Looking Back: The Contested Whiteness of Arab Identity

Unveiling the Invisible: Challenges Faced by Arab Women International Medical Graduates in U.S. Academia

PURPOSE

The Arab experience is understudied because until 2024 Arabs were categorized as White on the U.S. Census, leading to diminished documentation of their personal experiences. There is also little understanding of the Arab experience and its intersectionality with gender, being an international medical graduate (IMG), and working in academia. The authors studied the experience of Arab women IMGs working in the U.S. academic system.

METHOD

This qualitative study used interpretative phenomenological analysis to analyze in-depth interview data from 20 first-generation U.S. immigrant Arab women who were IMGs. Interpretative phenomenologicalanalysis involved data familiarization, immersion, and coding. Codes were grouped into potential themes on the participants' experience. The authors explored connections between the themes and engaged in reflexive practice through memo writing and team meetings. The study was performed from November 2022-May 2023.

RESULTS

The experiences of the 20 first-generation U.S. immigrant Arab women IMGs were as diverse as the Arab identity itself but congruent with some documented IMG experiences. Political turmoil, desire for new opportunities, and career goals were all reasons that led them to emigrate, but cultural differences, isolation from their home countries, and missing family were central to their experiences. Muslim women wearing the hijab or those with heavy accents faced more microaggressions and xenophobia in academic clinical settings. Those in environments that embraced their differences and supported them described less discrimination. They all felt, nonetheless, that they benefited from training in the United States. However, they noted room for improving cultural humility in residencies and the need for a more inclusive workplace.

CONCLUSIONS

This study highlights the visible and invisible challenges that affect Arab women IMGs' experience in the United States. Program directors and department leaders should try to learn about the backgrounds of IMGs and current geopolitical events that might affect IMGs and extend support.

Diabetes Among Racial and Ethnically Diverse Older Adults in the United States with Cognitive Limitations

Diabetes is one of the most common coexisting conditions among adults with cognitive limitations. Complexities of diabetes care present challenges for older adults and their caregivers. Few studies have evaluated disparities in the prevalence of coexisting diabetes among older adults with cognitive limitations by race/ethnicity and nativity. Our objectives were to (1) estimate the odds of coexisting diabetes among US- and foreign-born racial/ethnic groups compared to US-born non-Hispanic White older adults and (2) compare US- and foreign-born older adults within each racial/ethnic group. We linked and analyzed 2000-2017 National Health Interview Survey and 2001-2018 Medical Expenditure Panel Survey data among older adults with cognitive limitations (ages ≥ 65 years, n = 4688). The overall prevalence of coexisting diabetes among older adults with cognitive limitations was 30.3%. Among older adults with cognitive limitations and after adjusted for age, sex, education, and risk factors for diabetes and cognitive limitations, non-Hispanic Black (US-born OR = 1.56, 95%CI = 1.23-1.98; foreign-born OR = 2.69, 95%CI = 1.20-6.05) and Hispanic (US-born OR = 2.13, 95%CI = 1.34-3.40; foreign-born OR = 2.02, 95%CI = 1.49-2.72) older adults had higher odds of coexisting diabetes compared to US-born non-Hispanic Whites. There were no differences in the odds of coexisting diabetes among foreign-born non-Hispanic Black and Hispanic adults compared to US-born counterparts. Findings suggest a large potential burden of coexisting diabetes among this growing populations of US- and foreign-born racially/ethnically diverse older adults with cognitive limitations. Future studies are needed to examine how diabetes self-efficacy, treatment, and monitoring are impacted by cognitive limitations and determine ways to improve care in collaboration with caregivers and healthcare providers.

East is east … or is it? Racialization of Asian, Middle Eastern, and Pacific Islander persons

The conventional use of racial categories in health research naturalizes "race" in problematic ways that ignore how racial categories function in service of a White-dominated racial hierarchy. In many respects, racial labels are based on geographic designations. For instance, "Asians" are from Asia. Yet, this is not always a tenable proposition. For example, Afghanistan resides in South Asia, and shares a border with China and Pakistan. Yet, people from Afghanistan are not considered Asian, but Middle Eastern, by the US Census. Furthermore, people on the west side of the Island of New Guinea are considered Asian, whereas those on the eastern side are considered Pacific Islander. In this article, we discuss the complexity of the racial labels related to people originating from Oceania and Asia, and, more specifically, those groups commonly referred to as Pacific Islander, Middle Eastern, and Asian. We begin with considerations of the aggregation fallacy. Just as the ecological fallacy refers to erroneous inferences about individuals from group data, the aggregation fallacy refers to erroneous inferences about subgroups (eg, Hmong) from group data (ie, all Asian Americans), and how these inferences can contribute to stereotypes such as the "model minority." We also examine how group averages can be influenced merely by the composition of the subgroups, and how these, in turn, can be influenced by social policies. We provide a historical overview of some of the issues facing Pacific Islander, Middle Eastern, and Asian communities, and conclude with directions for future research.

Survival of Middle Eastern and North African Individuals Diagnosed with Colorectal Cancer: A Population-Based Study in California

BACKGROUND

Literature on colorectal cancer outcomes in individuals of Middle Eastern and North African (MENA) descent is limited. To address this gap, we estimated five-year colorectal cancer-specific survival by race and ethnicity, including MENA individuals, in a diverse, population-based sample in California.

METHODS

We identified adults (ages 18-79 years) diagnosed with a first or only colorectal cancer in 2004 to 2017 using the California Cancer Registry (CCR), including non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, Hispanic, and MENA individuals. For each racial/ethnic group, we calculated five-year colorectal cancer-specific survival and used Cox proportional hazards regression models to examine the association of race/ethnicity and survival, adjusting for clinical and socio demographic factors.

RESULTS

Of 110,192 persons diagnosed with colorectal cancer, five-year colorectal cancer-specific survival was lowest in Black (61.0%) and highest in MENA (73.2%) individuals. Asian (72.2%) individuals had higher survival than White (70.0%) and Hispanic (68.2%) individuals. In adjusted analysis, MENA [adjusted HR (aHR), 0.82; 95% confidence interval (CI), 0.76-0.89], Asian (aHR, 0.86; 95% CI, 0.83-0.90), and Hispanic (aHR, 0.94; 95% CI, 0.91-0.97) race/ethnicity were associated with higher, and Black (aHR, 1.13; 95% CI, 1.09-1.18) race/ethnicity was associated with lower survival compared with non-Hispanic White race/ethnicity.

CONCLUSIONS

To our knowledge, this is the first study to report colorectal cancer survival in MENA individuals in the United States. We observed higher survival of MENA individuals compared with other racial/ethnic groups, adjusting for sociodemographic and clinical factors.

IMPACT

Future studies are needed to identify factors contributing to cancer outcomes in this unique population.