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Revankar S, Agarwala A. Stepping Away from the Monolith: The Disaggregation of Asian Cardiovascular Data. Am J Cardiol 2024; 219:120-122. [PMID: 38582314 DOI: 10.1016/j.amjcard.2024.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 03/23/2024] [Indexed: 04/08/2024]
Affiliation(s)
- Shruti Revankar
- Department of Internal Medicine, Baylor College of Medicine, Houston, Texas
| | - Anandita Agarwala
- Center for Cardiovascular Disease Prevention, Baylor Scott and White Health Heart Hospital Baylor Plano, Plano, Texas.
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Bridi L, Albahsahli B, Bencheikh N, Baker DA, Godino JG, O'Laughlin KN, Al-Rousan T. Barriers and facilitators to self-measured blood pressure monitoring among US-resettled Arab refugees with hypertension: a qualitative study. BMC PRIMARY CARE 2023; 24:256. [PMID: 38036967 PMCID: PMC10687832 DOI: 10.1186/s12875-023-02215-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 11/20/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Minoritized communities including refugees are at an increased risk of poorly controlled hypertension. Evidence indicates that self-measured blood pressure monitoring (SMBP) is an effective method to improve blood pressure control in patients with hypertension. However, it has not been studied among refugee populations. The objective of this study is to examine barriers and facilitators to SMBP among Arab refugees resettled in the United States (US) with diagnosed hypertension. METHODS A total of 109 participants were recruited through a Federally Qualified Health Center system that is a major provider of healthcare to refugees in San Diego, California. Participants completed a questionnaire and were interviewed using in-depth, semi-structured interviews. Interviews were transcribed and translated, and data were coded using inductive thematic analysis and organized based on the theory of care-seeking behavior. RESULTS Several barriers to engaging in effective SMBP monitoring were identified. Clinical and sociodemographic barriers included reliance on public monitors and poor hypertension literacy. Psychosocial barriers of affect, norms, and habits included fear and anxiety from hypertension, cultural stigma of illness, and conditional SMBP with symptoms, respectively. Utility psychosocial barriers included lack of SMBP prioritization in treatment and perceived inaccuracy of home monitors. Family members' support with home monitoring served as an important facilitator to SMBP. CONCLUSIONS There are several barriers to effective SMBP among the US-resettled Arab refugee population that may reflect unique cultural and care-seeking behaviors. Tailored public health and clinical interventions are needed to support refugee patients and providers to improve hypertension self-management behaviors for this unique population.
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Affiliation(s)
- Lana Bridi
- School of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Behnan Albahsahli
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, USA
| | - Nissma Bencheikh
- School of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Dania Abu Baker
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, USA
- School of Social Work, San Diego State University, San Diego, CA, USA
| | - Job G Godino
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, USA
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, CA, USA
| | - Kelli N O'Laughlin
- Departments of Emergency Medicine and Global Health, University of Washington, Seattle, WA, USA
| | - Tala Al-Rousan
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, USA.
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Jensen NK, Frøslev T, Foverskov E, Glymour M, Sørensen HT, Hamad R. The association of neighborhood socioeconomic characteristics with cardiovascular health: A quasi-experimental study of refugees to Denmark. Health Place 2023; 84:103128. [PMID: 37844523 PMCID: PMC10823536 DOI: 10.1016/j.healthplace.2023.103128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/22/2023] [Accepted: 09/22/2023] [Indexed: 10/18/2023]
Abstract
Neighborhood socioeconomic disadvantage is associated with cardiovascular health, although it is unclear which specific aspects of neighborhoods matter most. We leveraged a natural experiment in which refugees to Denmark were quasi-randomly assigned to neighborhoods across the country during 1986-1998, creating variation in exposure to various aspects of neighborhood disadvantage. The cohort was followed through December 2018. Exposures included neighborhood-level family income, educational attainment, unemployment, and welfare transfers measured in the first neighborhood after arrival to Denmark. Outcomes included cardiovascular risk factors (hyperlipidemia, hypertension, diabetes and anxiety/depression) and cardiovascular disease (acute myocardial infarction and ischemic heart disease). Neighborhood-level income and education were most consistently associated with cardiovascular risk factors, whereas welfare transfers were most consistently associated with cardiovascular disease. Addressing these specific aspects of neighborhood disadvantage could therefore lower the risk of poor cardiovascular health among refugees. Future research is warranted to examine if results are generalizable to other immigrant groups, countries or time periods.
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Affiliation(s)
- Natasja Koitzsch Jensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark; Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Trine Frøslev
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Else Foverskov
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Maria Glymour
- Department of Epidemiology, Boston University, School of Public Health, Boston, MA, USA
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Rita Hamad
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA
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Wagner JA, Bermúdez-Millán A, Buckley TE, Buxton OM, Feinn RS, Kong S, Kuoch T, Master L, Scully MF. Secondary analysis of a randomized trial testing community health educator interventions for diabetes prevention among refugees with depression: effects on nutrition, physical activity and sleep. Int J Behav Nutr Phys Act 2023; 20:107. [PMID: 37700288 PMCID: PMC10496245 DOI: 10.1186/s12966-023-01509-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/28/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Refugees have high levels of psychological distress that hamper lifestyle change efforts. We previously reported that community health educator (CHE) diabetes prevention interventions decreased HbA1c and depressive symptoms among Cambodian-American refugees with depression; this paper reports health behavior outcomes of those interventions. METHODS Participants were aged 35-75, Khmer speaking, at risk for diabetes, and met study criteria for likely depression by either a) antidepressant medication and/or b) prolonged elevated depressive symptoms. Participants were randomized to one of three CHE interventions: 1) lifestyle intervention called Eat, Walk, Sleep (EWS), 2) EWS plus medication therapy management with a pharmacist/CHE team (EWS + MTM), or, 3) social services (SS; control). Physical activity and sleep were measured with 7 days of actigraphy. Nutrition was measured as carbohydrates as reported in a culturally tailored food frequency questionnaire. Assessments were at baseline, end point (12 months), and follow-up (15 months). RESULTS The n = 188 participants were 78% female, average age of 55 years, half had a household income < $20,000, and modal education was 7.0 years. Individuals in the two treatment groups that received the EWS intervention significantly increased their brown rice consumption (p < .001, Cohen's d = 0.76) and their moderate-to-vigorous activity (p = .039, d = 0.32). No intervention changed sleep duration, timing, efficiency or wake after sleep onset. Across groups, individuals who increased brown rice consumption, increased vigorous activity and decreased total sleep time variability showed decreased HbA1c, with small effect sizes. CONCLUSIONS CHEs may improve nutrition and physical activity in refugees with depression but more intensive interventions may be required to impact sleep. Improvements in all three behaviors appear to be associated with HbA1c lowering TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT02502929.
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Affiliation(s)
- Julie A Wagner
- UConn Health, 263 Farmington Ave., Farmington, CT, 06030, USA.
| | | | | | | | | | - Sengly Kong
- Khmer Health Advocates, West Hartford, CT, USA
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Lardier DT, Hess J, Winter L, Goodkind JR. The impact of postresettlement stressors and access to health care on health outcomes in recently resettled refugees in the United States. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2023; 93:516-531. [PMID: 37650800 PMCID: PMC10840636 DOI: 10.1037/ort0000697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
This mixed-methods study examines mechanisms connecting the deployment of economic, social, and health care resources to emotional distress and physical health outcomes. Examining such mechanisms is critical for informing strategies, policies, and other interventions for reducing health disparities and improving refugee health in the United States and other resettlement contexts. Data for this study were collected as part of a randomized control trial in a mid-sized city in the Southwestern United States. Two-hundred ninety recently resettled (< 3 years) refugee adults from 143 households were enrolled in the study (36.2% Afghan, 32.8% Iraqi/Syrian, and 31.0% Great Lakes African; 52% women). Qualitative interview data were collected via semistructured interviews. A longitudinal structural equation path model of quantitative data from three time points over 12 months tested hypotheses that emerged from qualitative findings. In semistructured interviews, refugees in the United States (a) attributed the development of worse or new physical health problems to postresettlement stressors related to financial instability and limited social support that contributed to their emotional distress and (b) reported several barriers to accessing health care in the United States, including insufficient knowledge of health care resources, inadequate patient-provider communication, and navigating complex American health insurance systems, all of which exacerbated their physical health problems. Guided by these qualitative findings, longitudinal quantitative data revealed that: (a) postmigration stressors were associated with emotional distress and poor self-reported physical health, (b) emotional distress mediated the association between postmigration stressors and global health satisfaction, and (c) emotional distress was negatively associated with global health satisfaction. Findings document stressors refugees experience in the context of the unique environment created by the American health care system and how these stressors contribute to poor physical health through increased emotional distress. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- David T Lardier
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, University of New Mexico
| | - Julia Hess
- Department of Pediatrics, University of New Mexico School of Medicine, University of New Mexico
| | - Lucas Winter
- Department of Internal Medicine, University of New Mexico School of Medicine, University of NewMexico
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Salameh Z, Kaki DA, Abu Baker D, Hijazi T, Godino J, Al-Rousan T. Refugee Telehealth Utilization for Hypertension Management During the COVID-19 Pandemic. Int J Public Health 2023; 68:1605913. [PMID: 37614638 PMCID: PMC10442489 DOI: 10.3389/ijph.2023.1605913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/26/2023] [Indexed: 08/25/2023] Open
Abstract
Objectives: The COVID-19 pandemic limited refugees' access to healthcare. Increased use of telehealth could enable continuity of care but also create barriers to chronic disease management. This study explores refugees' experience with telehealth and hypertension management during the pandemic. Methods: We recruited 109 refugee participants diagnosed with hypertension. We conducted semi-structured interviews about their experience with telehealth during the COVID-19 pandemic. Interviews were transcribed, translated, and data was coded using inductive thematic analysis. Results: 86% used telehealth modalities at least once during the pandemic. Interviews highlighted three main themes: (1) Social isolation worsened mental health, affecting their motivation to manage their blood pressure; (2) telehealth alleviated discontinuity of care but posed logistical and cultural challenges; (3) participants relied on public blood pressure monitors that were not available during the pandemic which affected disease management. Conclusion: Refugees faced challenges managing their hypertension during the COVID-19 pandemic. Virtual community building may alleviate their stress and isolation. Telehealth must be adapted to account for language, cultural, and technological barriers. Communities with hypertension should increase access to personal or public blood pressure monitors.
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Affiliation(s)
- Zaid Salameh
- Mailman School of Public Health, Columbia University, New York City, NY, United States
| | - Dahlia A Kaki
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Dania Abu Baker
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, United States
| | - Tarek Hijazi
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, United States
| | - Job Godino
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, United States
- Family Health Centers of San Diego, San Diego, CA, United States
| | - Tala Al-Rousan
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, United States
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Hussein HM, Kashyap B, O'Keefe L, Droegemueller C, Othman SI, Yang MK, Hanson LR. Stroke Characteristics in a Cohort of Hmong American Patients. J Am Heart Assoc 2023; 12:e026763. [PMID: 37466390 PMCID: PMC10492969 DOI: 10.1161/jaha.122.026763] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 05/18/2023] [Indexed: 07/20/2023]
Abstract
Background Prior studies have indicated high rates of vascular risk factors, but little is known about stroke in Hmong. Methods and Results The institutional Get With The Guidelines (GWTG) database was used to identify patients discharged with acute ischemic stroke, intracerebral hemorrhage, or subarachnoid hemorrhage between 2010 and 2019. Hmong patients were identified using clan names and primary language. Univariate analysis was used to compare Hmong and White patients. A subarachnoid hemorrhage comparison was not conducted because of the small sample size. We identified 128 Hmong patients and 3084 White patients. Hmong patients had more prevalent hemorrhagic stroke (31% versus 15%; P<0.0016). In the acute ischemic stroke cohort, compared with White patients, Hmong patients were younger (60±13 versus 71±15 years; P<0.0001), presented to the emergency department almost 4 hours later; and had a lower thrombolysis usage rate (6% versus 14%; P=0.03496), worse lipid profile, higher hemoglobin A1C, similar stroke severity, and less frequent discharge to rehabilitation facilities. The most common ischemic stroke mechanism for Hmong patients was small-vessel disease. In the intracerebral hemorrhage cohort, Hmong patients were younger (55±13 versus 70±15 years; P<0.0001), had higher blood pressure, and had a lower rate of independent ambulation on discharge (9% versus 30%; P=0.0041). Conclusions Hmong patients with stroke were younger and had poorer risk factor control compared with White patients. There was a significant delay in emergency department arrival and low use of acute therapies among the Hmong acute ischemic stroke cohort. Larger studies are needed to confirm these observations, but action is urgently needed to close gaps in primary care and stroke health literacy.
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Affiliation(s)
- Haitham M. Hussein
- Department of NeurologyUniversity of MinnesotaMinneapolisMNUSA
- Neuroscience Research, HealthPartners Neuroscience CenterBloomingtonMNUSA
- Regions Hospital Comprehensive Stroke CenterSaint PaulMNUSA
| | - Bhavani Kashyap
- Neuroscience Research, HealthPartners Neuroscience CenterBloomingtonMNUSA
- HealthPartners InstituteSaint PaulMNUSA
| | | | | | - Sally I. Othman
- Neuroscience Research, HealthPartners Neuroscience CenterBloomingtonMNUSA
| | - Mai Kau Yang
- Department of NeurologyUniversity of MinnesotaMinneapolisMNUSA
| | - Leah R. Hanson
- Neuroscience Research, HealthPartners Neuroscience CenterBloomingtonMNUSA
- HealthPartners InstituteSaint PaulMNUSA
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Wagner JA, Bermúdez-Millán A, Buckley TE, Buxton OM, Feinn RS, Kong S, Kuoch T, Scully MF. Community-based diabetes prevention randomized controlled trial in refugees with depression: effects on metabolic outcomes and depression. Sci Rep 2023; 13:8718. [PMID: 37253820 DOI: 10.1038/s41598-023-35738-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/23/2023] [Indexed: 06/01/2023] Open
Abstract
Depression and antidepressant medications increase risk for type 2 diabetes. Cambodian-Americans have exceedingly high rates of both depression and diabetes. This paper reports outcomes of a diabetes prevention trial for Cambodian-Americans with depression. Primary outcomes were HbA1c, insulin resistance and depressive symptoms. Participants were aged 35-75, Khmer speaking, at risk for diabetes, and met study criteria for likely depression by either (a) antidepressant medication and/or (b) prolonged elevated depressive symptoms. Participants were randomized to one of three community health worker (CHW) interventions: (1) lifestyle intervention called Eat, Walk, Sleep (EWS), (2) EWS plus medication therapy management sessions with a pharmacist/CHW team to resolve drug therapy problems (EWS + MTM), or, (3) social services (SS; control). Assessments were at baseline, post-treatment (12 months), and follow-up (15 months). The n = 188 participants were 78% female, average age of 55 years, half had a household income < $20,000, and modal educational attainment was 7.0 years. Compared to the other arms, EWS + MTM showed a significant decrease in HbA1c and a trend for reduced inflammation and stress hormones. Depressive symptoms improved for EWS and EWS + MTM relative to SS. There was no change in insulin resistance. Cardiometabolic and mental health can be improved in tandem among immigrant and refugee groups.
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Affiliation(s)
- Julie A Wagner
- University of Connecticut Schools of Medicine and Dental Medicine, UConn Health, 263 Farmington Ave., Farmington, CT, 06030, USA.
| | | | | | | | | | - Sengly Kong
- Khmer Health Advocates, West Hartford, CT, USA
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Hussein HM, Chrenka E, Yang MK, Margolis KL, Kottke TE. Describing Racial Disparity in Hypertension Control in a Large Minnesota Outpatient Practice. Health Serv Res Manag Epidemiol 2023; 10:23333928231192830. [PMID: 37641649 PMCID: PMC10460648 DOI: 10.1177/23333928231192830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/28/2023] [Accepted: 07/20/2023] [Indexed: 08/31/2023] Open
Abstract
Introduction This analysis is a part of ongoing quality improvement efforts aiming at improving hypertension control among various racial minority groups seen in a large outpatient practice with a special focus on two war refugee populations, the Hmong and the Somali populations. Method Deidentified medical records were reviewed for adult hypertensive patients who had an outpatient encounter with a hypertension diagnosis during the years 2015 through 2019. The study outcome was the rate of uncontrolled hypertension, defined as systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg, and stratified by race, age, and gender. Results There were 752,504 patient records representing 259,824 unique patients (mean age 61 ± 13 years) with 49.1% women, 82.1% white 8.3% African American, 4% Asian, 1.6% Hispanic, Somali 0.6%, and 0.2% Hmong. Hmong men had the highest rate of uncontrolled HTN (33.6%) followed by African American (31.3%) then Somali (29.2%). Among women, African Americans had the highest rate (28.6%) followed by Hmong (28.5%) then Somali (25.7%). In all races except Somali, the rate of uncontrolled hypertension was highest in the 18-29 age group, decreased progressively over the next several decades, then increased again in the ≥70 age group. Conclusion Hmong, African American, and Somali groups have the highest rates of uncontrolled hypertension. Efforts to address hypertension management need to be tailored to the specific characteristics of each racial group and to target young adults.
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Affiliation(s)
| | | | - Mai Kau Yang
- University of Minnesota Neurology Department, Minneapolis, MN, USA
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Dawson AZ, Walker RJ, Gregory C, Egede LE. Contributions of social determinants of health to systolic blood pressure in United States adult immigrants: Use of path analysis to validate a conceptual framework. Chronic Illn 2022; 18:757-769. [PMID: 33726528 PMCID: PMC8443685 DOI: 10.1177/17423953211000412] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Validate a conceptual framework and identify pathways between antecedent (life-course socioeconomic status (L-SES)), predisposing (age, sex, married, homeless as a child), enabling (health literacy, acculturation), and need (disability) social determinants of health (SDoH) and systolic blood pressure (SBP) in US immigrants. METHODS 181 immigrants were enrolled in the study. Path analysis was used to identify paths by which SDoH influence SBP and to determine if antecedents, predisposing, enabling, and need factors have direct and indirect relationships with SBP. RESULTS The final model(chi2(5)=14.88, p = 0.011, RMSEA = 0.070, pclose = 0.17, CFI = 0.96) showed L-SES was directly associated with age (0.12, p = 0.019) and disability(0.17, p = 0.001); and indirectly associated with disability (0.29, p < 0.001) and SBP (0.31, p < 0.001). Age (0.31, p < 0.001) and sex(0.25, p < 0.001) were directly associated with SBP, and age was directly associated with disability (0.29, p < 0.001) and indirectly associated with SBP(0.14, p = 0.018). Other predisposing factors such as being married (-0.32, p < 0.001) and being homeless as a child alone (0.16, p < 0.001) were directly associated with disability and indirectly associated (0.14, p = 0.018) with SBP. Enabling factor of health literacy (0.16, p = 0.001) was directly associated with disability and indirectly associated (0.14, p = 0.018) with SBP. Need factor of disability (0.14, p = 0.018) was directly associated with SBP. CONCLUSIONS This study provides the first validation of a conceptual model for the relationship between SDoH and SBP among immigrants and identifies potential targets for focused interventions.
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Affiliation(s)
- Aprill Z Dawson
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rebekah J Walker
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Chris Gregory
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Leonard E Egede
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
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Wagner J, Bermúdez-Millán A, Buckley T, Buxton OM, Feinn R, Kong S, Kuoch T, Nye LM, Scully M. Self-reported outcomes of a randomized trial comparing three community health worker interventions for diabetes prevention among Cambodian Americans with depression. PATIENT EDUCATION AND COUNSELING 2022; 105:3501-3508. [PMID: 36307274 DOI: 10.1016/j.pec.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Cambodian Americans have complex, interrelated and persistent medical and mental health problems stemming from genocide and the social determinants of health. We examined changes in multiple domains of self-reported health outcomes from a diabetes prevention trial. METHODS Cambodian Americans with depression and high risk for diabetes (n = 188) were randomized to one of three community health worker interventions: lifestyle vs lifestyle plus medication therapy management vs social services. Assessments were at baseline, 12- and 15-months. RESULTS The typical participant was 55 years old, female, earned below $20,000 annually, and had 7 years of education. About one-third were taking antidepressant medication and over half had elevated depressive symptoms. Relative to social services, lifestyle and lifestyle plus medication therapy management were both similarly effective at increasing diabetes knowledge, nutrition habits, sleep quality and decreasing pain; 2) lifestyle alone was superior to social services for self-reported health; and, 3) all three groups showed improved anxiety and insomnia. There were no effects on physical activity or physical functioning. CONCLUSION Community health worker interventions have multiple benefits beyond delaying diabetes. PRACTICE IMPLICATIONS Health promotion programs that are designed and delivered appropriately can impact even hard to reach and hard to treat groups.
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Affiliation(s)
- Julie Wagner
- UConn Schools of Medicine and Dental Medicine, United States.
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12
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Arafa A, Kashima R, Kokubo Y. Cardiovascular Disease and COVID-19 Among Refugees: A Call to Action. J Epidemiol Glob Health 2022; 12:572-573. [PMID: 36396782 PMCID: PMC9672638 DOI: 10.1007/s44197-022-00078-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/24/2022] [Indexed: 11/19/2022] Open
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Self-Reported Health of Working-Age Refugees, Immigrants, and the Canadian-Born. ADVANCES IN PUBLIC HEALTH 2022. [DOI: 10.1155/2022/9429242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Canada has a rapidly growing refugee population, yet, there are limited research studies on the physical health of working-age refugees in comparison to the health of immigrants and Canadian-born individuals. Investigating social capital and acculturation measures may provide important insights into the factors associated with good self-reported health and this may help to inform health promotion strategies for refugees in Canada. A secondary analysis was conducted on data collected from the Canadian General Social Survey 27 (GSS-27) comparing a sample of refugees (n = 753), immigrants (n = 5,063), and Canadian-born (n = 11,266) respondents between the ages of 15 and 64. Both bivariate and logistic regression analyses were conducted. Self-reported physical health, dichotomized into poor versus good, was the outcome of interest. The self-reported physical health status of refugees, immigrants, and Canadian-born respondents was comparable. Visible minority status was not significantly associated with self-reported health status. Among refugees, the likelihood of reporting good health was associated with being a woman, being married/common-law, being involved in a social group/organization, and having more than half of one’s friends who spoke a different mother tongue than the respondent. Refugees, however, were less likely to have a confidant and be involved in social groups/organizations as compared to immigrants or those born in Canada. The odds of reporting good health were significantly lower among those who had experienced discrimination within the last five years. Social capital and acculturation may be protective of the self-reported health of refugees in Canada. Initiatives to support refugees’ social connections are therefore warranted.
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Bermúdez-Millán A, Feinn R, Hahn C, Jui SA, Berthold SM, Buckley T, Buxton O, Kong S, Kuoch T, Scully M, Wagner J. SNAP participation moderates the association between household food insecurity and HbA1c among Cambodian Americans with depression. ETHNICITY & HEALTH 2022; 27:1718-1731. [PMID: 34121523 PMCID: PMC8666460 DOI: 10.1080/13557858.2021.1939272] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/28/2021] [Indexed: 05/31/2023]
Abstract
OBJECTIVES We tested whether participation in the Supplemental Nutrition Assistance Program (SNAP) moderated the relation between household food insecurity and HbA1c among Cambodian Americans with depression enrolled in a diabetes prevention trial. METHODS Community health workers assessed household food insecurity and SNAP participation. HbA1c was ascertained using direct enzymatic assay. RESULTS Among the n = 189 respondents, 19% were food insecure, 41% received SNAP benefits, and mean HbA1c = 5.5%. There was a significant interaction between SNAP and food insecurity. HbA1c was highest among participants without SNAP who were food insecure. Simple effects analysis revealed a significant difference within the no SNAP group [Mean (SD): Secure = 5.38 (0.38), Insecure = 5.78 (0.36)] and no difference within the SNAP group [Secure = 5.61(0.44), Insecure = 5.61(0.55)]. Differences remained significant after controlling for demographic, socioeconomic, and clinical indicators. CONCLUSIONS SNAP may protect against the deleterious association between household food insecurity and HbA1c.
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Affiliation(s)
- Angela Bermúdez-Millán
- Department of Public Health Sciences, School of Medicine, UConn Health, Program in Applied Public Health Sciences, Farmington, CT, USA
| | - Richard Feinn
- School of Medicine, Quinnipiac University, Hamden, CT, USA
| | - Chelsey Hahn
- Department of Public Health Sciences, School of Medicine, UConn Health, Program in Applied Public Health Sciences, Farmington, CT, USA
| | - Shanjida A Jui
- Department of Public Health Sciences, School of Medicine, UConn Health, Program in Applied Public Health Sciences, Farmington, CT, USA
| | - S Megan Berthold
- University of Connecticut, School of Social Work, Hartford, CT, USA
| | - Thomas Buckley
- Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, CT, USA
| | - Orfeu Buxton
- Elizabeth Fenton Susman Professor of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
| | - Sengly Kong
- Khmer Health Advocates, West Hartford, CT, USA
| | | | - Mary Scully
- Khmer Health Advocates, West Hartford, CT, USA
| | - Julie Wagner
- Department of Behavioral Sciences and Community Health, School of Dental Medicine, UConn Health, Farmington, CT, USA
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Hughes E, Kean S, Cuthill F. Fluctuating power: an exploration of refugee health nursing within the resettlement context in Victoria, Australia. J Res Nurs 2022; 27:217-228. [PMID: 35813176 PMCID: PMC9264413 DOI: 10.1177/17449871221083786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The Refugee Health Program (RHP) is a nurse-led community initiative, introduced in 2005 with the aim of responding to complex health issues of refugees arriving in Victoria, Australia. Little is known about refugee health nursing in the resettlement context and the impact of dedicated refugee healthcare. Aim To explore the experiences and perspectives of Refugee Health Nurses (RHNs), Refugee Health Managers (managers) and refugees, gaining insight into professional relationships and the complexities of offering a specialised refugee health service. Method A focused ethnographic approach incorporated semi-structured interviews with five RHNs, two managers and eight refugees, two focus groups with refugees and participant observation within the RHP during April 2017 to December 2017. Data collection was undertaken across two sites and interviews, focus groups and observations were transcribed and thematically analysed. Social constructionism asserts that the focus of enquiry should be on interaction, group processes and social practices. Emphasis is placed upon relationships between RHNs, managers and refugees, with knowledge viewed as relational and interactional. Results Professional relationships between RHNs and refugees are complex, with power oscillating between them. Contrary to discourses of ‘vulnerability’ of refugees, both RHNs and refugees demonstrated power in their relationships with each other. Nurses also suggested that these relationships were stressful and could lead to burnout. Key themes were developed: (1) nursing autonomy and gatekeeping; (2) vicarious trauma and burnout; and (3) refugee negotiation of care. Conclusions The balance of power is central to therapeutic relationships. In relationships between RHNs and refugees, power fluctuates as RHNs are exposed to vicarious trauma and symptoms of burnout, while refugees exercise agency by recognising benefits to specialised care. In developing effective therapeutic relationships between RHNs and refugees, attention should be paid to how care is delivered to protect RHNs from burnout while ensuring that refugees receive appropriate care.
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Affiliation(s)
- Emma Hughes
- Lecturer, Nursing Studies, Edinburgh Napier University, Edinburgh, Scotland
| | - Susanne Kean
- Lecturer, Nursing Studies, University of Edinburgh, Edinburgh, Scotland
| | - Fiona Cuthill
- Senior Lecturer, Nursing Studies, University of Edinburgh, Edinburgh, Scotland
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16
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Wagner J, Bermudez-Millan A, Berthold SM, Buckley T, Buxton O, Feinn R, Kong S, Kuoch T, Scully M, Seng K. Exposure to Starvation: Associations with HbA1c, Anthropometrics, and Trauma Symptoms Four Decades Later Among Cambodians Resettled in the USA. Int J Behav Med 2022; 30:424-430. [PMID: 35698017 DOI: 10.1007/s12529-022-10108-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Epidemiological data suggest that populations exposed to starvation show increased incidence of type 2 diabetes but these studies are limited by lack of person-level data. Cambodians resettled in the USA survived severe malnutrition during distinct historical eras. We examined the relationship of individual exposure to starvation with current HbA1c, anthropometrics, and trauma symptoms among Cambodian Americans. METHODS Participants were excluded for extant diabetes but all had elevated risk factors for type 2 diabetes and depression. Participants identified images on a 5-point scale that best depicted their body size during four distinct periods: before 1970 (peacetime), 1970-1975 (USA bombing campaign, widespread hunger), 1975-1979 (Pol Pot regime, mass starvation), and "now" (2016-2019, resettled in the USA). They reported trauma symptoms and provided anthropometrics and a blood sample. RESULTS The n = 189 participants were mean = 55 years old and had glycosylated hemoglobin (HbA1c) mean = 5.5%. Self-reported body size showed excellent validity by strong correlations between body thinness "now" and objectively measured waist circumference (r = -0.35), weight (r = -0.50), and body mass index (r = -0.50). Whereas there was some variability, modal self-reported body size started as normal during peacetime, became thinner during the USA bombing campaign, became emaciated during the Pol Pot regime, and rebounded to normal/slightly heavy "now." Body size during Pol Pot showed the strongest associations with long-term outcomes; thinner body size (greater starvation) was associated with higher trauma symptoms and higher HbA1c even after controlling for age, current waist circumference, and current body mass index. CONCLUSION Greater degree of starvation was associated with higher HbA1c and trauma symptoms four decades later.
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Affiliation(s)
- Julie Wagner
- Division of Behavioral Sciences and Community Health, University of Connecticut School of Dental Medicine, Farmington, USA. .,Department of Psychiatry, University of Connecticut School of Medicine, Farmington, USA.
| | - Angela Bermudez-Millan
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, USA
| | | | - Thomas Buckley
- Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Mansfield, USA
| | - Orfeu Buxton
- Department of Biobehavioral Health, Pennsylvania State University, State College, USA
| | - Richard Feinn
- Department of Medical Sciences, Frank H. Netter School of Medicine, Quinnipiac University, Hamden, USA
| | | | | | | | - Kagnica Seng
- Central Connecticut State University, New Britain, USA
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‘Swallow medicine, eat rice, pray about health’: health, health care and health-seeking experiences of South-East Asian older refugees. AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x22000290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
South-East Asian refugees have lived in the United States of America for nearly four decades, with early refugee immigrants experiencing ageing and later life within the refugee context. As refugees age, health concerns of this older population grow, highlighting the need for ongoing assessment of refugee health and health-seeking behaviours. This study builds on previous literature that assessed the health and health-seeking patterns of South-East Asian refugees in the early years following resettlement, exploring how health and health-seeking is understood among older refugees 40 years after immigration. This paper includes a subset of 37 older refugees from a larger, community-based participatory, mixed-methods intergenerational study of Cambodian and Laotian refugee families conducted over four years (quantitative N = 433; qualitative N = 183). Thematic analysis of 34 semi-structured interviews with these older refugees in coastal Alabama revealed trends in health and health-seeking practices. Older refugees reported high rates of diabetes and hypertension within their generational cohort, and indicated a shift in health-seeking behaviours, whereby Western biomedicine is sought first for such chronic concerns, followed by traditional medicines for mild ailments such as headaches or colds. Older refugees underscored barriers of language, finances and transportation as limiting access to Western health care. Implications for engaging in community health practices and incorporating services to specifically meet the needs of the ageing refugee population are discussed.
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18
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Al-Rousan T, AlHeresh R, Saadi A, El-Sabrout H, Young M, Benmarhnia T, Han BH, Alshawabkeh L. Epidemiology of cardiovascular disease and its risk factors among refugees and asylum seekers: Systematic review and meta-analysis. INTERNATIONAL JOURNAL OF CARDIOLOGY CARDIOVASCULAR RISK AND PREVENTION 2022; 12:200126. [PMID: 35199106 PMCID: PMC8851152 DOI: 10.1016/j.ijcrp.2022.200126] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/31/2021] [Accepted: 01/28/2022] [Indexed: 01/10/2023]
Abstract
Background Methods and results Conclusions
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Affiliation(s)
- Tala Al-Rousan
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
- Corresponding author. Herbert Wertheim School of Public Health, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
| | - Rawan AlHeresh
- Department of Occupational Therapy, Massachusetts General Hospital Institute of Health Professions, Boston, MA, USA
| | - Altaf Saadi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Hannah El-Sabrout
- University of California San Francisco Medical School, San Francisco, CA, USA
| | - Megan Young
- Department of Occupational Therapy, Massachusetts General Hospital Institute of Health Professions, Boston, MA, USA
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA, USA
| | - Benjamin H. Han
- Division of Geriatrics, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Laith Alshawabkeh
- Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, La Jolla, CA, USA
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19
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Wagner JA, Bermudez-Millan A, Berthold SM, Buckley T, Buxton OM, Feinn R, Kuoch T, Kong S, Lim M, Polomoff C, Scully M. Risk factors for drug therapy problems among Cambodian Americans with complex needs: a cross-sectional, observational study. Health Psychol Behav Med 2022; 10:145-159. [PMID: 35087696 PMCID: PMC8788352 DOI: 10.1080/21642850.2021.2021917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background Pharmaceutical drug therapy problems (DTPs) are a major public health problem. We examined patient-level risk factors for DTPs among Cambodian Americans. Methods Community health workers (CHWs) verbally administered surveys and completed a detailed medication review form with participants. A doctoral-level pharmacist reviewed the form with the patient and CHW to determine DTP number and type (appropriateness, effectiveness, safety, and adherence). Results Participants (n = 63) averaged 55 years old, 6 years of education, 52% were married, 87% spoke Khmer at home, with modal household income <$20,000 (41%). The percentage of participants with DTPs was: 45% appropriateness, 25% effectiveness, 64% safety, and 30% adherence, averaging 3.7 DTPs per patient. In multiple regressions, patient characteristics uniquely predicted each type of DTP. In a multiple regression controlling for number of medications, being married reduced total DTPs (IRR = 0.70) and being depressed increased total DTPs (IRR = 1.26). Conclusions Vulnerable patients should be prioritized for pharmacist/CHW teams to identify DTPs. Trial registration:ClinicalTrials.gov identifier: NCT02502929.
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Affiliation(s)
- Julie A. Wagner
- Behavioral Sciences and Community Health, University of Connecticut School of Dental Medicine, Farmington, CT, USA
| | - Angela Bermudez-Millan
- Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA
| | | | - Thomas Buckley
- Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, CT, USA
| | - Orfeu M. Buxton
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
| | - Richard Feinn
- Department of Medical Sciences, Quinnipiac University School of Medicine, Hamden, CT, USA
| | | | - Sengly Kong
- Khmer Health Advocates, West Hartford, CT, USA
| | - Mackenzie Lim
- Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, CT, USA
| | - Christina Polomoff
- Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, CT, USA
| | - Mary Scully
- Khmer Health Advocates, West Hartford, CT, USA
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20
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Pharmacists and community health workers improve medication-related process outcomes among Cambodian Americans with depression and risk for diabetes. J Am Pharm Assoc (2003) 2022; 62:496-504.e1. [PMID: 34838475 PMCID: PMC8934259 DOI: 10.1016/j.japh.2021.10.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/14/2021] [Accepted: 10/27/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Cambodian Americans have high rates of cardiometabolic and psychiatric disorders and disadvantaged social determinants of health (SDOH). These factors can make it challenging to resolve drug therapy problems (DTPs) and improve medication-related outcomes. This manuscript reports planned analyses from a randomized controlled trial in which participants were randomized to one of 3 treatment arms: (1) community health worker (CHW)-delivered lifestyle intervention called Eat, Walk, sleep (EWS), (2) EWS plus pharmacist/CHW-delivered medication therapy management (EWS + MTM), or (3) social services (SS: control). OBJECTIVES We compared the 3 arms on changes in self-reported medication adherence, barriers, and beliefs. Within the EWS + MTM arm only, we assessed the impact of EWS + MTM on DTP resolution and examined predictors of DTP resolution. METHODS Cambodian Americans at the age of 35-75 years at high risk of developing diabetes and meeting the criteria for likely depression (N = 188) were randomized (EWS, n = 67; EWS + MTM, n = 63; SS, n = 50; control). For all participants, self-reported surveys were collected at baseline, 12 months, and 15 months. DTPs were assessed on the same schedule but only for participants in the EWS + MTM. RESULTS All 3 groups reported a significant decrease in barriers to taking medications. Compared with the other arms, the EWS + MTM arm reported a decrease in forgetting to take medications at 15 months. In the EWS + MTM arm, mean DTPs per patient was 6.57 and 84% of DTPs were resolved. SDOH predictors of DTP resolution included years of education (odds ratio [OR] 0.94, P = 0.016), ability to write English (OR 0.73, P = 0.015), difficulty communicating with provider (OR 1.39, P < 0.001), private insurance (OR 1.99, P = 0.030), disability (OR 0.51, P = 0.008), and years living under Pol Pot (OR 0.66, P = 0.045). Medication barriers at baseline predicted DTP resolution (OR 0.79, P = 0.019) such that each additional barrier was associated with a 21% reduction (1-0.79) in the odds of having a resolution. CONCLUSION CHWs can reduce medications barriers and help pharmacists reduce DTPs in disadvantaged populations.
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21
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Sous W, Lupone CD, Harris MA, Mohamed A, Mohamed L, Lakomski MJ, Seward S, Shaw AV. Integrated Care Management to Improve Diabetes Outcomes in Refugee and Immigrant Patients (I-Care). Health Equity 2021; 5:781-788. [PMID: 34909549 PMCID: PMC8665810 DOI: 10.1089/heq.2020.0143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 11/12/2022] Open
Abstract
Purpose: Refugee and immigrant patients face significant barriers to health care and are more likely to have poorly controlled chronic disease than the general U.S. population. I-Care aims to improve health equity for refugees and immigrants who face a disproportionate burden of chronic disease. Methods: Refugees and immigrants with uncontrolled diabetes and associated cardiovascular risk factors were enrolled in a care management program within an academic adult medicine clinic. The program utilized a care manager to coordinate care and services between designated primary care providers, affiliated clinical teams, and community partners. Health literacy, chronic disease parameters, and care utilization were assessed at enrollment and 8-12 months later. Results: A total of 50 refugees and immigrants were followed for 8 to 12 months. Clinical parameters found a reduced mean HbA1c from 9.32 to 8.60 (p=0.05) and reduced low-density lipoprotein mean from 96.22 to 86.60 (p=0.01). The frequency of normal blood pressures was 9 (18%) at enrollment and 16 (32%) at 1 year. The cumulative frequency of emergency room visits decreased from 66% to 36% and hospitalizations from 22% to 8%. Rates of comprehensive care monitoring, including monofilament testing and one-time ophthalmology visits, increased from 60% to 82% and from 32% to 42%, respectively. Cumulative frequency of interdisciplinary support engagement with pharmacy and nutrition visits increased from 58% to 78% and from 26% to 38%, respectively. Conclusion: This program highlights the importance of a multidisciplinary community-engaged care model that has demonstrated improvement in quality metrics and health care costs for refugees and immigrants.
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Affiliation(s)
- Waseem Sous
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Christina D Lupone
- Department of Public Health and Preventive Medicine, and SUNY Upstate Medical University, Syracuse, New York, USA.,SUNY Upstate Medical University, Institute for Global Health and Translational Science, Syracuse, New York, USA
| | - Megan A Harris
- SUNY Upstate Medical University College of Medicine MD/MPH Program, Syracuse, New York, USA
| | - Ayan Mohamed
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Liban Mohamed
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Mary Jo Lakomski
- Department of Department of Pharmacy, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Simone Seward
- SUNY Upstate Medical University College of Medicine MD/MPH Program, Syracuse, New York, USA
| | - Andrea V Shaw
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, New York, USA.,SUNY Upstate Medical University, Institute for Global Health and Translational Science, Syracuse, New York, USA
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22
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McAlpine AA, George U, Kobayashi K, Fuller-Thomson E. Physical Health of Older Canadians: Do Intersections Between Immigrant and Refugee Status, Racialized Status, and Socioeconomic Position Matter? Int J Aging Hum Dev 2021; 95:326-348. [PMID: 34870483 PMCID: PMC9358229 DOI: 10.1177/00914150211065408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It is unclear whether racial or nativity health disparities exist among older
Canadians and what social and economic disadvantages may contribute to these
differences. Secondary analysis of data collected from respondents aged 55 and
older in the Canadian General Social Survey 27 was performed. The outcome
variable was self-reported physical health. Compared to racialized immigrants,
white immigrant and Canadian-born respondents had approximately 35% higher odds
of good health. Among racialized older adults, the odds of good health were
better if they were younger than 75, more affluent, better educated, had a
confidant, had not experienced discrimination in the past five years, and were
more acculturated. Racialized immigrants are at a health disadvantage compared
to white groups in Canada; however, greater acculturation, social support, and
lower experiences of discrimination contribute to better health among racialized
older adults.
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Affiliation(s)
| | - Usha George
- 7984Ryerson University, Toronto, Ontario, Canada
| | - Karen Kobayashi
- 8205University of Victoria, Victoria, British Columbia, Canada
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23
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Wagner J, Bermudez-Millan A, Buckley T, Buxton OM, Feinn R, Kong S, Kuoch T, Nahmod NG, Scully M. A randomized trial to decrease risk for diabetes among Cambodian Americans with depression: Intervention development, baseline characteristics and process outcomes. Contemp Clin Trials 2021; 106:106427. [PMID: 33957272 PMCID: PMC8312406 DOI: 10.1016/j.cct.2021.106427] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/26/2021] [Accepted: 05/01/2021] [Indexed: 11/29/2022]
Abstract
Background: Depression and antidepressant medications are associated with increased risk for type 2 diabetes. It is not known if diabetes can be prevented in the setting of depression. Cambodian Americans have high rates of both depression and diabetes. This paper reports intervention development, experimental design, baseline characteristics, and process outcomes of diabetes prevention interventions for Cambodian Americans with depression, “Diabetes Risk Reduction through Eat, Walk, Sleep and Medication Therapy Management” (DREAM). Methods: Participants were aged 35–75, Khmer speaking, at high risk for developing diabetes, and met criteria for likely depression by either a) antidepressant medication and/or b) elevated depressive symptoms at two time-points during a study eligibility period. Treatment arms were: 1) community health educator (CHE) delivered lifestyle intervention called Eat, Walk, Sleep (EWS), 2) EWS plus pharmacist/CHE-delivered medication therapy management (EWS + MTM), and, 3) social services (SS; control). Results: 188 participants were randomized. Treatment fidelity was high (98% checklist adherence) and on a scale from 0 to 3, participants reported high EWS treatment satisfaction (M = 2.9, SD = 0.2), group cohesion (M = 2.9, SD = 0.3), and therapeutic alliance to CHEs (M = 2.9, SD = 0.2) and to pharmacists (2.9, SD = 0.3). Attendance was challenging but highly successful; in EWS, 99% attended ≥ one session and 86% completed ≥ 24 sessions, M = 27.3 (SD = 3.7) sessions. Of those randomized to EWS + MTM, 98% attended at least one MTM session and 77%) completed ≥ 4 sessions. Retention was high, 95% at 12-month and 96% at 15-month assessments. Conclusions: The interventions were successfully implemented. Lessons learned and suggestions for future trials are offered. ClinicalTrials.gov identifier: NCT02502929
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Affiliation(s)
- Julie Wagner
- UConn Schools of Medicine and Dental Medicine, USA.
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24
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Lipid Levels in Refugees from Burma. J Community Health 2021; 46:1083-1089. [PMID: 33929629 DOI: 10.1007/s10900-021-00990-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
Cardiovascular risk is common among resettled refugees from Southeast Asia, but the association with refugee status is unclear. This study investigated the lipid levels of Burmese refugees as compared to the general population of Burma. This observational study included adult refugees from Burma undergoing domestic medical examination at a clinic in Minnesota (n = 127). The cholesterol levels of the refugee cohort were compared to a survey of Burmese residents sampled by the World Health Organization (WHO). The primary variable of interest, mean LDL, was 118.9 mg/dL in the refugee cohort. Adjusting for sex and age-group, this was 18.5 mg/dL higher than the WHO cohort (95% CI 10.0-27.1 mg/dL, p < 0.001). This study confirmed previous studies showing elevated lipid levels among Asian refugees. This work added to prior studies by including a refugee cohort that was newly-resettled and comparing it to the general population.
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25
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Ajrouch KJ, Barr R, Daiute C, Huizink AC, Jose PE. A lifespan developmental science perspective on trauma experiences in refugee situations. ADVANCES IN LIFE COURSE RESEARCH 2020; 45:100342. [PMID: 36698276 DOI: 10.1016/j.alcr.2020.100342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/29/2020] [Accepted: 05/06/2020] [Indexed: 06/17/2023]
Abstract
Developmental science theory and empirical research on refugee situations requires an updated approach to the study of trauma as a multi-systemic and multilevel phenomenon. We present a theoretical framework that integrates developmental science approaches to highlight critical threats to development in situations of violent displacement. Given the complexities of displacement (causes, trajectories, and living circumstances once displaced), this theoretical model highlights the utility of an approach that recognizes the person-age-context fit in which displaced individuals live their lives and how both trauma and ongoing major disruption to daily life affects outcomes. In so doing, we aim to broaden understanding for future trauma and intervention research as well as practice with those who experience potentially traumatic events and severe disruption to their social ecology at different points in the lifespan.
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Affiliation(s)
| | - Rachel Barr
- Georgetown University, Washington DC 20057 USA.
| | - Colette Daiute
- The Graduate Center, City University New York, New York, NY 10016 USA.
| | | | - Paul E Jose
- Victoria University of Wellington, Wellington 6140 New Zealand.
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26
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Hamad R, Öztürk B, Foverskov E, Pedersen L, Sørensen HT, Bøtker HE, White JS. Association of Neighborhood Disadvantage With Cardiovascular Risk Factors and Events Among Refugees in Denmark. JAMA Netw Open 2020; 3:e2014196. [PMID: 32821923 PMCID: PMC7442927 DOI: 10.1001/jamanetworkopen.2020.14196] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
IMPORTANCE Refugees are among the most disadvantaged individuals in society, and they often have elevated risks of cardiovascular risk factors and events. Evidence is limited regarding factors that may worsen cardiovascular health among this vulnerable group. OBJECTIVE To test the hypothesis that refugee placement in socioeconomically disadvantaged neighborhoods is associated with increased cardiovascular risk. DESIGN, SETTING, AND PARTICIPANTS The study population of this quasi-experimental, registry-based cohort study included 49 305 adults 18 years and older who came to Denmark as refugees from other countries during the years of Denmark's refugee dispersal policy from 1986 to 1998. Refugees were dispersed to neighborhoods with varying degrees of socioeconomic disadvantage in an arbitrary manner conditional on observed characteristics. The association of neighborhood disadvantage on arrival with several cardiovascular outcomes in subsequent decades was evaluated using regression models that adjusted for individual, family, and municipal characteristics. Health outcomes were abstracted from the inpatient register, outpatient specialty clinic register, and prescription drug register through 2016. Data analysis was conducted from May 2018 to July 2019. EXPOSURES A composite index of neighborhood disadvantage was constructed using 8 neighborhood-level socioeconomic characteristics derived from Danish population register data. MAIN OUTCOMES AND MEASURES Primary study outcomes included hypertension, hyperlipidemia, type 2 diabetes, myocardial infarction, and stroke. Before data analysis commenced, it was hypothesized that higher levels of neighborhood disadvantage were associated with an increased risk of cardiovascular risk factors and events. RESULTS A total of 49 305 participants were included (median [interquartile range] age, 30.5 [24.9-39.8] years; 43.3% women). Participant region of origin included 6318 from Africa (12.8%), 7253 from Asia (14.7%), 3446 from Eastern Europe (7.0%), 5416 from Iraq (11.0%), 6206 from Iran (12.6%), 5558 from Palestine (via Lebanon, Israel, Occupied Palestinian Territories; 11.3%), and 15 108 from Yugoslavia (30.6%). Adjusted models revealed an association between placement in disadvantaged neighborhoods and increased risk of hypertension (0.71 [95% CI, 0.30-1.13] percentage points per unit of disadvantage index; P < .01), hyperlipidemia (0.44 [95% CI, 0.06-0.83] percentage points; P = .01), diabetes (0.45 [95% CI, 0.09-0.81] percentage points; P = .01), and myocardial infarction (0.14 [95% CI, 0.03-0.25] percentage points; P = .01). No association was found for stroke. Individuals who arrived in Denmark before age 35 years had an increased risk of hyperlipidemia (1.16 [95% CI, 0.41-1.92] percentage points; P < .01), and there were no differences by sex. CONCLUSIONS AND RELEVANCE In this quasi-experimental cohort study, neighborhood disadvantage was associated with increased cardiovascular risk in a relatively young population of refugees. Neighborhood characteristics may be an important consideration when refugees are placed by resettlement agencies and host countries. Future work should examine additional health outcomes as well as potential mediating pathways to target future interventions (eg, neighborhood ease of walking, employment opportunities).
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Affiliation(s)
- Rita Hamad
- Philip R. Lee Institute for Health Policy Studies, University of California School of Medicine, San Francisco
- Department of Family & Community Medicine, University of California School of Medicine, San Francisco
| | - Buket Öztürk
- Department of Clinical Epidemiology, Aarhus University, Denmark
| | - Else Foverskov
- Philip R. Lee Institute for Health Policy Studies, University of California School of Medicine, San Francisco
- Department of Clinical Epidemiology, Aarhus University, Denmark
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University, Denmark
| | - Henrik T. Sørensen
- Department of Clinical Epidemiology, Aarhus University, Denmark
- Center for Population Health Science, Stanford University, Stanford, California
| | - Hans E. Bøtker
- Department of Cardiology, Aarhus University Hospital, Denmark
| | - Justin S. White
- Philip R. Lee Institute for Health Policy Studies, University of California School of Medicine, San Francisco
- Department of Epidemiology & Biostatistics, University of California School of Medicine, San Francisco
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Denli Yalvac ES. Cardiovascular diseases and their risk factors among Syrian refugees in Turkey. Rev Epidemiol Sante Publique 2020; 68:137-144. [PMID: 32139199 DOI: 10.1016/j.respe.2019.11.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/20/2019] [Accepted: 11/03/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Information on the world distribution of cardiovascular disease and its risk factors in refugees/migrants is not available at the same rate for all countries or for different ethnic and socioeconomic groups. Today, Syria's humanitarian catastrophe has become a public health concern, which cannot be ignored. METHODS A search was conducted across PubMed and Google Scholar for papers on cardiovascular diseases among refugees/migrants worldwide with a focus on Syrian in Turkey. RESULTS The total number of papers identified through the database searches and from reference lists was 486. Of these, 62 were found to be relevant after further screening. A further 42 papers were considered not eligible after full-text, language and data assessments, resulting in a final 20 papers included in the qualitative analysis. These studies discussed several major themes: cardiovascular diseases and their risk factors among refugees/migrants, the effects of changing living conditions on refugees/migrants, the effects of psychological and socioeconomic factors, and the prevention and treatment of cardiovascular diseases in refugees/migrants. The risk of cardiovascular disease varied by country of origin, country of destination, and duration of residence. The findings suggest that cardiovascular diseases and their risk factors are increased for Syrian refugees in Turkey. CONCLUSION Raising awareness, prevention, early detection, and good management as well as monitoring and reporting of risk factors are the key components to controlling cardiovascular diseases in refugees. Further studies and greater acquisition of survey data are urgently needed.
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Affiliation(s)
- E S Denli Yalvac
- Department of Cardiovascular Surgery, Göztepe Education and Research Hospital, Istanbul Medeniyet University, Kadiköy, Istanbul, Turkey.
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A Health Profile and Overview of Healthcare Experiences of Cambodian American Refugees and Immigrants Residing in Southern California. J Immigr Minor Health 2019; 21:346-355. [PMID: 29705910 DOI: 10.1007/s10903-018-0736-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Asian Americans are understudied in health research and often aggregated into one homogenous group, thereby disguising disparities across subgroups. Cambodian Americans, one of the largest refugee communities in the United States, may be at high risk for adverse health outcomes. This study compares the health status and healthcare experiences of Cambodian American refugees and immigrants. Data were collected via questionnaires and medical records from two community clinics in Southern California (n = 308). Chi square and t-tests examined the socio-demographic differences between immigrants and refugees, and ANCOVA models compared the mean differences in responses for each outcome, adjusting for age at immigration, education level, and clinic site. Cambodian American refugees reported overall lower levels of health-related quality of life (all p's < 0.05 in unadjusted models) and self-rated health [unadjusted means (SD) = 18.2 (16.8) vs. 21.7 (13.7), p < 0.05], but either similar or more positive healthcare experiences than Cambodian American immigrants. In adjusted analyses, refugees had higher rates of diabetes and cardiovascular disease risk (e.g. heart condition and hypertension; p's < 0.05) compared to Cambodian American immigrants. There were minimal differences in self-reported health behaviors between the two groups. There is a need for more health promotion efforts among Cambodian American refugees and immigrants to improve their health outcomes and perceived wellbeing.
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Berthold SM, Loomis AM, Kuoch T, Scully M, Hin-McCormick MM, Casavant B, Buckley T. Social Disconnection as a Risk Factor for Health among Cambodian Refugees and Their Offspring in the United States. J Immigr Minor Health 2019; 21:290-298. [PMID: 29796964 DOI: 10.1007/s10903-018-0760-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Studies of relatively recently resettled refugees have noted social disconnection, linked to various physical and mental health outcomes, as a concern. Limited studies have examined whether social disconnection and its effects persists within refugee populations resettled more than 3 decades prior. The relationship between social disconnection and self-reported health was explored in a secondary analysis of a cross-sectional needs assessment survey with a snowball sample of 100 Cambodian refugees residing in Connecticut. Social disconnectedness and comorbid health conditions were prevalent. Lack of religious and community engagement were associated with poor health outcomes, while individuals with a lack of ethnic engagement reported better overall health. This study underscores the importance of understanding the specific risks that social disconnection poses to refugees who have resettled many years before and their offspring that may assist in better serving currently settling refugees within the United States.
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Affiliation(s)
- S Megan Berthold
- University of Connecticut School of Social Work, 38 Prospect St., Hartford, CT, 06103, USA.
| | - Alysse Melville Loomis
- University of Connecticut School of Social Work, 38 Prospect St., Hartford, CT, 06103, USA
| | | | - Mary Scully
- Khmer Health Advocates, West Hartford, CT, USA
| | | | - Bryce Casavant
- Mount Holyoke College Department of Economics, South Hadley, MA, USA
| | - Thomas Buckley
- University of Connecticut School of Pharmacy, Storrs, CT, USA
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Malik MS, Afzal M, Farid A, Khan FU, Mirza B, Waheed MT. Disease Status of Afghan Refugees and Migrants in Pakistan. Front Public Health 2019; 7:185. [PMID: 31334212 PMCID: PMC6616124 DOI: 10.3389/fpubh.2019.00185] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 06/18/2019] [Indexed: 11/29/2022] Open
Abstract
World is facing the largest refugee crisis of its time due to continuously outgoing wars, conflicts and natural disasters. One of the important aspects of refugees and migrants is health. Till date, no comprehensive data was available related to health status of Afghan refugees and internally displaced persons (IDPs) in Pakistan. Here, we present health status for Afghan refugees for last seven years and for IDPs for 2–4 years. For Afghan refugees the data was provided by Commissionerate Afghan Refugee (CAR), Pakistan, whereas data for IDPs was collected from hospitals and Basic health units (BHUs) of different districts of Khyber Pakhtunkhwa namely Peshawar, Dera Ismail Khan and Bannu. Highest number of Afghan refugee's deaths occurred due to cardiovascular problems. Most prevalent reported infections were respiratory tract infections (48.05%). Skin diseases and Diarrhea collectively affected 21.08% of Afghan refugees. Overall, disease burden was more in females than males in Afghan refugee's population. To the best of our knowledge, this is the first comprehensive report on health and disease status of Afghan refugees and IDPs in Pakistan.
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Affiliation(s)
- Muhammad Suleman Malik
- Department of Biochemistry, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Muhammad Afzal
- Department of Animal Science, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | | | - Fati Ullah Khan
- Department of Biochemistry, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Bushra Mirza
- Department of Biochemistry, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Mohammad Tahir Waheed
- Department of Biochemistry, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
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Loomis AM, Berthold SM, Buckley T, Wagner J, Kuoch T. Integrated Health Care and mHealth: A Model of Care for Refugees with Complex Health Conditions. SOCIAL WORK IN PUBLIC HEALTH 2019; 34:189-200. [PMID: 30774044 DOI: 10.1080/19371918.2019.1575311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
High rates of comorbid physical and mental health conditions are documented among refugee populations. A dearth of evidence exists on the use of mHealth technologies to support integrated health care models, with interprofessional mental and physical healthcare teams, within the field of refugee health, despite the potential for mHealth technologies to reduce barriers to health care access for vulnerable populations. This conceptual article illustrates how mHealth can facilitate integrated health care models with refugees with comorbid conditions. Implications are made to support the application of mHealth technologies within integrated health care models serving at-risk refugee populations.
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Affiliation(s)
- Alysse M Loomis
- a University of Connecticut School of Social Work , West Hartford , Connecticut , USA
| | - S Megan Berthold
- a University of Connecticut School of Social Work , West Hartford , Connecticut , USA
| | - Thomas Buckley
- b University of Connecticut School of Pharmacy , Storrs , Connecticut , USA
| | - Julie Wagner
- c Division of Behavioral Sciences and Community Health , University of Connecticut School of Dental Medicine , Farmington , CT
- d Department of Psychiatry , University of Connecticut School of Medicine , Farmington , CT
| | - Theanvy Kuoch
- e Khmer Health Advocates , West Hartford , Connecticut , USA
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Lu JJ, D'Angelo KA, Kuoch T, Scully M. Honouring the role of community in community health work with Cambodian Americans. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:882-890. [PMID: 30014623 DOI: 10.1111/hsc.12612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 05/04/2018] [Accepted: 06/12/2018] [Indexed: 06/08/2023]
Abstract
Despite surviving extreme forms of violence, torture and other traumas during the Khmer Rouge genocide and forced migration, Cambodian Americans experience devastating health inequities and barriers to health access in the United States (U.S.). From the perspective of Cambodian American community health workers (CHWs), we explored three aims in this community-based participatory research (CBPR), qualitative study: Cambodian Americans' understanding of health, community health work strategies that improve health access of Cambodian Americans, and action steps that improve health access for Cambodian Americans. From 2014 to 2016, our two-phased study spanned seven U.S. states, which included a focus group (n = 5) and 16 semistructured interviews. Participants identified an indigenous concept of health, and micro-level (e.g. service navigation, peer education) and mezzo-level interventions (e.g. community building, coalition work) to improve health access. Finally, Khmer Health Advocates, a community-based health advocacy organisation, served as a vital study partner in this CBPR study.
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Affiliation(s)
- Jack J Lu
- Jane Addams College of Social Work, University of Illinois at Chicago, Chicago, Illinois
| | - Karen A D'Angelo
- Jane Addams College of Social Work, University of Illinois at Chicago, Chicago, Illinois
| | - Theanvy Kuoch
- Khmer Health Advocates, Inc., West Hartford, Connecticut
| | - Mary Scully
- Khmer Health Advocates, Inc., West Hartford, Connecticut
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Kamimura A, Sin K, Pye M, Meng HW. Cardiovascular Disease-related Health Beliefs and Lifestyle Issues Among Karen Refugees Resettled in the United States From the Thai-Myanmar (Burma) Border. J Prev Med Public Health 2018; 50:386-392. [PMID: 29207451 PMCID: PMC5717330 DOI: 10.3961/jpmph.17.098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 11/02/2017] [Indexed: 01/28/2023] Open
Abstract
Objectives Refugees resettled in the US may be at risk for cardiovascular disease (CVD). However, little is known about CVD-related issues among Karen refugees who have migrated to the US from the Thai-Myanmar border. The purpose of this study was to examine CVD-related health beliefs and lifestyle issues among Karen refugees resettled in the US. Methods Karen refugees resettled in the US from the Thai-Myanmar border (n=195) participated in a survey study on health beliefs related to CVD, salt intake, physical activity (PA), and smoking in the fall of 2016. Results A high-salt diet, physical inactivity, and smoking were major lifestyle problems. Participants who adhered to a low-salt diet considered themselves to be susceptible to CVD. Most participants did not engage in regular PA. Regular PA was associated with less perceived susceptibility to CVD and greater perceived benefits of a healthy lifestyle for decreasing the likelihood of CVD. Conclusions Each refugee population may require individualized strategies to promote PA and a healthy diet. Future studies should develop health education programs that are specifically designed for Karen refugees and evaluate such programs. In addition to health education programs on healthy lifestyle choices, tobacco cessation programs seem to be necessary for Karen refugees. At the same time, it is important to foster strategies to increase the utilization of preventive care among this population by promoting free or reduced-fee resources in the community to further promote their health.
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Affiliation(s)
- Akiko Kamimura
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
| | - Kai Sin
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
| | - Mu Pye
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
| | - Hsien-Wen Meng
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
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Migraine-Like Visual Auras Among Traumatized Cambodians with PTSD: Fear of Ghost Attack and Other Disasters. Cult Med Psychiatry 2018; 42:244-277. [PMID: 29019040 DOI: 10.1007/s11013-017-9554-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This article profiles visual auras among traumatized Cambodian refugees attending a psychiatric clinic. Thirty-six percent (54/150) had experienced an aura in the previous 4 weeks, almost always phosphenes (48% [26/54]) or a scintillating scotoma (74% [40/54]). Aura and PTSD were highly associated: patients with visual aura in the last month had greater PTSD severity, 3.6 (SD = 1.8) versus 1.9 (SD = 1.6), t = 10.2 (df = 85), p < 0.001, and patients with PTSD had a higher rate of visual aura in the last month, 69% (22/32) versus 13% (7/55), odds ratio 15.1 (5.1-44.9), p < 0.001. Patients often had a visual aura triggered by rising up to the upright from a lying or sitting position, i.e., orthostasis, with the most common sequence being an aura triggered upon orthostasis during a migraine, experienced by 60% of those with aura. The visual aura was often catastrophically interpreted: as the dangerous assault of a supernatural being, most commonly the ghost of someone who died in the Pol Pot period. Aura often triggered flashback. Illustrative cases are provided. The article suggests the existence of local biocultural ontologies of trauma as evinced by the centrality of visual auras among Cambodian refugees.
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D'Anna LH, Peong V, Sabado P, Valdez-Dadia A, Hansen MC, Canjura C, Hong M. Barriers to Physical and Mental Health: Understanding the Intersecting Needs of Cambodian and Latino Residents in Urban Communities. J Immigr Minor Health 2017; 20:1243-1260. [PMID: 29189993 DOI: 10.1007/s10903-017-0677-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A community needs assessment was conducted to explore barriers and facilitators to good physical and mental health among Cambodian and Latino residents in an urban community in Southern California. Thirty-six Cambodians and 29 Latinos completed the interviewer-facilitated survey administered door-to-door, and another 20 Cambodian and 18 Latino residents participated in focus groups. Crime, limited knowledge of positive health behaviors, lack of access to affordable healthcare, and lack of access to safe spaces for recreational activities were identified as threats to good health. Participant recommendations to support health in the community included increasing police presence to improve safety and reduce violence, and increasing opportunities/locations for physical exercise. While differences between Cambodian and Latino residents exist, the identified threats and suggested improvements were primarily associated with environmental factors, highlighting the need for systems level approaches that recognize the relationship between community context and health.
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Affiliation(s)
- L H D'Anna
- Center for Health Equity Research, California State University, Long Beach, 1250 Bellflower Blvd., F05-120, Long Beach, CA, 90840, USA.
| | - V Peong
- The Cambodian Family, Santa Ana, CA, USA
| | - P Sabado
- Center for Health Equity Research, California State University, Long Beach, 1250 Bellflower Blvd., F05-120, Long Beach, CA, 90840, USA
| | - A Valdez-Dadia
- Center for Health Equity Research, California State University, Long Beach, 1250 Bellflower Blvd., F05-120, Long Beach, CA, 90840, USA
| | - M C Hansen
- School of Social Work, California State University, Long Beach, Long Beach, CA, USA
| | - C Canjura
- Center for Health Equity Research, California State University, Long Beach, 1250 Bellflower Blvd., F05-120, Long Beach, CA, 90840, USA
| | - M Hong
- Care Counseling, Minneapolis, MN, USA
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Risk of Developing Diabetes Among Refugees and Immigrants: A Longitudinal Analysis. J Community Health 2016; 41:1274-1281. [DOI: 10.1007/s10900-016-0216-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Wagner J, Berthold SM, Buckley T, Kong S, Kuoch T, Scully M. Diabetes among refugee populations: what newly arriving refugees can learn from resettled Cambodians. Curr Diab Rep 2015; 15:56. [PMID: 26143533 DOI: 10.1007/s11892-015-0618-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A growing body of literature suggests that cardiometabolic disease generally and type 2 diabetes specifically are problems among refugee groups. This paper reviews rates of cardiometabolic disease and type 2 diabetes among refugees and highlights their unique risk factors including history of malnutrition, psychiatric disorders, psychiatric medications, lifestyle changes toward urbanization and industrialization, social isolation, and a poor profile on the social determinants of health. Promising interventions are presented for preventing and treating diabetes in these groups. Such interventions emphasize well-coordinated medical and mental health care delivered by cross-cultural and multidisciplinary teams including community health workers that are well integrated into the community. Finally, recommendations for service, policy, and research are made. The authors draw on local data and clinical experience of our collective work with Cambodian American refugees whose 30-year trajectory illustrates the consequences of ignoring diabetes and its risk factors in more recent, and soon to be arriving, refugee cohorts.
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Affiliation(s)
- Julie Wagner
- University of Connecticut Health Center, MC3910, 263 Farmington Ave., Farmington, CT, 06030, USA,
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