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Objectives. We described elevated blood lead level (BLL; ≥ 10 μg/dL) prevalence among newly arrived refugee children in Massachusetts. We also investigated the incidence of BLL increases and BLLs newly elevated to 20 μg/dL or higher in the year following initial testing, along with associated factors. Methods. We merged data from the Massachusetts Department of Public Health's Refugee and Immigrant Health Program and the Childhood Lead Poisoning Prevention Program on 1148 refugee children younger than 7 years who arrived in Massachusetts from 2000 to 2007. Results. Elevated BLL prevalence was 16% among newly arrived refugee children. The rate ratio for BLL elevation to 20 μg/dL or higher after arrival was 12.3 (95% confidence interval [CI] = 6.2, 24.5) compared with children in communities the state defines as high-risk for childhood lead exposure. Residence in a census tract with older housing (median year built before 1950) was associated with a higher rate of BLL increases after resettlement (hazard ratio = 1.7; 95% CI = 1.2, 2.3). Conclusions. Refugee children are at high risk of lead exposure before and after resettlement in Massachusetts. A national surveillance system of refugee children's BLLs following resettlement would allow more in-depth analysis.

Objectives. This study analyzed growth and identified related medical conditions among refugee children in Massachusetts. Methods. Between July 1995 and June 1998, 1825 refugee children were screened. Variables included positive tuberculin (purified protein derivative; PPD) test; dental abnormalities; pathogenic parasites; weight-for-age, height-for-age, and weight-for-height z scores; and body mass index greater than the 84th percentile. Results. Of all the children, 21% had parasites, 62% had caries, and 25% had a positive PPD reaction. Twelve percent overall and 28% younger than 2 years had anemia. Eight percent had height-for-age z scores less than –2, and 6% had weight-for-age z scores greater than +2. Of those aged 1 to 9 years, 7% had weight-for-height z scores greater than +2. Weight-for-height z scores less than –2 were concentrated among Africans and East Asians (both 8%). Height-for-age z scores less than –2 were seen among African (13%), Near Eastern (19%), and East Asian (30%) children. Weight-for-height z scores greater than +2 and body mass index greater than the 84th percentile were concentrated among children from the former Yugoslavia (8% and 15%) and the former Soviet Union (8% and 14%). Conclusions. Recently arrived refugee children have significant growth abnormalities. European refugees were overweight; those from developing countries had growth retardation.

Objectives. We assessed the impact of health literacy and acculturation on oral health status of Somali refugees in Massachusetts. Methods. Between December 2009 and June 2011, we surveyed 439 adult Somalis who had lived in the United States 10 years or less. Assessments included oral examinations with decayed, missing, and filled teeth (DMFT) counts and measurement of spoken English and health literacy. We tested associations with generalized linear regression models. Results. Participants had means of 1.4 decayed, 2.8 missing, and 1.3 filled teeth. Among participants who had been in the United States 0 to 4 years, lower health literacy scores correlated with lower DMFT (rate ratio [RR] = 0.78; P = .016). Among participants who had been in the country 5 to 10 years, lower literacy scores correlated with higher DMFT (RR = 1.37; P = .012). Literacy was not significantly associated with decayed teeth. Lower literacy scores correlated marginally with lower risk of periodontal disease (odds ratio = 0.22; P = .047). Conclusions. Worsening oral health of Somali refugees over time may be linked to less access to preventive care and less utilization of beneficial oral hygiene practices.

US law and regulations stipulate a process for the health screening of refugees. The responsibility of caring for refugees resettled in the United States rests, in part, with public health or welfare departments. Massachusetts has met its screening responsibilities through the innovative creation of a network of private preferred providers. We explore the Massachusetts model of public–private collaboration within the context of federal refugee health priorities and current state fiscal restraints affecting public health programs, and demonstrate the model’s accomplishments.

Objectives. This study assessed the potential impact of immigration reporting requirements on pediatricians' referrals to child protective services. Methods. A random sample of 200 Massachusetts pediatricians were surveyed. Chi-square and logistic regression analyses were performed. Results. Asked whether potential deportation of the family would cause them to question or alter a decision to refer, 50% of the respondents said yes. Conclusions. Pediatricians, as mandated reporters of child abuse, will face ethical dilemmas if laws requiring reporting of immigration status are enacted. (Am J Public Health. 1998;88:967-968)