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Objectives: Black Caribbeans in the United States have been the victims of major discrimination (e.g. unfairly fired, denied a promotion, denied housing). What is not known is the degree to which they also experience more routine forms of everyday discrimination such as receiving poor restaurant service, being perceived as dishonest, and being followed in stores. This paper investigates the distribution and correlates of everyday discrimination among a national sample of black Caribbeans in the U.S. Design: This analysis used the black Caribbean sub-sample (n = 1,621) of the National Survey of American Life. Demographic and immigration status correlates of ten items from the Everyday Discrimination Scale were investigated: being treated with less courtesy, treated with less respect, receiving poor restaurant service, being perceived as not smart, being perceived as dishonest, being perceived as not as good as others, and being feared, insulted, harassed, or followed in stores. Results: Roughly one out of ten black Caribbeans reported that, on a weekly basis, they were treated with less courtesy and other people acted as if they were better than them, were afraid of them, and as if they were not as smart. Everyday discrimination was more frequent for black Caribbeans who were male, never married, divorced/separated, earned higher incomes, and who were second or third generation immigrants. Black Caribbeans attributed the majority of the discrimination they experienced to their race. Conclusion: To our knowledge, this is the first study to provide an in-depth investigation of everyday discrimination among the black Caribbean population. It provides the frequency, types and correlates of everyday discrimination reported by black Caribbeans in the United States. Understanding the frequency and types of discrimination is important because of the documented negative impacts of everyday discrimination on physical and mental health. [ABSTRACT FROM AUTHOR]

ObjctivesSelf-rated health (SRH) is an important indicator of overall health, predicting morbidity and mortality. This paper investigates what individuals incorporate into their self-assessments of health and how acculturation plays a part in this assessment. The relationship of acculturation to SRH and whether it moderates the association between indicators of health and SRH is also examined. DesignThe paper is based on data from adults in the Boston Puerto Rican Health Study, living in the greater Boston area (n=1357) mean age 57.2 (SD = 7.6). We used multiple regression analysis and testing for moderation effects. ResultsThe strongest predictors of poor SRH were the number of existing medical conditions, functional problems, allostatic load and depressive symptoms. Poor SRH was also associated with being female, fewer years of education, heavy alcohol use, smoking, poverty, and low emotional support. More acculturated Puerto Rican adults rated their health more positively, which corresponded to better indicators of physical and psychological health. Additionally, acculturation moderated the association between some indicators of morbidity (functional status and depressive symptoms) and SRH.Self-assessments of overall health integrate diverse indicators, including psychological symptoms, functional status and objective health indicators such as chronic conditions and allostatic load. However, adults' assessments of overall health differed by acculturation, which moderated the association between health indicators and SRH. The data suggest that when in poor health, those less acculturated may understate the severity of their health problems when rating their overall health, thus SRH might thus conceal disparities. Using SRH can have implications for assessing health disparities in this population. [ABSTRACT FROM AUTHOR]

Objectives: Adequate knowledge of sexual health among young adults is a critical step in prevention of sexually transmitted diseases and maintenance of adult sexual health. Knowledge of specific barriers to accessing sexual health knowledge can help tailor approaches appropriately. The purpose of this paper was to identify sexual health knowledge barriers among Somali young adults in Ohio. Design: In-depth interviews were conducted with a convenience sample of 27 Somali young adults aged 18-25 years. Using a grounded theory approach, a semi-structured interview guide comprising open-ended questions and probes was utilized to collect data. Data were analyzed and coded using constant comparative analysis. Results: Findings revealed sexual health knowledge barriers in the following broad categories: religion, culture and stigma. Cultural and religious norms were deemed an important influence on the community norms largely impacting sexual health knowledge due to stigma and fear of judgment. Participants overcame barriers by seeking information from external sources such as doctors, Internet and peers. Conclusion: Study findings support an approach that will address sexual health barriers in the Somali immigrant young community at multiple levels: individual, interpersonal and community levels. A collaborative effort across religious, cultural and educational setting is necessary to tailor approaches that meet the needs of the priority group. [ABSTRACT FROM AUTHOR]

Objectives.Cancer is the second biggest killer of Aboriginal Australians. For some cancers, the mortality rate is more than three times higher in Aboriginal people than for non-Aboriginal people. The Aboriginal Patterns of Cancer Care Study explored barriers to and facilitators of cancer diagnosis and treatment among Aboriginal and Torres Strait Islander people in New South Wales. Design.Our team – which includes both Aboriginal and non-Aboriginal researchers – conducted in-depth interviews between 2009 and 2010 with Aboriginal people with cancer, their carers and health professionals who care for them. In this paper, we identify recurrent patterns of ‘discursive framing’ in the 16 interviews with health care professionals. We are particularly interested in how these frames assisted participants in constructing a professional position on what ‘cultural difference’ means for the design and delivery of cancer care services to Aboriginal people. Results.Despite geographical, organisational, disciplinary and cultural diversity, these interview participants consistently drew upon six discursive frames, which we have interpreted as eitherelidinga discussion ofdifference(‘everyone is the same’ and ‘everyone is different’) orfacilitatingthat discussion (‘different priorities,’ ‘different practices’ and ‘making difference safe’). An additional strategy appeared to actively resist either of these positions but then tended to ultimately prioritise the eliding frames. Conclusions.While none of our participants were dismissive of the idea that cultural identity might matter to Aboriginal people, their reliance upon familiar narratives about what that means for cancer care services has the potential to both symbolically and practically exclude the voices of a group of people who may already feel disenfranchised from the mainstream health care system. Critically unpacking the ‘taken for granted’ assumptions behind how health care professionals make sense of cultural difference can enrich our understanding of and response to the care needs of indigenous people affected by cancer. [ABSTRACT FROM PUBLISHER]

Objective.The paper examines the influence of religion on attitudes, behaviors, and HIV infection among rural adolescent women in Zimbabwe. Design.We analyzed data from a 2007 to 2010 randomized controlled trial in rural eastern Zimbabwe testing whether school support can prevent HIV risk behaviors and related attitudes among rural adolescent orphan girls; supplementary data from the 2006 Zimbabwe Demographic and Health Survey (ZDHS) were also analyzed. The present study design is largely cross-sectional, using the most recent available survey data from the clinical trial to examine the association between religious affiliation and religiosity on school dropout, marriage, and related attitudes, controlling for intervention condition, age and orphan type. The ZDHS data examined the effect of religious denomination on marriage and HIV status among young rural women, controlling for age. Results.Apostolic Church affiliation greatly increased the likelihood of early marriage compared to reference Methodist Church affiliation (odds ratio = 4.5). Greater religiosity independently reduced the likelihood of school dropout, increased gender equity attitudes and disagreement with early sex, and marginally reduced early marriage. Young rural Apostolic women in the ZDHS were nearly four times as likely to marry as teenagers compared to Protestants, and marriage doubled the likelihood of HIV infection. Conclusions.Findings contradict an earlier seminal study that Apostolics are relatively protected from HIV compared to other Christian denominations. Young Apostolic women are at increased risk of HIV infection through early marriage. The Apostolic Church is a large and growing denomination in sub-Saharan Africa and many Apostolic sects discourage medical testing and treatment in favor of faith healing. Since this can increase the risk of undiagnosed HIV infection for young married women and their infants in high prevalence areas, further study is urgently needed to confirm this emerging public health problem, particularly among orphan girls. Although empirical evidence suggests that keeping orphan girls in school can reduce HIV risk factors, further study of the religious context and the implications for prevention are needed. [ABSTRACT FROM PUBLISHER]

Objective. Previous studies have identified several factors to be associated with physical activity (PA) among African-Americans, e.g., demographic and health-related characteristics. Formative studies suggest a link between sociocultural factors and PA among ethnic minorities; yet, it is unclear whether these factors play a role in PA among African-Americans. This paper explores the association of selected sociocultural characteristics with self-reported PA by gender among African-American adults, taking into account demographic and health-related characteristics. Design. Data from the baseline survey of a colorectal cancer communication intervention trial were used. Participants included 446 African-American men and women, aged 45–75 years. Self-report data were collected on demographics, health-related characteristics, selected sociocultural constructs (e.g., ethnic identity, religiosity, collectivism, and medical mistrust), and PA. PA was categorized as meeting or not meeting recommended levels; recommended levels were defined as participating in vigorous PA for 20 minutes/day for at least three days/week or moderate PA for 30 minutes/day for at least five days/week or a minimum of 600 MET-minutes/week in at least five days. Chi-square and multivariate logistic regression models were used to characterize the association between the selected sociocultural constructs and PA among men and women, after adjusting for demographic and health-related characteristics. Results. Most participants reported some PA but only 59% were found to be meeting recommended levels. Univariate analyses revealed that high collectivist attitudes were associated with meeting recommended PA (OR=1.74), particularly for women (OR=1.81). In multivariate analyses, high collectivist attitudes were significantly associated with meeting PA recommendations among men (OR=1.87); while high religiosity and high collectivism were significant among women (OR=1.87 and 1.85, respectively). Conclusions. Few of the selected sociocultural characteristics were found to be associated with meeting recommended PA levels. Further study is needed to understand the association of these characteristics with PA among African-Americans. [ABSTRACT FROM PUBLISHER]

There is a general lack of information about how insufficient physical activity impacts blood pressure and physical fitness in Latin-American ethnic minorities. To describe the interactions between insufficient physical activity, blood pressure, and physical fitness outcomes in Latin-American schoolchildren of different ethnicity. This was a prospective, international, multi-center, and cross-sectional study of three Latin-American countries involving schoolchildren from seven ethnic groups of Colombia (Tikuna, Nasa, Embera), Brazil (African, Mulato), and Chile (Mapuche), and also European schoolchildren from Brazil and Chile. Data were categorized based on whether participants were physically active (PA) or insufficient physical activity (iPA) using the WHO physical activity recommendations. The main outcomes were systolic (SBP), diastolic (DBP), and mean arterial (MAP) blood pressure, and scores for physical and cardiorespiratory fitness (CRF, by estimated V ˙ O2max), handgrip muscle strength (HGS), and standing long jump (SLJ). Secondary outcomes were anthropometric measures (weight, height, body mass index [BMI], waist circumference [WC], waist-to-height ratio), and body fat percentage (BF%, limited data by country). Primary and secondary outcomes were ranked. For both PA and iPA categories, significant interactions between ethnic groups were found concerning SBP/DBP (F(37.7), ES 0.08; F(51.5), ES 0.08), V ˙ O2max (F(37.7), ES 0.08; F(51.5), ES 0.08), HGS (F(33.8), ES 0.07; F(5.03), ES 0.04), and SLJ (F(64.3), ES 0.14; F(64.3), 0.14). In the iPA category, Mapuche schoolchildren were classified 1st (119.5; 81.5) with highest SBP/DBP and highest MAP (94.6 mmHg); Embera schoolchildren were classified 1st with lowest V ˙ O2max (33.7 mL/kg/min); and European schoolchildren were classified 1st (19.9 kg) with lowest HGS and SLJ (121.4 m) physical fitness. Under conditions of insufficient physical activity conditions, Mapuche schoolchildren had the most detrimental blood pressure, whereas Embera, Tikuna, and European schoolchildren had the lowest levels of physical fitness. These results serve to highlight the need for the early and appropriate promotion of physical activity based on ethnic differences in Latin-American schools. [ABSTRACT FROM AUTHOR]

Physical activity (PA) can help individuals maintain physical function and independence. The association between PA and functional limitations (FL) has not been explored in the Native Hawaiian and Pacific Islander (NHPI) population. The purpose of this study was to examine relationships between PA and FL among NHPI adults (age ≥ 45 years) living in the United States. Cross-sectional data from the 2014 NHPI-National Health Interview Survey (N = 628) was used to create three constructs of FL based on responses from the Functioning and Disability Survey Module: needing equipment/assistance, having difficulty walking, and having difficulty with performing self-care and other fine motor activities. We used 2-stage least squares regression to examine the relationship between PA and FL of NHPI adults while accounting for the potential endogeneity of PA to FL. Compared to NHPI adults who met the guideline for recommended levels of aerobic and strengthening PA, those who met only the strengthening guideline experienced less difficulty in two FL constructs (use of medical equipment/assistance and difficulty walking). Those who met the aerobic guideline reported even less difficulties in all three FL constructs. NHPI adults who met both the aerobic and strengthening guidelines experienced the least difficulties in all three FL constructs compared to those who met neither PA guidelines. PA is associated with function in this adult NHPI population. Aerobic guidelines alone may be more beneficial than meeting the strengthening guideline alone; however, meeting both the aerobic and strengthening guidelines is most protective against FL. [ABSTRACT FROM AUTHOR]

Black immigrant women experience high risks for maternal complications, and some of these complications are related to dietary outcomes. This study aimed to explore Sub-Saharan African (SSA) pregnant women's dietary patterns and dietary transition post-immigration and during pregnancy. We used a narrative design with a Photovoice approach and collected data through semi-structured interviews, digital food diaries, and Photovoice interviews. We recruited eleven participants (n = 11) through community gatekeepers and analyzed data using a constructivist grounded theory approach with constant comparative methods. The changes in food processes and participants' reactions to these changes generated a dietary transition model with three stages: perplexity, deliberation, and acceptance. (1) Perplexity was caused by different food characteristics such as taste, texture, and options. (2) Participants described deliberation as a process of deciding the kind of foods/cooking styles that would be an integral part of their regular diet. All participants opted for what they referred to as the 'African diet.' (3) Acceptance was characterized by participants' resolve to figure out how to make their chosen types of food and eating habits 'work' for themselves and their families. This study emphasizes the importance of having a sense of self-efficacy, a positive attitude, and community support in enabling migrant women to navigate dietary transition until they are satisfied with newly constructed eating habits. This determination, along with community support and persistent connection to their home culture, might help immigrants resist dietary acculturation and maintain healthy cultural eating habits, which is particularly important during pregnancy, given the impact of diet on maternal and neonatal outcomes. These findings underscore the need for collaborating with migrants from SSA to develop culturally tailored dietary interventions focused on each stage of dietary transition. Future studies should include focus group discussions to leverage women's shared experiences and create knowledge/information exchange opportunities. [ABSTRACT FROM AUTHOR]

Objectives: HIV prevalence among sexual and gender minority (SGM) individuals in South Africa is among the highest in the world; however, SGM migrants, an especially vulnerable subgroup of both the SGM and migrant populations, have frequently been overlooked in the country's robust public health response. This qualitative study, guided by syndemics theory, explored the processes by which SGM migrants in South Africa are exposed to HIV risk and those that may reduce this risk. Design: We conducted 6 focus groups with a total of 30 SGM migrants living in Cape Town. Participants were men who have sex with men, women who have sex with women, and transgender women. Transcripts were analyzed using grounded theory. Results: Participants identified a number of interrelated factors (insecure immigration status, financial and housing instability, food insecurity, stigma and discrimination, and lack of social support) contributing to HIV risk. While some took PrEP or HIV medication, adherence could be affected by structural and psychosocial barriers. Conclusion: Interventions that respond to the syndemic impacts on HIV outcomes are needed to reduce disease burden among SGM migrants in South Africa. [ABSTRACT FROM AUTHOR]

Objective: To evaluate changes in health and health care utilization outcomes for Latinx adults with substance use and mental disorders receiving integrated behavioral and primary health care. Design: Study sample included enrollees who completed baseline, 6-month and 12-month assessments (n = 107). Study outcomes were depression symptom severity, anxiety symptom severity, illicit drug use, emergency department utilization and homelessness status. Pre–post analyses were conducted using paired t-test and McNemar test to examine changes in study outcomes. Multivariable regression model estimated through generalized estimating equations explored the influence of the intervention on study outcomes. Results were presented in adjusted odds ratios (AOR) and 95% confidence intervals (CI). Results: Participants were less likely to report depressive symptoms (AOR: 0.496, 95%CI: 0.296–0.832), less likely to report anxiety symptoms (AOR: 0.539, 95%CI: 0.329–0.884), and less likely to experience homelessness (AOR: 0.556, 95%CI: 0.328–0.943) at 6-month assessment compared to baseline. Participants were also less likely to report depressive symptoms (AOR: 0.378, 95%CI: 0.209–0.684), less likely to report anxiety symptoms (AOR: 0.471, 95%CI: 0.270–0.821), less likely to experience homelessness (AOR: 0.333, 95%CI: 0.189–0.587), and less likely to utilize the emergency department in the past 30 days (AOR: 0.397, 95%CI: 0.188–0.837) at 12-month assessment compared to baseline. Conclusions: Integrating culturally responsive behavioral and primary health care services is critical for addressing the needs of Latinx adults with mental and substance use disorders, and other chronic diseases. This initiative has the potential to reduce disparities in access to and engagement in care for Latinx adults. [ABSTRACT FROM AUTHOR]

African American are at risk for adverse emotional health. However, due to the intersection of their racial and gender identities which heightens their masculinity, emotional wellness is not always considered a priority by and for these men. This study aimed to examine African American men's emotional and physical health in relation to their overall health. An exploratory cross-sectional study was conducted to examine self-reported responses regarding emotional and physical health as predictors of overall wellness among a convenience sample of 115 African American men. The Wellness Self-Perception Questionnaire (WSPQ), a 15-item scale, was used to assess emotional and physical wellness. Overall health was assessed by a single item. Of the 115 study participants, the majority reported a positive perception of their overall health. Linear regression analyses revealed that both reported emotional wellness and physical wellness predicted better overall wellness, even when controlling for men's education and income. A review of the literature indicates this is the first study to assess emotional and physical wellness as predictors of overall health for African American men. Since African American men tend to utilize physical health services even for mental health concerns, implications for physicians are also discussed. [ABSTRACT FROM AUTHOR]

Background: HPV vaccination is the primary prevention method for HPV-related cancers, although among Hispanic populations, migrant farmworkers may experience exacerbated challenges to HPV vaccination due to intersecting political, social, and personal contexts. This study explored multi-level determinants of HPV vaccination among Hispanic migrant farmworker families. Methods: Using a community-engaged approach and guided by the socio-ecological model, Intervention Mapping, and PRECEDE-PROCEED constructs, we recruited parents who had a daughter and/or son age 9-15 years from a rural, faith-based, community organization in Florida. Three focus groups (n = 13) were conducted in Spanish and constant comparison methods were used to analyze qualitative data. Results: Micro-level determinants included moderate HPV vaccine knowledge, desire for more HPV vaccine information, concerns about HPV vaccine completion, health/preventive motivations, past experiences with the healthcare system, and parental gender roles related to health care. Macro-level determinants included facilitators (e.g. transportation services, clinics open after work hours, governmental programs) and barriers (e.g. supervisor/employment inflexibility, long clinic wait times) to accessing health care and vaccination in general (including HPV vaccination). Participants shared their preferences for future interventions that would meet the needs of this community, and discussed potential content and mechanisms for receiving HPV information, as well as what might facilitate their overall access, uptake, and completion of the HPV vaccine series. Discussion: Determinants to HPV vaccination emerged and underscore the importance of addressing the multi-level factors when designing and delivering an HPV vaccine intervention for this Hispanic migrant farmworker population. Improving HPV vaccination rates requires responding to situational and structural hardships that disproportionately impact this group. Thus, community-tailored and culturally appropriate multi-level interventions are needed, while emphasizing existing knowledge assets and preferences favorable towards HPV vaccination, with the ultimate goal of the decreasing HPV-related disparities. Findings suggest interventions must reach beyond the individual level to account for this unique population's lived experiences. [ABSTRACT FROM AUTHOR]

Objective: Previous research has shown that experiences of racial discrimination and sexual objectification are associated with health risk behaviours among gay and bisexual men of colour. However, little is known about whether racial discrimination and sexual objectification are associated with alcohol use among this population. This community-based study examined the association between racial discrimination, sexual objectification and alcohol use in a sample of 369 gay and bisexual men of colour (Black/African/Caribbean, Latino/Latin American, South Asian, and East and Southeast Asian) in Toronto. Design: Data were drawn from an online survey designed to examine issues of racism, homophobia, health and well-being among gay and bisexual men of colour in Toronto. Regression analysis assessed the relationship between scores on the Racism and Life Experiences Scale, Sexual Objectification Scale, and the CAGE questionnaire (a screen for alcohol use disorder). Results: Multivariable logistic regression analyses revealed that experiences of racism and sexual objectification are significantly and positively associated with a screening for alcohol use disorder. The interactions between Latino/Latin American race/ethnicity and experience of sexual objectification were also positively associated with a screening for alcohol use disorder. Conclusions: Health professionals should consider the role of racial discrimination and sexual objectification within the context of risk and treatment for alcohol use disorders, harm reduction, and HIV prevention for gay and bisexual men of colour. [ABSTRACT FROM AUTHOR]

Objective: Advance care planning (ACP) allows individuals to express their preferences for medical treatment in the event that they become incapable of making their own decisions. This study assessed the efficacy of a conversation game intervention for increasing South Asian Indian Americans' (SAIAs') engagement in ACP behaviors as well as the game's acceptability and cultural appropriateness among SAIAs. Design: Eligible community-dwelling SAIAs were recruited at SAIA cultural events held in central Texas during the summer of 2016. Pregame questionnaires included demographics and the 55-item ACP Engagement Survey. Played in groups of 3–5, the game consists of 17 open-ended questions that prompt discussions of end-of-life issues. After each game session, focus groups and questionnaires were used to examine the game's cultural appropriateness and self-rated conversation quality. Postintervention responses on the ACP Engagement Survey and rates of participation in ACP behaviors were collected after 3 months through phone interviews or online surveys. Data were analyzed using descriptive statistics, frequencies, and paired t-tests comparing pre/post averages at a.05 significance level. Results: Of the 47 participants, 64% were female, 62% had graduate degrees, 92% had lived in the U.S. for >10 years, 87% were first-generation immigrants, and 74% had no advance directive prior to the game. At the 3-month follow-up, 58% of participants had completed at least one ACP behavior, 42% had discussed end-of-life issues with loved ones, 15% did so with their healthcare providers, and 18% had created an advanced directive. ACP Engagement Survey scores increased significantly on all four of the process subscales by 3 months postgame. Conclusion: SAIA individuals who played a conversation game had a relatively high rate of performing ACP behaviors 3 months after the intervention. These findings suggest that conversation games may be useful tools for motivating people from minority communities to engage in ACP behaviors. [ABSTRACT FROM AUTHOR]

Objective: Ethnic minorities in the Netherlands experience worse (mental) health than Dutch natives. So far, socioeconomic factors, discrimination, and the migration process have been identified as underlying factors, neglecting the potential role of health-related behaviours. This study investigates the mediating effect of lack of physical activity, smoking and alcohol consumption on ethnic inequalities in (mental) health in the Netherlands. Design: Data from a municipal health survey (2012) in the four largest cities in the Netherlands, including 15,633 Dutch natives, 1,297 Surinamese, 850 Turks and 779 Moroccans were analysed. Mediation analyses were performed on the associations between ethnicity and psychological distress (range 10-50) and self-rated health (range 1-5). Results: Being from an ethnic minority was associated with higher distress and poorer self-rated health, especially for Turks (higher distress 4.69, 95%CI 4.22-5.16; poorer health 0.35, 95%CI 0.30-0.40). Moroccans and Turks were the least physically active, Turks smoked the most, and Dutch natives drank the most. Lack of physical activity partially mediated the association between Turks (6% respectively 11%) and Moroccans (13% respectively 9%) for psychological distress and self-rated health. Smoking played a mediating role (3%) in Turks. Conclusion: Lower physical activity and smoking more cigarettes partly explained ethnic health inequalities in the Netherlands. The current findings suggest that intervening and facilitating certain ethnic groups in engaging in health behaviours could contribute to improving their health and reduce ethnic health inequalities. [ABSTRACT FROM AUTHOR]

Objective: In remote, Alaska Native communities, traditional foods remain a significant source of essential nutrients and appear to protect against the development of chronic diseases. Relatively low intake of traditional foods among Alaska Native children is therefore of concern. The aim of this study was to identify household and parental predictors of child traditional food (TF) consumption and weight in remote Yup'ik communities of Alaska. Design: Children (10-18 years old) and parents in two communities (populations <500) were invited to participate in this cross-sectional study. Intake of traditional foods among children and parents was estimated from two-24 h recalls using NDS-R. Weight and height were measured and BMI calculated. Sociodemographic factors, including income and education, were collected from parents. A partial least square path modeling analysis and bootstrapping were performed to identify predictors of child TF consumption and weight. Results: Parental intake of traditional foods, Yup'ik identity and income were positively associated with child intake of traditional foods. Further, parental intake of traditional foods predicted lower child BMI. Parental education was negatively associated with child traditional food intake and positively associated with child BMI. Conclusions: Findings suggest that interventions targeting parents may be an effective strategy to increase intake of traditional foods and improve diet quality among Alaska Native youth. [ABSTRACT FROM AUTHOR]

Objectives:The purpose of this study was to (1) describe and compare two obstetric Mayan populations in Guatemala, the Tz’utujil and the Kachiquel and (2) evaluate possible associations of demographics, wood fuel use, and obesity with pregnancy/newborn outcomes. Design:This cross-sectional study interviewed participants at the time of routine obstetric ultrasounds at three institutions in Santiago Atitlán and one institution in San Lucas Tolimán. Data were collected from January 2010 to May 2013. Data entry and statistical analysis were performed using EPI InfoTM7.1.2.0 (CDC). Results:The two populations were similar in maternal age, BMI, ownership of a phone, gravidity (number of times a women has been pregnant), history of spontaneous abortions, history of term pregnancies, newborn birth weights, cesarean section rate, and percentage of low-birth-weight newborns (LBW < 2500 g). Obesity was present in 22% of the combined surveyed populations. Low-birth-weight newborns and newborn macrosomia (newborn birth weight greater than 4000 g) were present in 5.5% and 3.7%, respectively. The newborn gender ratio (male to female) was equal to 0.92. The two populations differed in ownership of gas stoves and percentage of newborn macrosomia. Significant associations included:(1) female newborn gender and low birth weight, (2) obesity and newborn macrosomia, and (3) obesity and male gender. Conclusion:The two Mayan populations were similar in many of the obstetric variables. The percentage of low-birth-weight infants (5.5%) is considerably lower than reported prevalence data for Guatemala. The obstetric characteristics, differences, and similarities between these two Mayan populations should help in policy planning for obstetric care for these two populations and possibly other indigenous populations in Guatemala. [ABSTRACT FROM AUTHOR]

Objectives.Few studies investigating health inequalities pay attention to the intersection between several social determinants of health. The purpose of this article is to examine the relation between perceptions of work-related health and safety risk (WHSR) and (1) immigrant background and (2) gender in the EU-15. The effects are controlled for educational attainment, the quality of work (QOW) and occupation. Design.Pooled data from the European Social Survey 2004 and 2010 are used in this study. The sample is restricted to respondents of working age (16–65 years) (N = 17,468). The immigrants are divided into two groups according to their country of origin: (semi-)periphery and core countries. Both groups of immigrants are compared to natives. Additionally, the research population is stratified by gender. Descriptive statistics and logistic regression analyses are used. Results.Core immigrants (both men and women) do not differ from natives in terms of QOW. (Semi-)periphery immigrants (both men and women) are employed in jobs with lower QOW. While no differences in WHSR are found among men, female immigrants (both (semi-)periphery and core) have significantly more WHSR compared to native women. Although WHSR is generally lower in women, (semi-)periphery women have a similar prevalence of WHSR as men. Conclusion.(Semi-)periphery immigrants are employed in lower quality jobs, while core immigrants do not differ from natives in that regard. Female immigrant workers – especially those from (semi-)periphery countries – have higher WHSR compared to native women. Our findings highlight the importance of an intersectional approach in the study of work-related health inequalities. [ABSTRACT FROM PUBLISHER]

Objectives.To investigate whether the levels of blood pressure and fasting glucose differ among Chinese children of three different ethnicities (i.e., Uyghurs, Kazakhs, and Hans) and whether the differences are explained by childhood obesity. Methods.A school-based cross-sectional study was conducted in a large three ethnic pediatric population (n= 6633), whose ages ranged from 7 to 18 years. Anthropometrics and blood pressure were measured using standard protocols. Fasting glucose was measured in a subset of children (n= 2295) who were randomly selected based on ethnicity and age. The age–sex stratified Chinese national cut-offs were used to define obesity and high blood pressure (HBP). The prevalence of HBP, impaired fasting glucose (IFG), mean levels of blood pressure, and glucose were compared among three ethnic groups. Results.2142 Uyghurs, 2078 Han, and 1997 Kazakhs were analyzed. After adjusting for age and body mass index (BMI), the mean blood pressure for Uyghurs was on average, 2–4 mm Hg lower than those for Hans and Kazakhs. Kazakhs had the lowest mean fasting glucose compared with Hans and Uyghurs (4.5 vs. 5.0 vs. 4.8 mmol/L, respectively). The differences in blood pressure and fasting glucose persisted even after adjusting for age and BMI, and the differences among ethnic groups in blood pressure levels and fasting glucose levels were observed as early as 7–9 years of age. Conclusions.The prevalence of HBP and IFG differed significantly among Uyghurs, Hans, and Kazakhs, and the ethnic differences observed in childhood were consistent with those observed in adults from the same region. While childhood obesity is a significant risk factor for hypertension and elevated glucose, the differences among ethnic groups were not explained by obesity alone. [ABSTRACT FROM PUBLISHER]

Objectives.Studies have repeatedly shown racial and ethnic differences in mental health care. Prior research focused on relationships between patient preferences and ethnicity, with little attention given to the possible relationship between physicians' ethnicity and their treatment recommendations. Design.A questionnaire was mailed to a national sample of US primary care physicians and psychiatrists. It included vignettes of patients presenting with depression, anxiety, and medically unexplained symptoms. Physicians were asked how likely they would be to advise medication, see the patient regularly for counseling, refer to a psychiatrist, or refer to a psychologist or licensed mental health counselor. Results.The response rate was 896 of 1427 (63%) for primary care physicians and 312 of 487 (64%) for psychiatrists. Treatment preferences varied across diagnoses. Compared to whites (referent), black primary care physicians were less likely to use antidepressants (depression vignette), but more likely to see the patient for counseling (all vignettes), and to refer to a psychiatrist (depression vignette). Asian primary care physicians were more likely to see the patient for counseling (anxiety and medically unexplained symptoms vignettes) and to refer to a psychiatrist (depression and anxiety vignettes). Asian psychiatrists were more likely to recommend seeing the patient regularly for counseling (depression vignette). Conclusions.Overall, these findings suggest that physician race and ethnicity contributes to different patterns of treatment for basic mental health concerns. [ABSTRACT FROM PUBLISHER]

Objective.Racial/ethnic disparities in the risk of preterm birth may be explained by various factors, and previous studies are limited in examining the role of institutional racism. This study focused on the following questions: what is the association between preterm birth and institutional racism as measured by residential racial segregation (geographic separation by race) and redlining (black–white disparity in mortgage loan denial); and what is the association between preterm birth and reported stress, discrimination, and neighborhood quality. Design.We used data from a clinic-based sample of pregnant women (n= 3462) participating in a stress and pregnancy study conducted from 1999 to 2004 in Philadelphia, PA (USA). We linked data from the 2000 US Census and Home Mortgage Disclosure Act (HMDA) data from 1999 to 2004 and developed measures of residential redlining and segregation. Results.Among the entire population, there was an increased risk for preterm birth among women who were older, unmarried, tobacco users, higher number of previous births, high levels of experiences of everyday discrimination, owned their homes, lived in nonredlined areas, and areas with high levels of segregation measured by the isolation index. Among black women, living in a redlined area (where blacks were more likely to be denied mortgage loans compared to whites) was moderately associated with a decreased risk of preterm birth (aRR = 0.8, 95% CI: 0.6, 0.99). Conclusion.Residential redlining as a form institutional racism and neighborhood characteristic may be important for understanding racial/ethnic disparities in pregnancy and preterm birth. [ABSTRACT FROM AUTHOR]

Objectives.Somali women are at increased risk of adverse pregnancy outcomes. Anxiety and perceived stigmatization toward female genital cutting (FGC) further fuels an atmosphere of miscommunication and distrust, contributing to poorer health outcomes. While the attitudes and experiences of Somali refugee women toward healthcare are widely known, the views of Somali refugee men are largely unknown. This study examines the perspectives of Somali men toward FGC and women's childbirth experiences in one refugee community in the USA. Design.Community-based participatory research partnerships with key stakeholders within the Somali refugee community incorporated qualitative methods comprising semi-structured focus groups and individual interviews to elicit male participants’ perspectives on FGC, experiences during childbirth, and the perception of increased cesarean deliveries among Somali women. Qualitative analyses involved a framework and team-based approach using grounded theory and conventional content analysis. Results.Acculturation influenced changes in traditional gender roles fostering new dynamics in shared decision-making within the household and during childbirth. Participants were aware of FGC-related morbidity, ongoing matriarchal support for FGC, and were generally not supportive of FGC. They perceived health-care providers as being unfamiliar with caring for women with FGC fueling profound aversion to cesarean deliveries, miscommunication, and distrust of the health-care system. Conclusion.Our work yields new insights into Somali reproductive healthcare through Somali men, namely: strong matriarchal support of FGC, discomfort in men's presence during delivery, and a strong aversion to cesarean delivery. Our findings support the need for advocacy to engage Somali women, their partners/spouses, and health-care providers in facilitating greater continuity of care, building greater trust as men become engaged throughout the spectrum of care in the decision-making process while respecting traditional norms. Cultural health navigators should bridge communication and support between providers and patients. Our work provides foundational knowledge to inform culturally appropriate health interventions within a Somali refugee community. [ABSTRACT FROM AUTHOR]

Objective.The objectives of this study are to examine racial and ethnic differences in suicidal behaviour, its main risk factors, and the effect of the risk factors on suicidal behaviour in young adults in the United States. Design.Using nationally representative data (n= 10,585) from Add Health, we calculate the prevalence of suicidal behavior and associated risk factors for non-Hispanic White, non-Hispanic Black, and Hispanic youth (aged 18–26) using logistic regression models of suicidal ideation stratified by race. Results.Non-Hispanic White and Hispanic young adults have higher rates of suicidal ideation than their non-Hispanic Black counterparts, but racial/ethnic differences in attempts are not statistically significant. Non-Hispanic Whites and Hispanic young adults are more likely to possess key risk factors for suicide. With the exception of substance use variables (i.e. alcohol and marijuana use) which appear to be more conducive to suicidal ideation in non-Hispanic Black than in non-Hispanic White young adults, the effects of risk factors appear to be similar across race/ethnicity. Conclusion.The higher prevalence of suicidal ideation in non-Hispanic White and Hispanic young adults may be driven by their greater exposure to risk factors, as opposed to differences in the effects of these risk factors. More research is needed to uncover why non-Hispanic White and Hispanic young adults have higher rates of suicidal ideation than their non-Hispanic Black counterparts; yet, rates of suicide attempts are comparable and non-Hispanic White young adults have the highest rate of completed suicides. [ABSTRACT FROM AUTHOR]

Objectives.This study compared trends in colorectal cancer (CRC) incidence and mortality rates among Koreans in South Korea and Korean Americans and non-Hispanic whites in California between 1999 and 2009, and examined CRC screening rates and socio-demographic correlates of CRC screening in the two Korean populations. Design.Age-standardized CRC incidence and mortality rates of Koreans in South Korea and Korean Americans and non-Hispanic whites in California for the years 1999–2009 were obtained from annual reports of cancer statistics and modeled using joinpoint regression. Using 2009 data from the Korean National Health and Nutrition Examination Survey and the California Health Interview Survey, we estimated and compared CRC screening rates and test modalities. We used multiple logistic regression to examine socio-demographic correlates of completion of CRC screening according to the guidelines among the two Korean populations. Results.CRC incidence and mortality rates among South Koreans increased during 1999–2009 but more slowly during the late 2000s. In California, CRC incidence increased among Korean American females but decreased among non-Hispanic whites. About 37% of South Koreans and 60% of Korean Americans reported completion of CRC screening according to guidelines in 2009. Among South Koreans, married status, higher income, and private health insurance were associated with CRC screening, adjusting for other factors. Among Korean Americans, having health insurance was associated with CRC screening. Conclusion.Despite almost identical CRC screening guidelines in South Korea and the USA and substantially higher screening rates among Korean Americans as compared to South Koreans, disparities remain in both populations with respect to CRC statistics. Thus, efforts to promote primary and secondary prevention of CRC in both Korean populations are critically important in both countries. [ABSTRACT FROM AUTHOR]

Objectives.Polygamy is a complex phenomenon and a product of power relations, with deep cultural, social, economic, and political roots. Despite being banned in many countries, the practice persists and has been associated with women's marginalization and mental health sequelae. In this study, we sought to improve understanding of this ongoing, complex phenomenon by examining the contribution of socioeconomic position (SEP) and social support to the excess of depressive symptoms (DS) and poor self-rated health (SRH) among women in polygamous marriages compared to women in monogamous marriages. Measuring the contribution of these factors could facilitate policies and interventions aimed at protecting women's mental health. Design.The study was conducted among a sample of Arab Bedouin women living in a marginalized community in southern Israel (N=464, age 18–50). The women were personally interviewed in 2008–2009. We then used logistic regression models to calculate the contribution of SEP (as defined by the women's education, family SEP, and household characteristics) and social support to excess of depressive symptoms and poor SRH among participants in polygamous versus monogamous marriages. Results.About 23% of the participants were in polygamous marriages. These women reported almost twice the odds of depressive symptoms (OR=1.91, 95%CI=1.22, 2.99) and poorer SRH (OR=1.73, 95%CI=1.10, 2.72) than those in monogamous marriages. Women's education changed these associations slightly, but family SEP and household characteristics resulted in virtually no further change. Social support reduced the odds for poor SRH and DS by about 23% and 28%, respectively. Conclusion.Polygamy is associated with higher risk for poor mental health of women regardless of their SEP and education. Social support seems to have some protective effect. [ABSTRACT FROM AUTHOR]

Background.Hmong women are reported to have very low rates of breast and cervical cancer screening compared to other Asian and White women in the USA. Reasons for low cancer screening rates among this population are not well understood. Methods.This qualitative study (n=83) explored Hmong women and men's perceptions of breast and cervical cancer and cancer screening, women's experiences with breast and cervical cancer screening, and health care system barriers to screening. Results.Hmong women and men perceived breast cancer to be more severe than other types of cancers. Participants believed that breast cancer is curable if detected early. Cervical cancer was not well understood and was of greater concern than breast cancer because of its location within the body and its consequences for reproduction. In general, few participants had personal experiences with breast and/or cervical cancer. Overall, women and men had positive things to say about screenings for breast and cervical cancer, expressing that screenings offered a ‘proof of illness.’ The majority of women did not report any concerns with the exams themselves, although some discussed embarrassment, pain, and discomfort. Barriers to screening included lack of health insurance, making co-payments, language, and issues related to scheduling appointments. Barriers differed for younger and older women. Conclusion.Results of this study provide new insight into perceptions, experiences, and barriers to breast and cervical cancer screening among Hmong women and men. These findings have implications for developing culturally appropriate interventions to increase breast and cervical cancer screening in this population. [ABSTRACT FROM PUBLISHER]

ObjectiveTo examine and quantify differences in both self-rated health (SRH) and mortality according to region of origin, migration history and educational level among adolescents and young adults living in the Brussels-Capital Region (BCR). DesignThe data consist of the census of 2001 for the BCR linked to death and emigration records for the period of 01/10/2001–01/01/2006. Belgian, Maghreb, Turkish and sub-Saharan African 15–34 year olds are included in the analyses. Odds ratios are calculated for SRH (0 = poor health, 1 = good health) using logistic regression. Age-standardised mortality rates are computed and mortality rate ratios are shown using Poisson regression. ResultsThere are marked health differences according to region of origin. While Maghrebins and Turks (M/T) feel less healthy, sub-Saharan Africans (SSA) feel healthier than Belgians. Furthermore, there are important differences within nationality groups, with second-generation M/T having a worse health status than the first generation. While first-generation SSA feel a lot healthier than Belgians, there is no difference between second-generation SSA and Belgians. Education plays a marked role in health and mortality differences, especially in young adulthood (25–34 years). Migration history is even more important than region of origin concerning mortality differences. First-generation M/T show lower mortality risks compared to Belgians and second-generation M/T, while the latter show comparable mortality risks as Belgians after controlling for education. ConclusionImportant differences are observed according to both region of origin and migration history among adolescents and young adults in the BCR. These differences significantly reduce when accounting for education, suggesting that investing in education is a public-health strategy worth considering. Further research in this area may benefit from taking migration history into account. [ABSTRACT FROM AUTHOR]

ObjectiveTo explore the process of decision-making of older people with limited English proficiency (LEP) about using a professional interpreter during their health care after stroke. DesignA constructivist grounded theory approach was used. Up to two in-depth interviews were conducted with 13 older people with LEP from seven different language groups, and one older person who preferred to speak English, who had recently received health care after an acute stroke. Professional interpreters assisted with 19 of the 24 study interviews. Data were analysed and theoretical processes developed using a constant comparative method. ResultsProfessional interpreters were not a strong presence in the health care experience after stroke for participants. The use of professional interpreters was a complex decision for participants, influenced by their perception of the language and health care expertise of themselves and others, their perceived position to make the decision and whom they trusted. Getting by in English allowed participants to follow rules-based talk of health professionals, but did not enable them to understand detailed information or explanation, or to engage in the management of their condition in a meaningful way. ConclusionHealth professionals have an opportunity and a mandate to demonstrate leadership in the interpreter decision by providing knowledge, opportunity and encouragement for people with LEP, to use an interpreter to engage in, and understand, their health care after stroke. Health professionals may need to advise when interpretation is needed for health care situations, when communication difficulties may not be anticipated by the person with LEP. [ABSTRACT FROM AUTHOR]

ObjectivesResearchers have posited that one potential explanation for the better-than-expected health outcomes observed among some Latino immigrants, vis-à-vis their US-born counterparts, may be the strength of social ties and social support among immigrants. MethodsWe examined the association between nativity status and social ties using data from the Chicago Community Adult Health Study's Latino subsample, which includes Mexicans, Puerto Ricans, and other Latinos. First, we used ordinary least squares (OLS) regression methods to model the effect of nativity status on five outcomes: informal social integration; social network diversity; network size; instrumental support; and informational support. Using multilevel mixed-effects regression models, we estimated the association between Latino/immigrant neighborhood composition and our outcomes, and whether these relationships varied by nativity status. Lastly, we examined the relationship between social ties and immigrants' length of time in the USA. ResultsAfter controlling for individual-level characteristics, immigrant Latinos had significantly lower levels of social ties than their US-born counterparts for all the outcomes, except informational support. Latino/immigrant neighborhood composition was positively associated with being socially integrated and having larger and more diverse social networks. The associations between two of our outcomes (informal social integration and network size) and living in a neighborhood with greater concentrations of Latinos and immigrants were stronger for US-born Latinos than for immigrant Latinos. US-born Latinos maintained a significant social ties advantage over immigrants – regardless of length of time in the USA – for informal social integration, network diversity, and network size. ConclusionAt the individual level, our findings challenge the assumption that Latino immigrants would have larger networks and/or higher levels of support and social integration than their US-born counterparts. Our study underscores the importance of understanding the contexts that promote the development of social ties. We discuss the implications of these findings for understanding Latino and immigrant social ties and health outcomes. [ABSTRACT FROM AUTHOR]

Objective.To examine the differences and characteristics of road traffic injuries (RTIs) among Jewish and Arab children, ages 0–17 years, in Israel. Design.A retrospective study based on data from the Israeli National Trauma Registry between 2001 and 2010. This study relates specifically to traffic-related hospitalizations among children ages 0–17 years. Data include demographic, injury, and hospitalization characteristics. Descriptive statistics and adjusted logistic regression were used to examine the differences of RTIs between the two ethnic groups. Results.A total of 18,884 children were included, of which Arab children comprised 38.2% of the total and 44.1% of the severely injured. Among Arab children 41.8% were pedestrians compared to 33.4% among Jewish children (p<0.0001). Arab children were younger, had more severe injuries and more traumatic brain injury (TBI) compared to Jewish children. Adjusted logistic regression analysis shows that the probability of an Arab child, relative to a Jewish child, to undergo surgical procedures was 1.2 (p<0.0001), to be hospitalized in intensive care units (ICUs) was 0.8 (p=0.003), and to be transferred to rehabilitation was 0.5 (p<0.0001). There was no significant difference in inpatient mortality between the two ethnic groups. Conclusions.Arab children in Israel are more likely to be hospitalized due to road accidents in comparison to Jewish children. Intervention programs should focus on Arab children and their unique characteristics. [ABSTRACT FROM PUBLISHER]

Objective.To explore social network members' role in educating African American adolescents about sexual health issues. Design.We conducted 21 focus groups with urban African American mothers (n=51), fathers (n=18), sons (n=20), and daughters (n=36) from Allegheny County, Pennsylvania, USA, between December 2007 and March 2008. At least one biological parent (or legal guardian) and one adolescent aged 15–17 years from each family participated. Group conversations were audio-recorded, transcribed, and analyzed using directive content analysis and the constant comparison method. Two coders independently read each transcript to identify emergent themes. Results.A broad range of people were reportedly involved in the education process. Older siblings, extended family, and peers were most commonly cited. However, unrelated adults were also described as playing important roles. Unrelated adults included the friends of an adolescent's parents and the parents of an adolescent's friends or romantic partners. Social network members were said to address three main issues: the facts about sex and sexuality, the social aspects of sexuality (e.g., appropriate dating behaviors, choosing dating partners), and promotion of family values. When educating adolescents about sex, social network members were described as playing eight functional roles, including that of a teacher, guide, challenger, confidant, shelterer, supervisor-chaperone, role model, and provider of access to reproductive health services. These roles were not mutually exclusive, meaning that social network members often assumed different roles depending on the situation. The influence of individuals who were not an adolescent's parent was highly dependent on adolescents' relationship with their parents or on their parents' comfort dealing with sexual issues. Conclusions.African American adolescents' social networks were described by parents and adolescents as dense, complex, and routinely involved in educating adolescents about sex. [ABSTRACT FROM PUBLISHER]

Background.Dietary changes among Latino immigrants are often attributed to acculturation. Acculturation-diet research typically assumes that migration to the US is necessary for negative dietary changes to occur in Latino immigrants' diets. Objective.The goal of this article is to demonstrate that extant acculturation research is not adequate in capturing changes in Latino immigrants' diets. This is due to the role of globalization and transnational processes in modernizing their diets in Latin America. Design.Utilizing an interactionist cultural studies approach, this exploratory situational analysis based on 27 in-depth interviews with Latino immigrants, nutrition reports, and transnational food companies' websites, examines how Latino immigrants were already engaging in negative dietary practices in their former country. Results.Latino immigrants who resided in urban areas in their former countries and migrated to the US on or after 2000 were fully engaged in negative dietary practices prior to migration. Such practices included consuming food outside of the home and integrating processed food into their cooking. Their dietary practices were also informed by nutrition discourses. Themodernization of food production and consumptionand thetransnational transmission of nutritionare transnational processes changing Latino immigrants' diets prior to migration. Conclusion.Researchers should approach the study of dietary change among Latino immigrants in the US through a transnational perspective in order to avoid overlooking potential confounders such as current food insecurity, new socioeconomic positions as undocumented, low-income persons, and increased hours worked outside of the home. [ABSTRACT FROM PUBLISHER]

Objectives.The aim was (1) to investigate the association between education and smoking status (current, former and never-smoking) among non-western immigrants in Norway and (2) examine if these associations fit the pattern predicted by the model of the cigarette epidemic. Design.Data came from the Oslo Health Study and the Oslo Immigrant Health study (2000–2002). The first included all Oslo citizens from seven selected birth cohorts. The second included all Oslo citizens born in Turkey, Iran, Pakistan, Vietnam and Sri Lanka. 14,768 respondents answered questions on smoking, education and relevant background variables (over-all response rate 43.3%). Two gender specific multinomial logistic regression models with smoking status [current, former or never-smoker (reference)] as dependent variable were computed and predicted probabilities of smoking status among groups with different levels of education were calculated. Results.Smoking prevalence among men ranged from 19% among Sri Lankans to 56% among Turks. Compared to the smoking prevalence among Norwegian men (27%), smoking was widespread among Iranians (42%) and Vietnamese (36%). Higher education was associated with lower probability of current smoking among all male immigrant groups except Sri Lankans. Never having smoked was positively associated with education among Pakistani and Norwegian men. Among women, <5% smoked among Pakistanis, Vietnamese and Sri Lankans. Smoking prevalence among Turkish (28%) and Iranian (23%) women were comparable to Norwegian women (30%). The probability of smoking among Turkish and Iranian women with secondary education was higher than for other levels of education. The probability of being a never-smoker was high among Turkish and Iranian women with primary education. Conclusions.High smoking prevalence among Turkish and Iranian men highlights the importance of addressing smoking behaviour in subgroups of the general population. Smoking was almost non-existent among Pakistani, Vietnamese and Sri Lankan women and indicates strong persistent social norms against smoking. [ABSTRACT FROM PUBLISHER]

Objectives.To evaluate ethnic group differences in the association between trauma exposure and health status among an ethnically diverse sample originating in Hawai‘i. Design.Across a 10-year period (1998–2008), participants (N=833) completed five waves of questionnaire assessments. Trauma exposure was measured retrospectively at the most recent assessment (wave 5), socioeconomic resources (educational attainment and employment status) were measured at wave 1, and self-rated health was measured at each of the five waves. Results.Results indicated that greater exposure to trauma was associated with poorer self-rated health, as were lower educational attainment and lower work status. In addition, there was ethnic group variation in health ratings, as well as in how strongly trauma exposure predicted health status. Specifically, within Filipino American and Native Hawaiian ethnic groups, there was a stronger negative association between trauma exposure and self-rated health. Conclusion.These results suggest complex interrelations among trauma, ethnicity, socioeconomic status, and physical health. Further understanding these relations may have implications for medical and behavioral interventions in vulnerable populations. [ABSTRACT FROM PUBLISHER]

Objective.This research examined how race, psychiatric comorbidity, and headache characteristics are inter-related in patients with severe headache disorders. Design.This study used a naturalistic cohort design and assessed 114 Black and 173 White patients receiving treatment in headache subspecialty clinics in Cincinnati, Cleveland, Columbus, and Toledo, OH. Face-to-face interviews yielded headache and psychiatric diagnoses; 30-day daily diaries collected data on headache frequency, severity, and disability; and self-administered surveys obtained data on headache management self-efficacy, headache locus of control, and quality of life. Results.Compared with Whites, Blacks reported more frequent and severe headaches, were more likely to be diagnosed with depressive disorders, and were more likely to be diagnosed with chronic headaches. White and Black patients diagnosed with both depression and anxiety reported the most frequent headache days per month and the lowest levels of life quality and headache management self-efficacy. Conclusions.Additional research on race, psychiatric comorbidity, and headache characteristics is needed that can inform culturally contextualized interventions for persons with severe headache disorders. [ABSTRACT FROM PUBLISHER]

Objective.This is a report of development and psychometric testing of the East Asian Acculturation Measure-Chinese version (EAAM-C) scale. Design.An instrument validation design with a cross-sectional survey was conducted. The process was carried in two phases. In Phase 1, Barry's East Asian Acculturation Measure was translated and back translated to evaluate its content, face validity, and feasibility validity. In Phase 2, the 16-item EAAM-C was pilot-tested among 485 female immigrants for test-retest reliability, internal consistency, theoretically-supported construct validity and concurrent validity. Results.The pilot work and the survey results indicated the tools possessed adequate content and face validity. The Cronbach's Alphas for the EAAM-C was 0.72, and 0.76–0.79 for its subscales, and the correlation of test-retest reliability (at 3 weeks) was 0.75. After dropping one item, four theoretically-supported factors which explained 61.82% of the variance were abstracted using exploratory factor analysis: assimilation, integration, separation, and marginalization. Based on the underlying four-factor theoretical structures of the EAAM, the confirmatory factor analysis of the EAAM-C was further examined. The analysis revealed that the four-factor model was an acceptable fit for the data which demonstrated adequate finding in its construct validity. These factors were inter-correlated, and showed statistically significant correlation with the Chinese Health Questionnaire, indicating adequate concurrent validity. Conclusions.The scale shows acceptable validity and consistency, and suggests that immigrant acculturation is a complex construct. This quick evaluation instrument can be applied to assess clients’ acculturation and in further developing certain interventions to improve their health. [ABSTRACT FROM PUBLISHER]

Objectives.There is evidence to suggest that immigrant groups from low- or medium-human development index countries show a significant adoption of obesogenic behaviors and experience weight gain following migration to Australia. The objective of this study is to understand the changes that Iranian immigrants experience in relation to the determinants of obesity after migration to Victoria, Australia. Design.We conducted five focus group discussions with 33 recent Iranian immigrants. This study took an interpretive qualitative approach to data analysis using the constant comparative method. Results.Participants discussed individual level acculturation (e.g., in diet, body size, attitudes), as well as environmental level changes (e.g., physical/structural and sociocultural) that occurred after immigration. Stress during the initial immigration transition, which affected diet and physical activity habits, was a common experience among participants. Gender and the effect of political/religious changes were also important factors. Participants' discourse largely focused on their ability and willingness to adopt positive health behaviors after migration. Conclusion.This study provides insight into the effect of migration on the determinants of obesity among Iranian immigrants in Victoria, Australia, and offers a contrast with the existing evidence by considering the experience of a group that is generally well educated, often emigrates for reasons related to personal freedom as opposed to material deprivation, and has rates of obesity similar to high-income countries. [ABSTRACT FROM PUBLISHER]

Objective.The study presented in this article explored psychosocial and relational problems of African immigrant women in the Netherlands who underwent female genital mutilation/cutting (FGM/C), the causes they attribute to these problems – in particular, their opinions about the relationship between these problems and their circumcision – and the way they cope with these health complaints. Design. This mixed-methods study used standardised questionnaires as well as in-depth interviews among a purposive sample of 66 women who had migrated from Somalia, Sudan, Eritrea, Ethiopia or Sierra Leone to the Netherlands. Data were collected by ethnically similar female interviewers; interviews were coded and analysed by two independent researchers. Results.One in six respondents suffered from post-traumatic stress disorder (PTSD), and one-third reported symptoms related to depression or anxiety. The negative feelings caused by FGM/C became more prominent during childbirth or when suffering from physical problems. Migration to the Netherlands led to a shift in how women perceive FGM, making them more aware of the negative consequences of FGM. Many women felt ashamed to be examined by a physician and avoided visiting doctors who did not conceal their astonishment about the FGM. Conclusion.FGM/C had a lifelong impact on the majority of the women participating in the study, causing chronic mental and psychosocial problems. Migration made women who underwent FGM/C more aware of their condition. Three types of women could be distinguished according to their coping style: the adaptives, the disempowered and the traumatised. Health care providers should become more aware of their problems and more sensitive in addressing them. [ABSTRACT FROM PUBLISHER]

Background.African migrants to the West are at increased risk of hypertensive related diseases and certain cancers compared with other ethnic groups. Little is known about their awareness of this risk or knowledge of associated risk factors. Objectives.To explore African migrants' perceptions of chronic disease risk, risk factors and underlying explanatory models. Design.In-depth interviews with 19 Africans from French- or Swahili-speaking countries living in Glasgow were conducted. Interviews were transcribed and 10 translated (3 Swahili and 7 French). Analysis was informed by a grounded theory approach. Results.Narratives suggested low awareness of chronic disease risk among participants. Africans reported a positive outlook on life that discouraged thought about future sickness. Infectious diseases were considered the dominant health threat for African migrants, mainly HIV but also TB and ‘flu’. Chronic diseases were sometimes described as contagious. Explanatory models of chronic disease included bodily/dietary imbalance, stress/exertion, heredity/predisposition and food contamination. Cancer was feared but not considered a major threat. Cancer was considered more common in Europe than Africa and attributed to chemical contamination from fertilisers, food preservatives and industrial pollution. Evidence cited for these chemicals was rapid livestock/vegetable production, large size of livestock (e.g., fish), softness of meat and flavourless food. Chemicals were reported to circulate silently inside the body and cancer to form in the part where they deposit, sometimes years later. Cardiovascular diseases were described in terms of acute symptoms that required short-term medication. Confidentiality concerns were reported to prevent discussion of chronic disease between Africans. Conclusion.This study suggests a need to improve chronic disease health literacy among African migrants to promote engagement with preventive behaviours. This should build on not only participants' existing knowledge of disease causation and risk factors but also their self-reliance in the pursuit of a healthy lifestyle and desire to retain cultural knowledge and practice. [ABSTRACT FROM PUBLISHER]

Objective.To determine migrant workers' exposure to select occupational risks and compare it with that of non-migrant workers in Europe. Design.Based on the European Working Conditions Survey (EWCS-2005,n=29,654 workers, 31 countries) we examined differential prevalence amongst migrant and non-migrant workers' primary paid jobs in terms of employment arrangements (working >10 hours/day, working >5 days/week, on Sundays, without a contract, changes in the work schedule and not free to decide when to take holidays or days off) and working conditions (exposure to hazards including chemical, physical agents, physical load and psychological conditions). For the purpose of this study, a migrant is defined as a person without nationality of the country of residence (n=926). Adjusted prevalence ratios (aPRs) for age, economic sector and education were calculated. Results.Differences in employment arrangements and working conditions were noted by migration status, gender and occupational status. Among non-manual workers, migrant males are more exposed than non-migrant males to negative psychosocial conditions – working at a very high speed (aPR 1.23; 95% CI 1.07–1.42) and shift work (aPR 1.66; 95% CI 1.27–2.17) – and adverse employment arrangements: working on Sundays (aPR 1.91; 95% CI 1.42–2.55), variable starting/finishing times (aPR 1.17; 95% CI 1.04–1.32) and changes in work schedule (aPR 1.56; 95% CI 1.30–1.88). Compared with non-migrant males, male migrant manual workers are the group with a greater number of disparities in terms of exposure to negative working conditions. Female migrant non-manual workers are more exposed to psychosocial conditions – working at very high speed (aPR 1.26; 95% CI 1.10–1.44) and shift work (aPR 1.61; 95% CI 1.29–2.01) while female manual migrant workers were more likely to report standing or walking (aPR 2.43; 95% CI 1.98–2.97), not having a contract (aPR 2.94; 95% CI 2.07–4.10) and not being free to decide days off and holidays (aPR 1.25; 95% CI 1.07–1.48) than non-migrants. Conclusion.Migrant workers across Europe are more likely to be exposed to certain working and employment arrangements that may place them at higher risk of future health problems. [ABSTRACT FROM PUBLISHER]

Objective. Few empirical studies have specifically examined the relationship between socio-economic status (SES) and health in Indigenous populations of Australia. We sought to provide insights into the nature of this relationship by examining socio-economic disparities in physical health outcomes among Aboriginal and Torres Strait Islander children in Western Australia. Design. We used a diverse set of health and SES indicators from a representative survey conducted in 2000–2002 on the health and development of 5289 Indigenous children aged 0–17 years in Western Australia. Analysis was conducted using multivariate logistic regression within a multilevel framework. Results. After controlling for age and sex, we found statistically significant socio-economic disparities in health in almost half of the associations that were investigated, although the direction, shape and magnitude of associations differed. For ear infections, recurring chest infections and sensory function problems, the patterns were generally consistent with a positive socio-economic gradient – where better health was associated with higher SES. The reverse pattern was found for asthma, accidents and injuries, and oral health problems, although this was primarily observed for area-level SES indicators. Conclusion. Conventional notions of social position and class have some influence on the physical health of Indigenous children, although the diversity of results implies that there are other ways of conceptualising and measuring SES that are important for Indigenous populations. We need to consider factors that relate specifically to Indigenous circumstances and culture in the past and present day, and give more thought to how we measure social position in the Indigenous community, to gain a better understanding of the pathways from SES to Indigenous child health. [ABSTRACT FROM PUBLISHER]

Background. The current form of the Diabetes Population Risk Tool (DPoRT) includes a non-specific category of ethnicity in concordance with publicly data available. Given the importance of ethnicity in influencing diabetes risk and its significance in a multi-ethnic population, it is prudent to determine its influence on a population-based risk prediction tool. Objective. To apply and compare the DPoRT with a modified version that includes detailed ethnic information in Canada's largest and most ethnically diverse province. Methods. Two additional diabetes prediction models were created: a model that contained predictors specific to the following ethnic groups – White, Black, Asian, south Asian, and First Nation; and a reference model which did not include a term for ethnicity. In addition to discrimination and calibration, 10-year diabetes incidence was compared. The algorithms were developed in Ontario using the 1996–1997 National Population Health Survey (N=19,861) and validated in the 2000/2001 Canadian Community Health Survey (N=26,465). Results. All non-white ethnicities were associated with higher risk for developing diabetes with south Asians having the highest risk. Discrimination was similar (0.75–0.77) and sufficient calibration was maintained for all models except the detailed ethnicity models for males. DPoRT produced the lowest overall ratio between observed and predicted diabetes risk. DPoRT identified more high risk cases than the other algorithms in males, whereas in females both DPoRT and the full ethnicity model identified more high risk cases. Overall DPoRT and full ethnicity algorithms were very similar in terms of predictive accuracy and population risk. Conclusion. Although from the individual risk perspective, incorporating information on ethnicity is important, when predicting new cases of diabetes at the population level and accounting for other risk factors, detailed ethnic information did not improve the discrimination and accuracy of the model or identify significantly more diabetes cases in the population. [ABSTRACT FROM PUBLISHER]

Objectives. Little is known about socio-demographic patterns of non-fatal suicidality in early life in South Africa. We investigated the prevalence of self-reported early suicidality (suicidal ideation, planning and attempts) in a nationally representative sample of South Africans. Design. As part of a larger mental health survey, 3158 individuals aged over 25 years were asked to recall whether they engaged in non-fatal suicidal behaviour in early life (measured from childhood to 25 years). Race-based discrimination institutionalised under Apartheid profoundly influenced delivery and outcomes in health and other social services. Racial categories entrenched during Apartheid were therefore used to analyse data collected from individuals born before 1946, 1947–1956, 1957–1966 and 1967–1976. Results. 3.4% (95% CI=2.6–4.1) of participants recalled early suicidal behaviour. The youngest group (born 1967–1976) recalled higher rates of early suicidality than older groups in all races. In unadjusted analysis, White people were 2.84 (95% CI=1.62–4.97) and Coloured people 1.84 (95% CI=1.15–2.93) times more likely than Black people to recall early suicidality. Individuals growing up in urban and higher socio-economic settings were approximately twice (OR=2.2; 95% CI=1.14–4.28 and OR=1.92; 95% CI=1.27–2.90) as likely to recall early suicidality as those growing up in rural and lower socio-economic settings. Those with post-primary education were 2.79 (CI=1.71–4.53) times as likely to recall early suicidality as those with no or only primary education. Racial differences ceased to be significant after adjustment for rural/urban location and other socio-economic measures estimated for early life. Conclusion. The study provides novel evidence of increasing levels of early non-fatal suicidality recalled by younger South Africans. Levels appeared significantly higher in Whites than in Blacks. Socio-economic contexts in early life were interpreted as mediators rather than confounders of the association between race and recalled early suicidality. The findings for decreased levels of suicidality among participants growing up in lower socio-economic strata and rural settings in South Africa require further investigation. The need for widespread suicide prevention programmes targeting young people at a population level is emphasised. [ABSTRACT FROM PUBLISHER]

Objective. Differences in psychiatric symptoms are often reported between minority and majority groups. The aim of this study was to compare Roma psychiatric outpatients who are Greek citizens living in Thrace (Greece) with outpatients belonging to the ‘majority Greek group’ with respect to socio-demographic characteristics, psychopathological symptoms and psychiatric diagnoses. Design. A sample of 122 Roma and 132 majority Greek patients visiting the Outpatient Psychiatric Clinic at the University General Hospital of Alexandroupolis, Greece, were examined with the Structured Clinical Interview for DSM III-R (SCID-I), the International Personality Disorder Examination (IPDE) and the Derogatis Psychiatric Rating Scale (DPRS). Only those with a psychiatric diagnosis were retained in the analyses. The two groups of patients were compared in relation to their socio-demographic characteristics, their diagnoses and their scores on the DPRS symptom dimensions. Results. In comparison to the majority group, Roma patients were younger, more often women, less educated, married, parents of more children, without social security coverage; The Roma group had higher scores on many DPRS symptom dimensions such as somatisation, hostility, sleep disturbance, phobic anxiety, psychoticism, psychomotor retardation, hysterical behaviour and abjection–disinterest. In addition, Roma women presented psychotic and bipolar disorders less often than the majority group women. Symptoms did not differ by ethnic group for those seeking medical certification. Conclusion. Roma patients face serious social problems and show greater levels of symptoms than the majority group. The limitations of this include that the sample was not representative of the general psychiatric patient population and language, as well as other cultural and educational barriers, might have obscured important aspects of the Roma people's psychopathology. [ABSTRACT FROM PUBLISHER]

Objective. Changes in socio-economic position in people who migrate may have adverse associations with mental health. The main objective of this review was to assess the association of social mobility with common mental disorders in migrant and second-generation groups, to inform future research. Design. Systematic review and meta-analysis of English-language studies assessing the association of social mobility in migrant or second-generation groups with common mental disorders. Approaches to operationalise ‘social mobility’ were reviewed. Results. Twelve studies (n=18,548) met criteria for retrieval. Very few included second-generation groups, and most studies were cross-sectional in design. Approaches to operationalise ‘social mobility’ varied between studies. Downward intragenerational social mobility was associated with migration in the majority of studies. Random effects meta-analysis (n=5179) suggested that migrants to higher income countries who experienced downward mobility or underemployment were more likely to screen positive for common mental disorders, relative to migrants who were upwardly mobile or experienced no changes to socio-economic position. Conclusions on second-generation groups were limited by the lack of research highlighted for these groups. Downward intragenerational mobility associated with migration may be associated with vulnerability to common mental disorders in some migrant groups. Conclusion. Given the increasing scale of global migration, further research is needed to clarify how changes to socio-economic position associated with international migration may impact on the mental health of migrants, and in their children. [ABSTRACT FROM PUBLISHER]

Objective. To describe the mental health service use of Haitian, African-American, and non-Latino White youth in a community mental health setting. Groups are compared on adherence to treatment guidelines for attention-deficit/hyperactivity disorder (ADHD) and depressive disorders. Design. Retrospective review of outpatient mental health charts (n=252) from five community sites in an urban area of the Northeastern United States. We recorded the total number and treatment type of sessions during the first six months of treatment. Guideline-adherent treatments were compared and predicted after controlling for clinical need. Results. Most Haitian and African-American youth stopped treatment by six months, with the majority attending less than eight sessions. One third of Haitian and African-American patients attended just one session. Haitian patients who presented with less severe symptoms and dysfunction were more likely to have single-session treatments. Guideline-adherent treatment for ADHD and depression was less likely for Haitians. Older patients were more likely to receive adequate depression treatment. Haitian youth were relatively underinsured, had more family separations documented, and received Adjustment Disorder diagnoses more often. Conclusions. Haitian youth use outpatient mental health services in similar proportion to African-American youth and at lower rates than White youth. Guideline-adherent treatment for ADHD and depression is limited by low retention in care for Black youth. Low insurance coverage is likely an important contributor to reduced use of services, especially for Haitians. These findings are discussed in the context of providing culturally sensitive mental health care to diverse communities. [ABSTRACT FROM AUTHOR]

Background. Colorectal cancer (CRC) is a significant cause of mortality among Asian Americans and Pacific Islanders (AAPIs), yet studies have consistently reported lower CRC screening rates among AAPIs than among non-Latino Whites and African Americans. Moreover, existing research tends to aggregate AAPIs as one group when reporting CRC screening, masking the disproportionate burden in cancer screening that exists across AAPI groups. Methods. This study examines differences in CRC screening rates in both aggregated and disaggregated AAPI groups as compared with non-Latino Whites in order to identify the most vulnerable AAPI subgroups in terms of obtaining CRC screening. This study utilizes merged data from the 2001, 2003, and 2005 California Health Interview Survey (CHIS), specifically the data pertaining to adults aged 50 and older (n=52,491) from seven AAPI groups (Chinese, Japanese, Korean, Filipino, South Asian, Vietnamese, and Pacific Islander) and non-Latino Whites. Andersen's Behavioral Model of Health Services Use was utilized to select potential confounders to racial/ethnic differences in CRC screening. Results. When AAPI groups were considered as an aggregate, their CRC screening rate (46.8%) was lower than that of non-Latino Whites (57.7%). When AAPI groups were disaggregated, further disparity was noted: Koreans (32.7%) showed the lowest CRC screening rate, whereas Japanese (59.8%) had the highest. When the influence of potential predisposing, enabling, and need confounders was adjusted, Koreans, Filipinos, and South Asians were found to have a lower likelihood than non-Latino Whites to undergo CRC screening. Comparisons among AAPI subgroups further revealed that Filipinos, Koreans, Pacific Islanders, and South Asians were less likely than Chinese, Japanese, and Vietnamese to receive CRC screening. Conclusion. These results highlight the importance of identifying differences in CRC screening behavior among disaggregated AAPI subgroups in order to help health professionals and policy-makers prioritize which AAPI subgroups need the most urgent interventions in terms of CRC screening promotion. [ABSTRACT FROM AUTHOR]

Objectives. To explore the origins and content of service users' prior knowledge of universal antenatal and newborn screening for haemoglobin disorders; and to explore related familial communication and screening decisions, sources of support and the impact of carrier results on service users and their families. Design. A cross-sectional, qualitative study using semi-structured interviews with 37 purposively sampled service users. Results. Families influenced participants' screening knowledge, decisions and service use. Families often provided the knowledge base upon which service information was built, leading to some messages being dismissed or misunderstood. Families were involved in screening decisions explicitly when requested by participants, but also by imposing their views on participants. Families were often participants' main source of support. Implicit familial influences included withdrawing support, avoidance of conversations or controlling the information available to participants. Likewise some participants selectively disclosed information to the family in order to retain control. Conclusions. Families were highly influential throughout the interviewees' screening experience. The explicit and implicit familial influences on understanding, adaptation, communication and decisions regarding screening need to be further researched to ensure that people undergoing screening are adequately informed and supported. This work highlights the challenges of directing antenatal and newborn screening largely towards individual mothers. Services are often providing information to users in competition with other actors and knowledge which may shape screening decisions and adaptation. [ABSTRACT FROM AUTHOR]

Objectives. To explore early experiences of sickle cell disorder (SCD) in families with a young affected child, and the way these experiences influence relations within families. To consider ways in which stigma could be counteracted in health and research programmes in sub Saharan Africa. Design. A qualitative study was conducted in a rural area of coastal Kenya including in-depth interviews with 13 families affected by SCD and 12 staff of a local biomedical research progamme. Purposive selection aimed to maximize diversity in socioeconomic and educational status, religion, severity of illness burden and religion amongst families and draw on relevant experience for staffs. Interviews were recorded, transcribed and analysed using the constant comparative method for family interviews and a thematic framework approach for staff data. Results. Low initial recognition of SCD and its cause were associated with lay practices of surveillance within affected families, contributing to stigmatisation that occurred independently of genetic knowledge. Blame was often placed on mothers, including a risk of blame for misaligned paternity. Mothers are often particularly affected by SCD through the loss of independent livelihoods and their limited options in coping with this chronic condition. Conclusions. Mothers of children with SCD were particularly vulnerable to stigmatisation within families, with underlying structural influences that suggest these findings may apply to other similar settings in Africa, and have relevance for other genetic conditions. The potential, nature and form of stigmatisation point to the role of effective communication and SCD management in addressing for blame and discriminative effects of having a child with SCD. The findings highlight the importance of broader social programmes targeting underlying gender and economic inequalities. [ABSTRACT FROM AUTHOR]