Reason for immigration and immigrants' health

Criminological and Psychiatric Profiles of Immigrant and Refugee Offenders: A Retrospective Analysis of Cases in a Forensic Setting

This study aimed to scrutinize the characteristics of immigrant and refugee offenders within our institution, focusing on factors such as immigrant status, country of birth, duration of residence in Turkey, as well as psychiatric, socio-demographic, and criminal profiles. The data were obtained through a retrospective examination of case records referred to the Observation Department of the Council of Forensic Medicine for the assessment of criminal responsibility between 2017 and 2022. The study categorized the cases into two groups: refugees and immigrants, comprising 35 and 22 offenders, respectively. Significant differences in educational levels were identified between immigrants and refugees within our study group (p < .001). Notably, drug use disorders were more prevalent among refugees, whereas alcohol use disorders were more common among immigrants, with statistical significance (p < .005). During forensic psychiatric assessments, 57.1% of refugees and 54.5% of immigrants required interpretation services. The most prevalent offense in the refugee group was homicide (37.1%), followed by child sexual abuse (28.6%). In contrast, homicide (31.8%) and theft and extortion (22.7%) were the most common offenses for the immigrant group. Six cases (10.5%) were judged to have reduced or no criminal liability. Among the cases, 52.6% had a history of prior outpatient psychiatric referrals, with the most frequent diagnosis being atypical psychosis at 10.5%. The findings underscore the necessity for additional research and targeted interventions to address the mental health and criminological complexities confronted by this vulnerable population.

Reasons for migration, parental acculturation, and language: the case of Chinese American and Mexican American parents and dual language learners

Migration is a complex process associated with a range of social, economic, and political reasons. In the U.S., almost one-quarter of the total population of parents are immigrant parents of children ages 0-10. Immigrant parents transmit values from their culture of origin as well as their language to their children. Additionally, they may undergo a process of cultural and psychological change known as acculturation. Research has shown that acculturation can be linked to parenting styles and adolescents' psychological well-being and behavioral problems. However, little is known about the associations among immigrant parents' acculturation, their home language and literacy practices, and their bilingual children's language skills. This study explores the relationships among reasons for migration, parental acculturation, home language and literacy practices, and child expressive vocabulary in English and their heritage language (HL). A group of 190 Spanish-English (N = 66) and Chinese-English (N = 124) dual language learners (DLLs) (mean age = 48.98 months) and their Chinese and Mexican parents (mean age of migration = 18.57 and 21.38 years old respectively participated. Frequency counts revealed that Mexican American families migrated to the U.S. mostly for multiple reasons, including joining family members, getting married, and looking for better education or job opportunities, whereas most Chinese American families migrated for family reasons only. Path analysis models showed that, for both cultural groups, language input in Spanish and Chinese mediated the relationship between parents' cultural orientations and DLLs' HL expressive vocabulary. These findings emphasize that despite the heterogeneity of immigrant families and the variability in DLLs' vocabulary skills in preschool, there exist some similarities across immigrant parents and bilingual children. A deeper understanding of acculturation practices and home language use can help educators better support children from diverse backgrounds and promote cultural awareness and sensitivity in the classroom.

Reasons for Migration, Post-Migration Sociocultural Characteristics, and Parenting Styles of Chinese American Immigrant Families

With the growing percentage of Chinese immigrants in the U.S. population, it is crucial to understand how pre-migration factors (such as reasons for migration) are related to the adjustment of families in the host country. The present study examined reasons for migration and their associations with post-migration sociocultural factors and parenting styles in a community-based sample of Chinese American immigrant families (N = 258) living in the San Francisco Bay Area. The parents' self-reported reasons for migration included family reasons (55.1%, e.g., family reunification), betterment reasons (18.0%, e.g., better education and occupational opportunities), and both family and betterment reasons (26.9%). Those who migrated for betterment reasons reported significantly higher parental education and per capita income than the family reason group (p < 0.001) and significantly higher income than the combined reason group (p = 0.007). No significant group differences emerged in cultural orientations and parenting styles after controlling for socioeconomic factors. The findings suggested that Chinese immigrant families who migrated solely for better education and occupational opportunities had significantly higher post-migration socioeconomic status than other reason groups. These differences have relevance for programs and services for new immigrants, as families might need different types of support (e.g., socioeconomic vs. relational) depending on their motivations for migration and post-migration socioeconomic resources.

European immigrant health policies, immigrants' health, and immigrants' access to healthcare

OBJECTIVE

Evidence indicates presence of immigrant health disparities in the European Union (EU) and the United States (US). We examined the association between immigrant health policies and the gap in health status, unmet needs and service use between immigrants and citizens, in the EU and US.

METHODS

We used the Migrant Integration Policy Index (MIPEX), European Health Interview Survey, and National Health Interview Survey for 2014. Our independent variables of interest were MIPEX Health strand score and citizenship. Our dependent variables were four measures of health status (self-reported poor health; severely limited in general activities; two or more comorbidities; one or more ambulatory care sensitive conditions) and four measures of health access and utilization (unmet need due to non-financial reasons; could not afford needed health care; one or more primary care visits last year; any hospitalization last year). We conducted linear probability models and presented the marginal effects of each outcome in percentage points.

FINDINGS

We found that immigrant-friendly health policies were significantly associated with better health and less unmet need due to non-financial reasons.

CONCLUSION

Our findings supported the promotion of immigrant-friendly and a 'Health-in-All Policies' (HiAP) approach to preserve the health of immigrants.

Migrants' primary care utilisation before and during the COVID-19 pandemic in England: An interrupted time series analysis

Background

How international migrants access and use primary care in England is poorly understood. We aimed to compare primary care consultation rates between international migrants and non-migrants in England before and during the COVID-19 pandemic (2015-2020).

Methods

Using data from the Clinical Practice Research Datalink (CPRD) GOLD, we identified migrants using country-of-birth, visa-status or other codes indicating international migration. We linked CPRD to Office for National Statistics deprivation data and ran a controlled interrupted time series (ITS) using negative binomial regression to compare rates before and during the pandemic.

Findings

In 262,644 individuals, pre-pandemic consultation rates per person-year were 4.35 (4.34-4.36) for migrants and 4.60 (4.59-4.60) for non-migrants (RR:0.94 [0.92-0.96]). Between 29 March and 26 December 2020, rates reduced to 3.54 (3.52-3.57) for migrants and 4.2 (4.17-4.23) for non-migrants (RR:0.84 [0.8-0.88]). The first year of the pandemic was associated with a widening of the gap in consultation rates between migrants and non-migrants to 0.89 (95% CI 0.84-0.94) times the ratio before the pandemic. This widening in ratios was greater for children, individuals whose first language was not English, and individuals of White British, White non-British and Black/African/Caribbean/Black British ethnicities. It was also greater in the case of telephone consultations, particularly in London.

Interpretation

Migrants were less likely to use primary care than non-migrants before the pandemic and the first year of the pandemic exacerbated this difference. As GP practices retain remote and hybrid models of service delivery, they must improve services and ensure primary care is accessible and responsive to migrants' healthcare needs.

Funding

This study was funded by the Medical Research Council (MC_PC 19070 and MR/V028375/1) and a Wellcome Clinical Research Career Development Fellowship (206602).

The Missing Mortality Advantage for European Immigrants to the United States in the Early Twentieth Century

Immigrant populations typically have lower mortality rates and longer life expectancies than their nonimmigrant counterparts. This immigrant mortality advantage has been a recurrent finding in demographic and population health research focused on contemporary waves of immigration. However, historical data suggest that European immigrants to the United States in the early twentieth century had worse health and higher rates of mortality, yet it remains unclear why a mortality advantage was absent for immigrants during this period. This article combines Vital Statistics records and Lee-Carter mortality models to analyze mortality by nativity status for the U.S. White population from 1900 to 1960, examining variation by age, sex, time, and place. Contrary to contemporary expectations of a foreign-born mortality advantage, White immigrants had higher mortality rates in the early 1900s, with the largest foreign-born disadvantage among the youngest and oldest populations. Although foreign-born and U.S.-born White mortality rates trended toward convergence over time, the foreign-born mortality penalty remained into the 1950s. A decomposition analysis finds that immigrants' concentration in cities, which had higher rates of infectious disease mortality, accounted for nearly half of the nativity difference in 1900, and this place effect declined in subsequent decades. Additional evidence, such as a spike in mortality inequalities during the 1918 influenza pandemic, suggests that common explanations for the immigrant mortality advantage may be less influential in a context of high risk from infectious disease.

Self-Rated Health Among Italian Immigrants Living in Norway: A Cross-Sectional Study

Background

Most studies on immigrant health focus on immigrant groups coming from extra-European and/or low-income countries. Little attention is given to self-rated health (SRH) in the context EU/EEA migration. To know more about health among European immigrants can provide new insights related to social determinants of health in the migration context. Using the case of Italian immigrants in Norway, the aim of this study was to (i) examine the levels of SRH among Italian immigrants in Norway as compared with the Norwegian and the Italian population, (ii) examine the extent to which the Italian immigrant perceived that moving to Norway had a positive or negative impact on their SRH; and (iii) identify the most important factors predicting SRH among Italian immigrants in Norway.

Methods

A cross-sectional survey was conducted among adult Italian immigrants in Norway (n = 321). To enhance the sample's representativeness, the original dataset was oversampled to match the proportion of key sociodemographic characteristics of the reference population using the ADASYN method (oversampled n = 531). A one-sample Chi-squared was performed to compare the Italian immigrants' SRH with figures on the Norwegian and Italian populations according to Eurostat statistics. A machine-learning approach was used to identify the most important predictors of SRH among Italian immigrants.

Results

Most of the respondents (69%) rated their SRH as "good" or "very good". This figure was not significantly different with the Norwegian population, nor to the Italians living in Italy. A slight majority (55%) perceived that their health would have been the same if they continued living in Italy, while 23% perceived a negative impact. The machine-learning model selected 17 variables as relevant in predicting SRH. Among these, Age, Food habits, and Years of permanence in Norway were the variables with the highest level of importance, followed by Trust in people, Educational level, and Health literacy.

Conclusions

Italian immigrants in Norway can be considered as part of a "new mobility" of high educated people. SHR is shaped by several interconnected factors. Although this study relates specifically to Italian immigrants, the findings may be extended to other immigrant populations in similar contexts.

(Not That) Essential: A Scoping Review of Migrant Workers' Access to Health Services and Social Protection during the COVID-19 Pandemic in Australia, Canada, and New Zealand

Migrant workers have been disproportionately affected by the COVID-19 pandemic. To examine their access to health services and social protection during the pandemic, we conducted an exploratory scoping review on experiences of migrant workers in three countries with comparable immigration, health, and welfare policies: Australia, Canada, and New Zealand. After screening 961 peer-reviewed and grey literature sources, five studies were included. Using immigration status as a lens, we found that despite more inclusive policies in response to the pandemic, temporary migrant workers, especially migrant farm workers and international students, remained excluded from health services and social protection. Findings demonstrate that exploitative employment practices, precarity, and racism contribute to the continued exclusion of temporary migrant workers. The interplay between these factors, with structural racism at its core, reflect the colonial histories of these countries and their largely neoliberal approaches to immigration. To address this inequity, proactive action that recognizes and targets these structural determinants at play is essential.

Acculturation Strategies and Pap Screening Uptake among Sub-Saharan African Immigrants (SAIs)

Although regular cervical cancer screening can prevent cervical cancer, screening utilization remains low among immigrant population including sub-Saharan African immigrants (SAIs). Acculturation is a complex process, which can lead to adoption of positive or negative health behaviors from the dominant culture. Acculturation strategies are the varying ways in which individuals seek to go about their acculturation by either maintaining or rejecting their own cultural values ip or accepting or rejecting the host culture’s cultural values. Cervical cancer screening behaviors among SAI women may be influenced by their acculturation strategies. We conducted a secondary analysis of data to examine the relationship between acculturation strategies and Pap screening among 99 SAI women recruited from community settings. Data were collected on Pap screening behavior and acculturation strategy. Traditionalists and Integrationists were the dominant acculturation strategies; 32.3% women were Traditionalists and 67.7% Integrationists. From the logistic regression models, Integrationists had seven times the odds of having ever been screened compared to Traditionalists (OR = 7.08, 95% CI = 1.54–28.91). Cervical cancer screening interventions should prioritize Traditionalists for cancer screening. Acculturation strategies may be used to tailor cancer prevention and control for SAIs. More research among a larger SAI women sample is warranted to further our understanding of Pap screening patterns and acculturation strategies.

When in America, do as the Americans? The evolution of health behaviors and outcomes across immigrant cohorts

This study seeks to understand US immigrants' health-related behaviors and outcomes across arrival cohorts. We simultaneously examine risky consumption choices (smoking and drinking) and physical health conditions (asthma, diabetes, vision problems, and coronary heart diseases) using data from the National Health Interview Surveys (1989-2018). We incorporate cohort fixed-effects and the interactions between cohort effects and years since immigration into our empirical framework to capture the dynamics of immigrant health over time. For all health indicators, we find that there are important differences between arriving immigrants and natives. Despite some heterogeneity in the dynamics of unhealthy behaviors, this heterogeneity seems to dissipate as we explore longer-term health outcomes. Overall, our findings provide an interesting outlook on how the integration into the host society affects American immigrants' health. We contribute new results to the immigrant assimilation literature, which has primarily focused on obesity and wages.

Exploring the impact of multidimensional refugee vulnerability on distancing as a protective measure against COVID-19: The case of Syrian refugees in Lebanon and Turkey

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The conditions of refugee living make distancing an impractical COVID-19 protection measure.

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Refugees are increasingly susceptible to the biological and socioeconomic effects of COVID-19, due to the decreased ability to practice distancing measures.

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We suggest an interdisciplinary framework, based on biosocial perspectives on health, to guide more relevant COVID-19 responses in refugee communities.

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Intervention and protection measures should consider the political, material, spatial, physiological, psychological and sociocultural dimensions of refugee vulnerability to mitigate decreased distancing abilities in settings of refugee life.

Background

The unequal physiological and socioeconomic consequences of the COVID-19 pandemic across the world are revealing the multidimensional components of health and vulnerability. As governments have pushed physical and social distancing as protective strategies, this study explores the extent to which this approach is relevant for Syrian refugees living in Lebanon and Turkey.

Methods

This qualitative study draws on 11 interviews with refugee experts and development practitioners (3) and Syrian refugee families (4 from Turkey, 4 from Lebanon) during the COVID-19 pandemic, as well as a review of recent literature. In addition, it draws on 71 semi-structured interviews with staff at NGOs supporting refugees (48 from Turkey, 23 from Lebanon) collected in 2018. Qualitative data analysis software ATLAS.ti 8 was used to perform content-based thematic analysis using both deductive and inductive coding.

Findings

The study finds that distancing—physically and socially—can be ineffective as a disease protection strategy in Syrian refugee communities. This is influenced by six major interconnected dimensions of refugee vulnerability—political, material, spatial, physiological, psychological and sociocultural—which collectively form an interdisciplinary framework to guide more relevant COVID-19 interventions in refugee communities. The inability to distance is not necessarily rooted in lack of knowledge. Rather, when the inside conditions of living are crowded and unhygienic, but also include cultural expectations of familial care, and the outside conditions of survival-necessitated work are perpetuated through precarious political protections, distancing becomes impractical in application, despite the sense of internalized responsibility to keep one another safe.

Conclusions

The findings suggest that more relevant COVID-19 interventions and protection measures must consider the non-physiological manifestations of disease across multiple dimensions of vulnerability to mitigate decreased distancing abilities in settings of refugee life.

Health-related quality of life of refugees: a systematic review of studies using the WHOQOL-Bref instrument in general and clinical refugee populations in the community setting

Purpose

To systematically review studies on HRQOL, measured by the WHOQOL-Bref instrument, of refugees in general and clinical populations who are settled in the community of the hosting country, and outline the differences in scores among the two population groups and across the four domains of WHOQOL-Bref (physical, psychological, social relationships and environment domain) as well as factors impacting those outcomes.

Methods

Several databases were systematically searched by using a broad search strategy. Additionally, a hand search for grey literature was performed. Studies had to comply with the following inclusion criteria: (a) population of refugees; (b) living in the community of the country of destination; (c) assessing HRQOL through the WHOQOL-Bref instrument.

Results

15 studies were identified and divided into two subgroups: (a) general population of refugees (b) clinical population of refugees, who were specifically selected for their mental status or because they had experienced relevant past traumas. Although we can outline common patterns among the two groups, in terms of domains scoring the highest and the lowest, heterogeneous values of HRQOL are observed across the studies included.

Conclusions

Individuals who were included in the clinical refugee group have a lower quality of life in respect to the general population of refugees. However, among the two groups different patterns can be outlined considering each domain of HRQOL: higher scores for the Physical and lower for the Environment domain when considering the general population of refugees and higher scores for the Environment and lower for the Psychological domain when referring to the clinical one. These lower scores are probably due to having a higher rate of mental distress and being more exposed to somatization, stigmatization and barriers to access the healthcare system of the hosting country.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13031-021-00378-1.

Implications of Migration Patterns and Sex Work on Access to Health Services and Key Health Outcomes: A Qualitative Study on Male Migrant Sex Workers in London

Objectives

This paper describes migration toward the UK, sex work involvement, use of health services, and health issues.

Methods

This qualitative study interviewed twenty-five men. The data were analyzed using thematic analysis.

Results

Five main themes emerged: emigration, migration routes, sex work entrance, use of health services, and main health outcomes.

Conclusions

Discrimination and social exclusion were identified before and during migration. Participants had used the NHS system and told positive experiences. They reported STI-HIV, recreational drugs and mental health issues. Findings suggest the influence of migration and sex work on their vulnerabilities and health outcomes.

Climate-related migration and population health: social science-oriented dynamic simulation model

BACKGROUND

Social science models find the ecological impacts of climate change (EICC) contribute to internal migration in developing countries and, less so, international migration. Projections expect massive climate-related migration in this century. Nascent research calls to study health, migration, population, and armed conflict potential together, accounting for EICC and other factors. System science offers a way: develop a dynamic simulation model (DSM). We aim to validate the feasibility and usefulness of a pilot DSM intended to serve as a proof-of-concept and a basis for identifying model extensions to make it less simplified and more realistic.

METHODS

Studies have separately examined essential parts. Our DSM integrates their results and computes composites of health problems (HP), health care (HC), non-EICC environmental health problems (EP), and environmental health services (ES) by origin site and by immigrants and natives in a destination site, and conflict risk and intensity per area. The exogenous variables include composites of EICC, sociopolitical, economic, and other factors. We simulate the model for synthetic input values and conduct sensitivity analyses.

RESULTS

The simulation results refer to generic origin and destination sites anywhere on Earth. The effects' sizes are likely inaccurate from a real-world view, as our input values are synthetic. Their signs and dynamics are plausible, internally consistent, and, like the sizes, respond logically in sensitivity analyses. Climate migration may harm public health in a host area even with perfect HC/ES qualities and full access; and no HP spillovers across groups, conflict, EICC, and EP. Deviations from these conditions may worsen everyone's health. We consider adaptation options.

CONCLUSIONS

This work shows we can start developing DSMs to understand climate migration and public health by examining each case with its own inputs. Validation of our pilot model suggests we can use it as intended. We lay a path to making it more realistic for policy analysis.

Cancer incidence in non-immigrants and immigrants in Norway

BACKGROUND

Major cancers are associated with lifestyle, and previous studies have found that the non-immigrant populations in the Nordic countries have higher incidence rates of most cancers than the immigrant populations. However, rates are changing worldwide - so these differences may disappear with time. Here we present recent cancer incidence rates among immigrant and non-immigrant men and women in Norway and investigate whether previous differences still exist.

MATERIAL AND METHODS

We took advantage of a recent change in the Norwegian Cancer Registry regulations that allow for the registry to have information on country of birth. The number of person years for 2014-2018 was aggregated for every combination of sex, five-year age-group and country of birth, by summing up each year's population in these groups. The number of cancer cases was then counted for the same groups, and age-standardised incidence rates calculated by weighing the age-specific incidence rates by the Nordic and World standard populations. Further, we calculated incidence rate ratios using the non-immigrant population as a reference.

RESULTS

Immigrants from Eastern Europe, the Middle East, Africa and Asia had lower incidence of total cancer compared to the non-immigrant population in Norway and immigrants born in the other Nordic or high-income countries. However, some cancers were more common in certain immigrant groups. Asian men and women had threefold the incidence of liver cancer than non-immigrant men and women. Men from the other Nordic countries and from Eastern Europe had higher lung cancer rates than non-immigrant men.

CONCLUSION

National registries should continuously monitor and present cancer incidence stratified on important population subgroups such as country of birth. This can help assess population subgroup specific needs for cancer prevention and treatment, and could eventually help reduce the morbidity and mortality of cancer.

Health Disparities: A Perspective on Internal Migration and Health Behavior in Sudan

Background:

Natural hazards, poor socio-economic conditions, low literacy levels, and long-standing conflicts affect traditional gold miners in Sudan and contribute to multiple health vulnerabilities. An extensive survey reveals differential health risk among internal migrant miners leading to short-, medium-, and long-term health consequences and disparities. The need to identify determinants of health behavior and limited prior research on internal migrants involved in traditional gold mining in Sudan motivated this research.

Objective:

To investigate potential health disparities between internal migrant workers participating in traditional gold mining and their local counterparts.

Methods:

Questionnaires on socio-demographic and health status in the Abideya area in the River Nile state of Sudan were administered to 211 miners. Composite score variables were devised based on existing literature and data for assessment of underlying risk determinants for the miners’ vulnerability (migrants and non-migrants). Six new composite variables were constructed and subjected to analysis by immigration status.

Findings:

There are disparities in drivers of health behavior related to the immigration status of traditional gold miners. Access to water, sanitation, and hygiene services are common determinants for the health behavior of both internal migrant miners (p < 0.001) and their local counterparts (p < 0.001). However, knowledge (p < 0.05) and perception (p < 0.05) are additional critical determinants for the health behavior of local miners, while education (secondary, p < 0.01) is an additional modifier for the immigrants’ health behavior.

Conclusions:

The outcomes of this field-based research suggest increased awareness and risk perceptions among migrants could improve health-related behaviors. The study advocates for policymaking and implementation of health programs at all levels to reduce health disparities between migrants and non-migrants, improving the health status of the entire community.

The Relationships between Loneliness, Social Support, and Resilience among Latinx Immigrants in the United States

Globally, international migrants are at elevated risk for experiencing loneliness due to separation from social networks in their countries of origin. In the United States, the political rhetoric has been particularly exclusionary against Latinx immigrants, exposing them to discrimination and fear of deportation. Such environments may result in heightened levels of social isolation, which may contribute to greater risk of poor mental and physical health outcomes. Latinx immigrants, however, may access social support in their destination communities that buffers against these negative outcomes. This study sought to examine how social support and loneliness shape Latinx immigrants' abilities to address the challenges related to migration. Multivariate linear regression analyses were conducted with survey data collected from Latinx immigrants in New York City (n=306). Results revealed that Latinx immigrants with greater social support and less feelings of loneliness were more resilient. Specifically, findings suggest that social support may partially protect against the negative impact of isolation on Latinx immigrants' capacity to thrive. Clinical social workers who work with immigrant groups may consider how migration during the life course affects immigrants' social supports and experiences of loneliness. Social work interventions that integrate strategies to increase social support may provide opportunities to address social isolation and other obstacles associated with migration. Such approaches acknowledge loneliness not only as a psychological symptom, but also as a consequence of unfavorable social environments towards immigrant populations. Future research may develop and assess culturally relevant strategies to promote social support and reduce loneliness among marginalized immigrants.

Factor Structures of Reasons for Immigration Among Older Asian and Latino Immigrants in the United States

Backgrounds and Objectives

Although reasons for immigration are significant predictors of immigrants’ health, factor structures of reasons for immigration are still unclear among older immigrants. The present study examined the factor structure of reasons for immigration among older Asian and Latino immigrants in the United States.

Research Design and Methods

Drawn from the National Latino and Asian American Study, 396 Latino and 298 Asian immigrants over 55 years of age were selected for analysis. Exploratory factor analysis was conducted for nine items concerning reasons for immigration in each immigrant group.

Results

Three factors were extracted from both Asian and Latino immigrant elders: (a) “voluntary reasons” to pursue development, (b) “involuntary reasons” due to uncontrollable situations, and (c) “semivoluntary reasons” regarding family/medical duties. While immigration to join family members was located in the “semivoluntary reasons” factor among older Asian immigrants, it was located in the “voluntary reasons” factor among older Latino immigrants.

Discussion and Implications

These findings suggest that three underlying factors of reasons for immigration should be understood considering the different characteristics of two racial/ethnic groups of immigrants. In addition, a migratory reason to join the family should be considered differently for elderly Asian and Latino immigrants. This three-factor framework of reasons for immigration can help clinicians provide more culturally sensitive interventions for older minority immigrants.