Encouraging majority support for immigrant access to health services:multiple categorization and social identity complexity as antecedents of health equality

Health disparities between groups remain even after accounting for established causes such as structural and economic factors. The present research tested, for the first time, whether multiple social categorization processes can explain enhanced support for immigrant health (measured by respondents’ behavioral intention to support immigrants’ vaccination against A H1N1 disease by cutting regional public funds). Moreover, the mediating role of individualization and the moderating role of social identity complexity were tested. Findings showed that multiple versus single categorization of immigrants lead to support their right to health and confirmed the moderated mediation hypothesis. The potential in developing this sort of social cognitive intervention to address health disparities is discussed.

The healthy immigrant effect: Patterns and evidence from four countries

The existence of a healthy immigrant effect—where immigrants are on average healthier than the native born—is a widely cited phenomenon across a multitude of literatures including epidemiology and the social sciences. There are many competing explanations. The goals of this paper are twofold: first, to provide further evidence on the presence of the healthy immigrant effect across source and destination country using a set of consistently defined measures of health; and second, to evaluate the role of selectivity as a potential explanation for the existence of the phenomenon. Utilizing data from four major immigrant recipient countries, USA, Canada, UK, and Australia allows us to compare the health of migrants from each with the respective native born who choose not to migrate. This represents a much more appropriate counterfactual than the native born of the immigrant recipient country and yields new insights into the importance of observable selection effects. The analysis finds strong support for the healthy immigrant effect across all four destination countries and that selectivity plays an important role in the observed better health of migrants vis a vis those who stay behind in their country of origin.

La symptomatologie dépressive prénatale : une étude comparative des femmes canadiennes et immigrantes à Montréal.

Contexte : Environ 20 % des femmes enceintes présentent un risque élevé de dépression prénatale. Les femmes immigrantes présentent des symptômes dépressifs élevés pendant la grossesse, le début de la période suivant l'accouchement et comme mères de jeunes enfants. Tandis que les disparités ethniques dans la symptomatologie dépressive pendant la grossesse ont été décrites, la combinaison de la longueur du séjour dans le pays d’accueil et la région d'origine sont rarement évalués dans des études qui portent sur la santé des immigrants au Canada. En outre, les études auprès des femmes immigrantes enceintes ont souvent un échantillon de taille qui ne suffit pas pour démêler les effets de la région d'origine et de la durée du séjour sur la santé mentale. De plus, au Canada, presque une femme sur cinq est un immigrant, mais leur santé mentale au cours de la grossesse, les niveaux d'exposition aux facteurs de risque reconnus pour la dépression prénatale et comment leur exposition et la vulnérabilité face à ces risques se comparent à celles des femmes enceintes nés au Canada, sont peu connus. De plus, le processus d'immigration peut être accompagné de nombreux défis qui augmentent le risque de violence subie par la femme. Néanmoins, les preuves existantes dans la littérature sont contradictoires, surtout en ce qui concerne le type de violence évaluée, les minorités ethniques qui sont considérées et l'inclusion de l'état de santé mentale. Objectifs : Tout d'abord, nous avons comparé la santé mentale de femmes immigrantes et les femmes nées au Canada au cours de la grossesse en tenant compte de la durée du séjour et de la région d'origine, et nous avons évalué le rôle des facteurs socio-économiques et du soutien social dans la symptomatologie dépressive prénatale. Deuxièmement, nous avons examiné la répartition des facteurs de risque contextuels de la symptomatologie dépressive prénatale selon le statut d'immigrant et la durée du séjour au Canada. Nous avons ensuite évalué l'association entre ces facteurs de risque et les symptômes de dépression prénataux et ensuite comparé la vulnérabilité des femmes nés au Canada et les femmes immigrantes à ces facteurs de risque en ce qui concerne les symptômes de la dépression prénatale. En troisième lieu, nous avons décrit la prévalence de la violence pendant la grossesse et examiné l'association entre l'expérience de la violence depuis le début de la grossesse et la prévalence des symptômes de la dépression prénatale, en tenant compte du statut d’immigrant. Méthodes : Les données proviennent de l'étude de Montréal sur les différences socio-économiques en prématurité. Les femmes ont été recrutées lors des examens de routine d'échographie (16 à 20 semaines), lors de la prise du sang (8-12 semaines), ou dans les centres de soins prénatals. L’échelle de dépistage Center for Epidemiologic Studies (CES-D) a été utilisée pour évaluer la symptomatologie dépressive à 24-26 semaines de grossesse chez 1495 immigrantes et 3834 femmes nées au Canada. Les niveaux d'exposition à certains facteurs de risque ont été évalués selon le statut d'immigrant et la durée de séjour à l'aide des tests Chi-2 ou test- t. L'échelle de dépistage Abuse Assessment screen (AAS) a été utilisée pour déterminer la fréquence et la gravité de la violence depuis le début de la grossesse. La relation avec l'agresseur a été également considérée. Toutes les mesures d'association ont été évaluées à l'aide de régressions logistiques multiples. Des termes d'interaction multiplicative furent construits entre chacun des facteurs de risque et statut d'immigrant pour révéler la vulnérabilité différentielle entre les femmes nés au Canada et immigrantes. Résultats : La prévalence des symptômes de dépression prénatales (CES-D > = 16 points) était plus élevée chez les immigrantes (32 % [29,6-34,4]) que chez les femmes nées au Canada (22,8 % (IC 95 % [21.4-24.1]). Des femmes immigrantes présentaient une symptomatologie dépressive élevée indépendamment du temps depuis l'immigration. La région d'origine est un fort indice de la symptomatologie dépressive : les prévalences les plus élevées ont été observées chez les femmes de la région des Caraïbes (45 %), de l’Asie du Sud (43 %), du Maghreb (42 %), de l'Afrique subsaharienne (39 %) et de l’Amérique latine (33 %) comparativement aux femmes nées au Canada (22 %) et celle de l'Asie de l’Est où la prévalence était la plus faible (17 %). La susceptibilité de présenter une dépression prénatale chez les femmes immigrantes était attenuée après l’ajustement pour le manque de soutien social et de l'argent pour les besoins de base. En ce qui concerne la durée du séjour au Canada, les symptômes dépressifs ont augmenté avec le temps chez les femmes d’origines européenne et asiatique du sud-est, diminué chez les femmes venant du Maghreb, de l’Afrique subsaharienne, du Moyen-Orient, et de l’Asie de l'est, et ont varié avec le temps chez les femmes d’origine latine et des Caraïbes. Les femmes immigrantes étaient beaucoup plus exposées que celles nées au Canada à des facteurs de risques contextuels indésirables comme la mésentente conjugale, le manque de soutien social, la pauvreté et l'encombrement au domicile. Au même niveau d'exposition aux facteurs de risque, les femmes nées au Canada ont présenté une plus grande vulnérabilité à des symptômes de la dépression prénatale en l'absence de soutien social (POR = 4,14 IC95 % [2,69 ; 6.37]) tandis que les femmes immigrées ont présentées une plus grande vulnérabilité à des symptômes de la dépression prénatale en absence d'argent pour les besoins de base (POR = 2,98 IC95 % [2.06 ; 4,32]). En ce qui concerne la violence, les menaces constituent le type de la violence le plus souvent rapporté avec 63 % qui ont lieu plus d'une fois. Les femmes immigrantes de long terme ont rapporté la prévalence la plus élevée de tous les types de violence (7,7 %). La violence par le partenaire intime a été la plus fréquemment rapportées (15 %) chez les femmes enceintes les plus pauvres. Des fortes associations ont été obtenues entre la fréquence de la violence (plus d'un épisode) et la symptomatologie dépressive (POR = 5,21 [3,73 ; 7,23] ; ainsi qu’entre la violence par le partenaire intime et la symptomatologie dépressive (POR = 5, 81 [4,19 ; 8,08). Le statut d'immigrant n'a pas modifié les associations entre la violence et la symptomatologie dépressive. Conclusion: Les fréquences élevées des symptômes dépressifs observées mettent en évidence la nécessité d'évaluer l'efficacité des interventions préventives contre la dépression prénatale. La dépression chez les femmes enceintes appartenant à des groupes minoritaires mérite plus d'attention, indépendamment de leur durée de séjour au Canada. Les inégalités d’exposition aux facteurs de risque existent entre les femmes enceintes nées au Canada et immigrantes. Des interventions favorisant la réduction de la pauvreté et l'intégration sociale pourraient réduire le risque de la dépression prénatale. La violence contre les femmes enceintes n'est pas rare au Canada et elle est associée à des symptômes de la dépression prénatale. Ces résultats appuient le développement futur du dépistage périnatal de la violence, de son suivi et d'un système d'aiguillage culturellement ajusté.

Sex Talk: A Multiple Case Study to Explore and Understand Parent-Child Sexual Health Communication in Chinese Immigrant Families

Parent-child sexual health communication can be beneficial. Many factors affect such communication in Chinese immigrant families. This qualitative study explored the influences of acculturation, parenting, and parental participation in the Raising Sexually Healthy Children Program (RSHC) on such communication. With a hermeneutic framework, the purpose was to develop understanding based on the topic, context, and researcher interpretations. Twelve interviews elicited data from six parent-child dyads, three from the RSHC. Analysis involved coding processes; data were compared repeatedly and organized into themes. Perceived personality differences between generations were confounded with cultural communicative differences. Parents used implicitness observed in Chinese culture to establish "open" communication; children expected explicitness observed in Western culture. Post- RSHC, parents perceived themselves as more open to talking about sex; children did not perceive such parental changes. Future research should include joint interviews and longitudinal program evaluation. Future practice should focus on cross-cultural communication and involving children in RSHC.

A qualitative analysis of immigrant population health practices in the Girona Healthcare Region

The research we present here forms part of a two-phase project - one quantitative and the other qualitative - assessing the use of primary health care services. This paper presents the qualitative phase of said research, which is aimed at ascertaining the needs, beliefs, barriers to access and health practices of the immigrant population in comparison with the native population, as well as the perceptions of healthcare professionals. Moroccan and sub-Saharan were the immigrants to who the qualitative phase was specifically addressed. The aims of this paper are as follows: to analyse any possible implications of family organisation in the health practices of the immigrant population; to ascertain social practices relating to illness; to understand the significances of sexual and reproductive health practices; and to ascertain the ideas and perceptions of immigrants, local people and professionals regarding health and the health system. Methods: qualitative research based on discursive analysis. Data gathering techniques consisted of discussion groups with health system users and semi-structured individual interviews with healthcare professionals. The sample was taken from the Basic Healthcare Areas of Salt and Banyoles (belonging to the Girona Healthcare Region), the discussion groups being comprised of (a) 6 immigrant Moroccan women, (b) 7 immigrant sub-Saharan African women and (c) 6 immigrant and native population men (2 native men, 2 Moroccan men and 2 sub-Saharan men); and the semi-structured interviews being conducted with the following healthcare professionals: (a) 3 gynaecologists, (b) 3 nurses and 1 administrative staff. Results: use of the healthcare system is linked to the perception of not being well, knowledge of the healthcare system, length of time resident in Spain and interiorization of traditional Western medicine as a cure mechanism. The divergences found among the groups of immigrants, local people and healthcare professionals with regard to healthcare education, use of the healthcare service, sexual and reproductive healthcare and reticence with regard to being attended by healthcare personnel of the opposite sex demonstrate a need to work with the immigrant population as a heterogeneous group. Conclusions: the results we have obtained support the idea that feeling unwell is a psycho-social process, as it takes place within a specific socio-cultural situation and spans a range of beliefs, perceptions and ideas regarding symptomology and how to treat it

Equity in health: tuberculosis in the Bolivian immigrant community of Sao Paulo, Brazil

Objectives To analyse the profile of tuberculosis (TB) among Bolivian immigrants, investigate the impact that this population has on the trends of TB and assess equity in access to TB treatment, in the city of Sao Paulo, Brazil. Methods Descriptive study of the epidemiological profile of TB in four city districts with large Bolivian populations, comparing cases among Brazilians and Bolivians, during the 19982008 period was carried out. We used logistic regression to adjust the treatment outcome for potential confounders. Results We identified 2056 new TB cases: 65.7% in Brazilians, 32.1% in Bolivians and 2.2% among other nationalities. Although TB incidence remained stable (high) over the study period, the annual proportion of cases among Bolivians increased from 15.0% to 53.0%. In comparison with the Brazilians, the Bolivians were younger (median age, 24 vs. 40 years; P < 0.0001) and presented a lower unemployment rate (3.1%vs. 11.6%; P < 0.0001), a lower rate of HIV co-infection (1.5%vs. 28.5%; P < 0.001), a higher proportion of individuals receiving supervised treatment (81.5%vs. 62.0%; P < 0.0001) and a higher proportion of cures (71.6%vs. 63.2%; P < 0.0001). After having been adjusted for potential confounder, cure after treatment was not associated with nationality. Conclusions Bolivian immigrants influenced the incidence but not the trends of TB among Brazilians in the study area. We found no significant differences between Bolivians and Brazilians regarding healthcare access or treatment outcome. Guaranteed universal health care access for all, including undocumented individuals, contributes to health equity. Specific intervention strategies are warranted for immigrants with tuberculosis.

Invisible work, unseen hazards: the health of women immigrant household service workers in Spain

BACKGROUND: Household service work has been largely absent from occupational health studies. We examine the occupational hazards and health effects identified by immigrant women household service workers. METHODS: Exploratory, descriptive study of 46 documented and undocumented immigrant women in household services in Spain, using a phenomenological approach. Data were collected between September 2006 and May 2007 through focus groups and semi-structured individual interviews. Data were separated for analysis by documentation status and sorted using a mixed-generation process. In a second phase of analysis, data on psychosocial hazards were organized using the Copenhagen Psychosocial Questionnaire as a guide. RESULTS: Informants reported a number of environmental, ergonomic and psychosocial hazards and corresponding health effects. Psychosocial hazards were especially strongly present in data. Data on reported hazards were similar by documentation status and varied by several emerging categories: whether participants were primarily cleaners or carers and whether they lived in or outside of the homes of their employers. Documentation status was relevant in terms of empowerment and bargaining, but did not appear to influence work tasks or exposure to hazards directly. CONCLUSIONS: Female immigrant household service workers are exposed to a variety of health hazards that could be acted upon by improved legislation, enforcement, and preventive workplace measures, which are discussed.

Work-related health problems among resident immigrant workers in Italy and Spain

Background: in both Spain and Italy the number of immigrants has strongly increased in the last 20 years, currently representing more than the 10% of workforce in each country. The segregation of immigrants into unskilled or risky jobs brings negative consequences for their health. The objective of this study is to compare prevalence of work-related health problems between immigrants and native workers in Italy and Spain. Methods: data come from the Italian Labour Force Survey (n=65 779) and Spanish Working Conditions Survey (n=11 019), both conducted in 2007. We analyzed merged datasets to evaluate whether interviewees, both natives and migrants, judge their health being affected by their work conditions and, if so, which specific diseases. For migrants, we considered those coming from countries with a value of the Human Development Index lower than 0.85. Logistic regression models were used, including gender, age, and education as adjusting factors. Results: migrants reported skin diseases (Mantel-Haenszel pooled OR=1.49; 95%CI: 0.59-3.74) and musculoskeletal problems among those employed in agricultural sector (Mantel-Haenszel pooled OR=1.16; 95%CI: 0.69-1.96) more frequently than natives; country-specific analysis showed higher risks of musculoskeletal problems among migrants compared to the non-migrant population in Italy (OR=1.17; 95% CI: 0.48-1.59) and of respiratory problems in Spain (OR=2.02; 95%CI: 1.02-4.0). In both countries the risk of psychological stress was predominant among national workers. Conclusions: this collaborative study allows to strength the evidence concerning the health of migrant workers in Southern European countries.

Changes in Access to Health Services of the Immigrant and Native-Born Population in Spain in the Context of Economic Crisis

Aim: To analyze changes in access to health care and its determinants in the immigrant and native-born populations in Spain, before and during the economic crisis. Methods: Comparative analysis of two iterations of the Spanish National Health Survey (2006 and 2012). Outcome variables were: unmet need and use of different healthcare levels; explanatory variables: need, predisposing and enabling factors. Multivariate models were performed (1) to compare outcome variables in each group between years, (2) to compare outcome variables between both groups within each year, and (3) to determine the factors associated with health service use for each group and year. Results: unmet healthcare needs decreased in 2012 compared to 2006; the use of health services remained constant, with some changes worth highlighting, such as the decline in general practitioner visits among autochthons and a narrowed gap in specialist visits between the two populations. The factors associated with health service use in 2006 remained constant in 2012. Conclusion: Access to healthcare did not worsen, possibly due to the fact that, until 2012, the national health system may have cushioned the deterioration of social determinants as a consequence of the financial crisis. Further studies are necessary to evaluate the effects of health policy responses to the crisis after 2012.

A qualitative exploration of the impact of the economic recession in Spain on working, living and health conditions: reflections based on immigrant workers' experiences

Background: This study aimed to analyse how immigrant workers in Spain experienced changes in their working and employment conditions brought about Spain's economic recession and the impact of these changes on their living conditions and health status. Method: We conducted a grounded theory study. Data were obtained through six focus group discussions with immigrant workers (n = 44) from Colombia, Ecuador and Morocco, and two individual interviews with key informants from Romania living in Spain, selected by theoretical sample. Results: Three categories related to the crisis emerged – previous labour experiences, employment consequences and individual consequences – that show how immigrant workers in Spain (i) understand the change in employment and working conditions conditioned by their experiences in the period prior to the crisis, and (ii) experienced the deterioration in their quality of life and health as consequences of the worsening of employment and working conditions during times of economic recession. Conclusion: The negative impact of the financial crisis on immigrant workers may increase their social vulnerability, potentially leading to the failure of their migratory project and a return to their home countries. Policy makers should take measures to minimize the negative impact of economic crisis on the occupational health of migrant workers in order to strengthen social protection and promote health and well-being.

Health inequality between immigrants and natives in Spain: the loss of the healthy immigrant effect in times of economic crisis

Background: The immigrant population living in Spain grew exponentially in the early 2000s but has been particularly affected by the economic crisis. This study aims to analyse health inequalities between immigrants born in middle- or low-income countries and natives in Spain, in 2006 and 2012, taking into account gender, year of arrival and socioeconomic exposures. Methods: Study of trends using two cross-sections, the 2006 and 2012 editions of the Spanish National Health Survey, including residents in Spain aged 15–64 years (20 810 natives and 2950 immigrants in 2006, 14 291 natives and 2448 immigrants in 2012). Fair/poor self-rated health, poor mental health (GHQ-12 > 2), chronic activity limitation and use of psychotropic drugs were compared between natives and immigrants who arrived in Spain before 2006, adjusting robust Poisson regression models for age and socioeconomic variables to obtain prevalence ratios (PR) and 95% confidence interval (CI). Results: Inequalities in poor self-rated health between immigrants and natives tend to increase among women (age-adjusted PR2006 = 1.39; 95% CI: 1.24–1.56, PR2012 = 1.56; 95% CI: 1.33–1.82). Among men, there is a new onset of inequalities in poor mental health (PR2006 = 1.10; 95% CI: 0.86–1.40, PR2012 = 1.34; 95% CI: 1.06–1.69) and an equalization of the previously lower use of psychotropic drugs (PR2006 = 0.22; 95% CI: 0.11–0.43, PR2012 = 1.20; 95% CI: 0.73–2.01). Conclusions: Between 2006 and 2012, immigrants who arrived in Spain before 2006 appeared to worsen their health status when compared with natives. The loss of the healthy immigrant effect in the context of a worse impact of the economic crisis on immigrants appears as potential explanation. Employment, social protection and re-universalization of healthcare would prevent further deterioration of immigrants’ health status.

Evaluation of the Feasibility of a Yoga and Mindfulness-Based Mental Health Intervention for Latina Immigrant Mothers

Thesis (Master's)--University of Washington, 2016-06

Intergroup relations and Muslims’ mental health in Western societies

This review article proposes that theories and research of intergroup contact, prejudice, and acculturation, enhance understanding of the current intercultural relations between Muslims and non-Muslims in Western societies, such as in Australia. The actual and perceived prejudice that many Muslims studying, working, and living in the West have been experiencing following the 2001 terrorist attacks, adds an additional layer of stress to the psychosocial adjustment of Muslim immigrants and sojourners, affecting their cross-cultural adaptation and mental health. Stephan and colleagues’ Integrated Threat Theory argues that the perceived threat experienced by all parties, explains the acts of prejudice. Berry’s acculturation framework highlights that adaptive acculturation is determined by congruent host nation policies and practices and immigrant acculturation strategies. Implications for multicultural policy, intercultural training, and mental health practice, and suggestions for future research, are discussed.

Construction of Francophone families’ health literacy in a linguistic minority situation

With the increase in international mobility, healthcare systems should no longer be ignoring language barriers. In addition to the benefit of reducing long‐term costs, immigrant‐friendly organizations should be concerned with mitigating the way language barriers increase individuals’ social vulnerabilities and inequities in health care and health status. This paper reports the findings of a qualitative, exploratory study of the health literacy of 28 Francophone families living in a linguistic‐minority situation in Canada. Analysis of interviews revealed that participants’ social vulnerability, mainly due to their limited social and informational networks, influenced the construction of family health literacy. Disparities in access to healthcare services could be decreased by having health professionals’ work in alliance with Francophone community groups and by hiring bilingual health professionals. Linguistic isolation and lack of knowledge about local cultural organizations among Francophone immigrants were two important findings of this study