USA, and Continent of Origin

The objectives of this study were to assess the prevalence and predictors of discrimination among a community-based sample of refugees resettled in the USA. We sought to test whether language, gender, time in the USA and country of origin were associated with the experience of discrimination among individuals resettled in the USA as part of the refugee resettlement program. Perceived discrimination was assessed among individuals from East Africa (n = 92), West Africa (n = 74), and from Eastern Europe (n = 112) using a multi-item measure of discrimination. Bivariate associations revealed statistically significant associations between experiences of discrimination and time in the USA, language ability, and sending country. A logistic regression model revealed that refugees from African sending countries were more likely than Eastern European individuals to experience discrimination, even after controlling for potentially confounding factors. We interpret this finding as evidence of racism and discuss the implications for population health and resettlement practice.     

Legal Status,Time in the USA,and the Well-Being of Latinos in Los Angeles

In the USA, undocumented Latino immigrants may have poorer health because of barriers to health care, stressors, and detrimental effects of immigration enforcement. Previous immigrant health research, however, suggests that recently arrived Latino immigrants have better health than US-born Latinos and their health deteriorates over time. Given the current environments that undocumented immigrants face, legal status is a structural factor that likely influences the patterns of immigrant health. Therefore, the aim of this study was to examine the extent to which physical and mental health differed by legal status and duration in the USA for the Latino population in Los Angeles County, California. We conducted analysis of Latino respondents (n = 1396) to the Los Angeles Family and Neighborhood Survey (L.A.FANS) Wave II. We examined self-reported health, depression measured by the Composite International Diagnostic Interview—Short Form, and blood pressure collected by trained interviewers. Respondents reported their legal status, time in the USA, and other sociodemographic characteristics. Regression models were used to test associations between each outcome and 1) legal status and 2) legal status by duration (≤ 15 and > 15 years) in the USA. Without taking duration into account, we found no significant differences in outcomes between undocumented, documented, or US-born Latinos. Taking duration into account, shorter duration undocumented immigrants had worse self-reported health than the US born. Undocumented immigrants, regardless of duration, had higher blood pressure than documented immigrants who had been in the USA for less time and the same level of blood pressure as the US born. In contrast, shorter duration documented immigrants had lower blood pressure compared to longer duration documented immigrants and US-born counterparts, and marginally lower blood pressure than shorter duration undocumented immigrants. The findings suggest that the “health advantage” generally presumed to exist among immigrants may not affect undocumented immigrants.     

Engaging Indigenous families in a community‐based Indigenous early childhood programme in British Columbia,Canada: A cultural safety perspective

This article is part of a larger study that explored how an Indigenous early intervention programme in British Columbia (BC), Canada, known as the ‘Aboriginal Infant Development Program’ (AIDP), influenced family and children's health and well‐being and was responsive to child health inequities. Postcolonial feminist and Indigenous feminist perspectives provided a critical analytical lens to this qualitative inquiry. The study was undertaken with AIDPs based in diverse community organisations located in off‐reserve urban municipalities throughout the province of BC. From September 2013 to March 2014, in‐depth, semi‐structured interviews were undertaken with: Indigenous primary caregivers (n = 10), Indigenous Elders (n = 4), AIDP workers (n = 18) and administrative leaders (n = 3). The purpose of this article is to examine and analyse the findings that focus on how AIDP workers supported family and children's health and well‐being by transforming their routine policies and practices in ways that fostered caregivers' active engagement in their programmes. Findings centre on three main themes: (i) overcoming mistrust; (ii) ‘being willing to move a step forward’ and (iii) resisting what's taken‐for‐granted. These inter‐related themes are examined and discussed in relation to the concept of cultural safety. The findings have international relevancy for social and healthcare community‐based programmes that are questioning how to engage with parents who may be hard to reach as a result of multi‐faceted social and structural factors.     

Interpersonal and social correlates of depressive symptoms among Latinas in farmworker families living in North Carolina

ABSTRACT

Little research is available about the mental health of Latina women in farmworker families living in the southern United States, where Latino immigrants are relatively recent arrivals. This study examined interpersonal correlates (family conflict, family’s outward orientation, and perceived discrimination) and social correlates (residential mobility and economic insecurity) of depressive symptoms and of meeting a threshold of depressive symptoms that could be clinically significant (a cut-point of 10 or higher in a short Center for Epidemiologic Studies-Depression Scale) among Latinas in farmworker families living in North Carolina. Data were collected from April 19, 2011 to April 20, 2012 as part of Niños Sanos, a prospective study of Latino women and children (N = 248). Regression models showed that exposure to family conflict, perceived discrimination, and economic insecurity were associated with more depressive symptoms. Likewise, perceived discrimination and economic insecurity were associated with a threshold of depressive symptoms that could be clinically significant, above and beyond family conflict. The findings suggested that policies that lessen the discrimination of farmworkers and their families and reduce economic insecurity, as well as interventions that support positive family functioning, might be beneficial for the mental health of Latinas in farmworker families living in new immigrant destinations.     

The Influence of Immigrant Status and Acculturation on the Development of Overweight in Latino Families: A Qualitative Study

Exposure to obesogenic environments in the U.S. may foster development of overweight in immigrants with greater acculturation. Few studies document mechanisms of the acculturation process from immigrants’ own perspectives or describe implications on the children of immigrants. Focus groups and in-depth interviews were conducted with immigrant Latina mothers (N = 51) examining mothers’ beliefs, attitudes and practices related to early child feeding and weight. Focus group participants completing the Marin Acculturation Scale more closely identified with Latino culture, although the mean score (2.04, SD = 0.59) was close to “bicultural”. Analysis revealed seven themes when mothers compared lifestyles between their native countries and the U.S., related to changes in (1) diet, perceived food quality and availability, (2) food and eating practices, (3) breastfeeding practices, (4) beliefs about food, child feeding and weight status, (5) weight status of mothers and children, (6) physical activity and sedentary lifestyles, and (7) social isolation and support.