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The purpose of this study was to determine the prevalence of respiratory and/or physical fitness health problems in adolescent (ages 18-21) water pipe (WP) smokers (with or without cigarette smoking), cigarette-only smokers, and nonsmokers.A comparative four-group study design was used to recruit a non-probability sample of 153 WP smokers only, 103 cigarette smokers only, and 102 cigarette+WP smokers along with 296 nonsmokers. Our hypothesis was that youth who smoked WPs and/or cigarettes would report more respiratory problems and/or poorer physical fitness than those who did not smoke.The results showed that coughs were significantly associated with smoking in all three of the smoking groups (p.05). Cigarette-only smokers reported the most adverse outcomes with more wheezing, difficulty breathing, and less ability to exercise without shortness of breath. A dose-response analysis showed similar patterns of adverse health effects for both WP and cigarette smokers. The combined use of both products was not appreciably worse than smoking one product alone. This could be due to cigarette+WP smokers' reporting using less of the respective products when only one product was smoked.Even during the adolescent years, WP and/or cigarette smoking youth experienced reportable negative health effects.

POLICY POINTS: Engaging and involving underrepresented communities when setting research priorities could make the scientific research agenda more equitable, more just, and more responsive to their needs and values. Groups and individuals from minority and underserved communities strongly prioritized child health and mental health research, often choosing to invest at the highest possible level. Groups consisting of predominantly Native American or Arab American participants invested in culture and beliefs research at the highest level, while many groups did not select it at all. The priority given to culture and beliefs research by these groups illustrates the importance of paying special attention to unique preferences, and not just commonly held views, when getting public input on spending priorities for research. CONTEXT: A major contributor to health disparities is the relative lack of resources—including resources for science—allocated to address the health problems of those with disproportionately greater needs. Engaging and involving underrepresented communities in setting research priorities could make the scientific research agenda more equitable, more just, and more responsive to their needs and values. We engaged minority and underserved communities in informed deliberations and report here their priorities for health research. METHODS: Academic‐community partnerships adapted the simulation exercise CHAT for setting health research priorities. We had participants from minority and medically underserved communities (47 groups, n = 519) throughout Michigan deliberate about health research priorities, and we used surveys and CHAT software to collect the demographic characteristics and priorities selected by individuals and groups. FINDINGS: The participants ranged in age (18 to 88), included more women than men, and were overrepresented by minority groups. Nearly all the deliberating groups selected child health and mental health research (93.6% and 95.7%), and most invested at the highest level. Aging, access, promote health, healthy environment, and what causes disease were also prioritized by groups. Research on mental health and child health were high priorities for individuals both before and after group deliberations. Access was the only category more likely to be selected by individuals after group deliberation (77.0 vs 84.0%, OR = 1.63, p = .005), while improve research, health policy, and culture and beliefs were less likely to be selected after group deliberations (all, p < .001). However, the level of investment in many categories changed after the group deliberations. Participants identifying as Black/African American were less likely to prioritize mental health research, and those of Other race were more likely to prioritize culture and beliefs research. CONCLUSIONS: Minority and medically underserved communities overwhelmingly prioritized mental health and child health research in informed deliberations about spending priorities.

How intimate partner violence (IPV), depression, and barriers to services affect Arab American women in the United States is not very well documented. This cross-sectional exploratory descriptive study examines (a) the relationship between depression and IPV and (b) whether living in the United States 10 or more years decreases barriers to reporting intimate partner violence and depression in a sample ( N = 312) of Arab American women 19 years and older. Findings demonstrate significant relationships between women who were at risk for IPV and depression scores ( r = .44, p < .001), and number of years living in the United States and barriers to service ( r = .25, p < .001). There was a significant negative relationship between barriers to service and depression ( r = −.30, p < .001), and barriers to service and IPV ( r = −.23, p < .001), and number of years living in the United States and depression ( r = .25, p < .001). Findings underscore the importance of screening referral and follow-up for Arab American women experiencing IPV and depression.

To assess the feasibility and acceptability of a community-based, culturally-specific, Diabetes Prevention Program (DPP)-adapted, group lifestyle intervention in Arab-Americans.Overweight (BMI ≥ 27 kg/m(2)) Arab-Americans aged ≥ 30 years and without a history of diabetes were recruited to participate in a 24-week group lifestyle intervention. The DPP core-curriculum was culturally rewritten, translated into Arabic, and delivered in weekly sessions over a 12-week period. Follow-up was performed at week-24. The primary goals were to achieve ≥ 7% weight loss and ≥ 150 min/week of physical activity. An intent-to-treat analysis was performed.Of the 71 participants (mean age ± SD 47 ± 10 years, 38% males), 44% achieved ≥ 7% weight loss, 59% achieved ≥ 5% reduction in weight, and 78% reached the physical activity goal of ≥ 150-min/week. The mean ± SD weight loss was 5.2 ± 4.4 kg at week-24 (p0.0001), Marked reduction in body measurements, daily energy and fat intake were noted. Retention was high with 86% completing the intervention.This trial demonstrates that a culturally-specific, DPP-adapted, group lifestyle intervention implemented in a community setting is feasible and effective in Arab-Americans.

Background. To address the issue of cancer disparities among women whose first language is not English, researchers and public health educators are challenged to develop culturally and linguistically appropriate material and instruments. Methods. This study documents the process used to linguistically and culturally translate breast and cervical cancer literacy assessment tools from English to Spanish and from English to Arabic by using a community-based method. Results. Results from field testing the assessments demonstrated good reliability for overall cancer literacy in English (Cronbach's alpha .99), Spanish (Cronbach's alpha .99), and Arabic (Cronbach's alpha .81). Conclusion. Using a community-based approach to translate the cancer assessments helped to insure they were culturally appropriate.

Asthma and obesity-related health problems disproportionately impact low-income ethnic minority communities residing in urban areas. Environmental risk factors, particularly those related to housing and indoor air, may impact the development or exacerbation of asthma. There is increasing evidence to suggest a link between obesity-related health problems and asthma. Previous studies have also reported that immigrant status may influence myriad risk factors and health outcomes among immigrant populations. The Arab American Environmental Health Project (AAEHP) was the first study to explore environmental health problems among Arab Americans. This paper examined whether hypertensive status modified the relationship between environmental risk factors and asthma among Arab Americans in metro Detroit. An environmental risk index (ERI) was used to quantify household environmental risk factors associated with asthma. Physician diagnosed hypertension was self-reported, and asthma status was determined using responses to a validated symptoms checklist and self-reported diagnosis by a physician. Hypertension significantly modified the relationship between ERI and asthma in this study population. The positive association between household environmental risk factors and asthma was stronger among participants diagnosed with hypertension. Effect modification of the relationship between environmental risk factors and asthma could have serious implications among high-risk communities. However, further research is needed to elucidate the relationships between hypertension, environmental risk factors, and asthma.

OBJECTIVE—To estimate the prevalence of the metabolic syndrome in Arab Americans by age, sex, and BMI and to examine the association between insulin resistance and each of the components of the metabolic syndrome. RESEARCH DESIGN AND METHODS—We studied a representative, cross-sectional, population-based sample of 542 Arab Americans aged 20–75 years. The metabolic syndrome was defined by Adult Treatment Panel III (ATP III) and World Health Organization (WHO) diagnostic criteria. Insulin resistance was estimated by homeostasis model assessment (HOMA-IR). RESULTS—The age-adjusted prevalence of the metabolic syndrome was 23% (95% CI 19–26%) by the ATP III definition and 28% (24–32%) by the WHO definition. Although the prevalence increased significantly with age and BMI in both sexes by both definitions, differences in estimates were noted. With ATP III, the age-specific rates were similar for men and women aged 20–49 years but were significantly higher for women aged ≥50 years. With WHO, rates were higher for men than women aged 20–49 years and similar for those aged ≥50 years. The most common component of the metabolic syndrome in men and women was low HDL cholesterol with the ATP III and the presence of glucose intolerance and HOMA-IR with the WHO. Strong associations between HOMA-IR and individual components of the metabolic syndrome were observed. After fitting a model with HOMA-IR as the outcome, waist circumference, triglyceride level, and fasting plasma glucose level were significantly associated with HOMA-IR. CONCLUSIONS—The metabolic syndrome is common among Arab Americans and is related to modifiable risk factors.

OBJECTIVE—To examine the relationship between dysglycemia (impaired fasting glucose, impaired glucose tolerance, and diabetes) and acculturation, physical activity, and perceived stress in Arab immigrants in the U.S. RESEARCH DESIGN AND METHODS—In a cross-sectional population-based study, we examined 520 Arab Americans, aged 20–75 years, who were born in the Middle East and immigrated to southeastern Michigan. Dysglycemia was assessed by history and with a 2-h 75-g oral glucose tolerance test. Acculturation, physical activity, and perceived stress were measured with standardized questionnaires. RESULTS—Associations were found between dysglycemia in men and older age at immigration, unemployment, speaking Arabic with friends, being less active in Arabic organizations, more frequent consumption of Arabic food, and less integration into American society. Dysglycemia in women was associated with being raised in rural areas of the Middle East, older age at immigration, longer length of stay in the U.S., not being employed outside the home, less than high school education, not attending Arabic or American schools, and not being able to read Arabic. Among men, older age at immigration, shorter length of stay in the U.S., less activity in Arab organizations, and eating Arabic food were associated with dysglycemia independent of age and BMI. Among women, acculturation was very low and was confounded with age and BMI as powerful risk factors for dysglycemia. No association was found between physical activity, perceived stress, and the risk of dysglycemia in either sex. CONCLUSIONS—Lack of acculturation is an important risk factor for dysglycemia in immigrant Arab Americans. Intervention programs aimed at diabetes prevention should consider the acculturation process.

Background Although breast and cervical cancer deaths have declined due to early screening, detection, and more effective treatment, racial and ethnic disparities persist. This paper describes the study design and baseline characteristics of a randomized controlled trial (RCT) evaluating the effectiveness of the Kin KeeperSM Cancer Prevention Intervention, a family-focused educational intervention for underserved women applied in a community-based setting to promote health literacy and screening adherence to address cancer disparities. Methods Female public health community health workers (CHWs) were trained to administer the intervention. They recruited female clients from their public health program caseload and asked each to assemble two to four adult female family members for the breast and cervical cancer home-based education sessions the CHWs would deliver in English, Spanish or Arabic. We randomized the clients into the kin keeper group (treatment) or the participant client group (control). Results Complete data were obtained on 514 Black, Latina, and Arab women. Close to half were unemployed and had yearly family income below $20,000. Thirty-four percent had no medical insurance, and 21% had diabetes. Almost 40% had no mammography in the last year. Treatment and control groups were similar on most sociodemographics but showed differences in breast and cervical screening history. Conclusions This innovative study demonstrates the implementation of an RCT using community-based participatory research, while delivering cancer prevention education across woman's life span with women not connected to the health care system.

Background All mass gatherings can place travelers at risk for infectious diseases, but the size and density of the annual Hajj pilgrimage to the Kingdom of Saudi Arabia (KSA) present important public health and infection control challenges. This survey of protective practices and respiratory illness among US travelers to the 2009 Hajj was designed to evaluate whether recommended behavioral interventions (hand hygiene, wearing a face mask, cough etiquette, social distancing, and contact avoidance) were effective at mitigating illness among travelers during the 2009 Hajj. Methods US residents from Minnesota and Michigan completed anonymous surveys prior to and following travel to the 2009 Hajj. Surveys assessed demographics, knowledge, attitudes, and practices (KAP) related to influenza A(H1N1), vaccination, health‐seeking behaviors, sources of health information, protective behaviors during the Hajj, and respiratory illness during and immediately after the Hajj. Results Pre‐ and post‐travel surveys were completed by 186 participants. Respiratory illness was reported by 76 (41.3%) respondents; 144 (77.4%) reported engaging in recommended protective behaviors during the Hajj. Reduced risk of respiratory illness was associated with practicing social distancing, hand hygiene, and contact avoidance. Pilgrims who reported practicing more recommended protective measures during the Hajj reported either less occurrence or shorter duration of respiratory illness. Noticing influenza A(H1N1) health messages during the Hajj was associated with more protective measures and with shorter duration of respiratory illness. Conclusions Recommended protective behaviors were associated with less respiratory illness among US travelers to the 2009 Hajj. Influenza A(H1N1) communication and education in KSA during the Hajj may also have been an effective component of efforts to mitigate illness. Evaluations of communication efforts and preventive measures are important in developing evidence‐based public health plans to prevent and mitigate disease outbreaks at the Hajj and other mass gatherings.

Refugees suffer from a higher rate of mental health symptoms than the general population since they have experienced extreme suffering and the accumulated effects of trauma. Because of the diversity of regions from which refugees originate, there is a need to understand some of the unique experiences that are specific to each sub-groups of immigrants. The purpose of the present study was to explore mental health symptoms in Iraqi refugee clients who immigrated to the United States after the Gulf War of the early 1990's. As part of a larger study, 116 adult Iraqi immigrants to the United States (46 male, 70 females) who were seeking mental health services completed measures of anxiety, depression, and posttraumatic stress disorder. As expected, the majority of refugees reported intense anxiety and depression, and many met the DSM IV criteria for posttraumatic stress disorder. Like refugees from other countries-of-origin, Iraqi refugees are in need of culturally sensitive assessment and mental health treatment. The results are discussed in light of the treatment needs of Iraqi refugee clients, their resilience and motivation for a better life, and the ways that health professionals can assist in optimizing their adjustment.

The quality of care received by Arab American patients with type 2 diabetes residing in a city with a large migrant Arab population has not been examined. Arab American adults with a self-reported diagnosis of diabetes were identified in a rigorous cross-sectional, population-based epidemiologic study conducted in Dearborn, MI. Quality of diabetes care was determined by assessing adherence to the American Diabetes Association (ADA) clinical practice recommendations. The Third National Health and Nutrition Examination Survey (NHANES) and the Behavioral Risk Factor Surveillance System (BRFSS) provided data for a national comparison. Among the 53 participants, mean age was 59+/-12 years and the mean duration of diabetes was 11.3+/-13.3 years. The ADA goal for an A1c of7% was met by 30% of study subjects. LDL (100mg/dL) and BP (130/85) goals were met by 36% and 16% of subjects, respectively. The majority of the Arab American subjects studied were treated less aggressively with pharmacologic agents than recommended by the ADA. 26% of the Arab Americans had an A1c9.5% as compared to 18% of the national population. Arab Americans generally had worse blood pressure control but better lipid control compared to the national sample. This is the first report of the quality of diabetes care in an Arab American population, and demonstrates sub-optimal quality of care according to the ADA clinical practice recommendations.

Background There is a paucity of knowledge relating to dermatologic conditions in Arab Americans. Objective To assess common skin diseases and concerns and to evaluate access to dermatologic care and perception of skin in Arab Americans. Methods Arab Americans from 3 Southeast Michigan locations (community health center [n = 207], mosque [n = 95], and church [n = 99]) completed a survey questionnaire. Results The most common self-reported skin conditions were acne, eczema/dermatitis, warts, fungal skin infections, and melasma. The most pressing skin concerns were uneven skin tone, skin discoloration, dry skin, acne, and facial hair. Significant associations exist between socioeconomic status and having seen a dermatologist. Attitudes surrounding skin perception were related to the number of years of residence in the United States. Limitations The skin condition data were gathered from a self-reported survey. Conclusions Skin conditions and other related issues that affect Arab Americans are similar to those which affect other skin-of-color populations.

The Gulf War in 1991 resulted in an influx of refugees from Iraq to the United States and to other regions of the world. The purpose of this study was to describe the self-reported medical complaints of Iraqi American refugees who were seeking mental health services in southeastern Michigan. We anticipated that the frequency and pattern of medical symptoms would differ from that reported in the literature on United States Gulf War veterans or other Arab Americans who immigrated to the U.S. in the 1990s. Potential reasons for such differences include indirect effects, such as neglect of general health prior to and during the war, or direct effects, such as the impact of environmental changes from the war itself. As part of a larger study on the health of refugees from Iraq, self-reported medical conditions and symptoms were analyzed in a sample of 116 adult Iraqi immigrants (46 male, 70 female) who were seeking or already receiving outpatient mental health services (n = 87) or treatment in a partial hospitalization program (n = 29). Measures were translated into Arabic and administered in an interview format by one of two bilingual mental health workers. The results were consistent with other studies on refugees in which the number of medical complaints reported was relatively high. Discussion centers on the importance of addressing the specific medical needs of refugees in general, and of the Iraqi refugees in particular, and on how they may be better served within our primary health care systems.

Immigrant populations provide a unique intersection of cultural and environmental risk factors implicated in asthma etiology. This study focuses on asthma prevalence and severity in 600 Arab American households in metro Detroit, the largest immigrant reception zone for Arab Americans in North America. The survey method introduced a number of novel features: (a) a ranking scheme for the key environmental risk factors for asthma was used to derive an aggregated environmental risk index (ERI) for each household, and (b) an aggregate measure of asthma severity based on symptom frequency and intensity. Environmental risk factors and surrogates for socioeconomic status (SES) were found to be stronger predictors of asthma prevalence than asthma severity, while demographic variables such as English fluency and birth in the United States were better predictors of asthma severity than asthma prevalence. These results suggest that SES variables may be more reflective of environmental exposures in communities involved in this study, while English fluency and birth in the United States may be linked to health care access and utilization behavior that can influence the asthma management. We also found a significant relationship between asthma prevalence and degree of acculturation. Asthma prevalence was highest among moderately acculturated immigrants compared with new immigrants and those who were well acculturated, suggesting that among Arab Americans in the Detroit area, risk factors associated with new immigrant status are replaced by “western” risk factors as the population becomes more acculturated.

Exposure to environmental contaminants is complicated by factors related to socioeconomic status, diet, and other culturally conditioned risk behaviors. Determination of a trace element profile in toenails can be used as a tool in biomonitoring the exposure history or assessing the deficiency of a particular element in a study population, which can lead to a better understanding of environmental and disease risks. Toenail clippings from 259 Arab Americans (163 adults, 96 children) residing in a highly industrialized area were analyzed for Al, V, Cr, Mn, Co, Ni, Cu, As, Se, Mo, Cd, Ba, Tl, and Pb using an inductively coupled plasma-mass spectrometer. Mean concentrations were compared with published values, and the influence of age, gender, and other demographic factors were explored. Elevated levels of Ni in this population warrant further investigation. Significant differences in the mean concentration of Al, V, Cr, Mn, Cd, Pb, and Se exist between toenails of adults and children. Pearson correlation coefficients reveal strong significant associations among Cd, Cr, and Tl (p

OBJECTIVE—To examine the prevalence of diabetes and glucose intolerance by age and sex in the Arab-American community of Dearborn, Michigan. RESEARCH DESIGN AND METHODS—Participants were randomly selected adult Arab Americans, 20–75 years of age, from randomly selected households in Dearborn, Michigan. Demographic and anthropometric data were recorded. Glucose tolerance was assessed with 2-h 75-g oral glucose tolerance tests and classified according to 1997 American Diabetes Association and 1998 World Health Organization criteria. RESULTS—A total of 626 eligible adults were selected, and 542 participated (87% response rate). Because prevalence increases with age and the overall response rate for women (328/352; 93%) was higher than that for men (214/274; 78%), prevalence rates were adjusted for age and sex. The overall prevalence of diabetes was 15.5% (95% CI 12.2–18.7%) in women and 20.1% (15.0–25.2%) in men (P = 0.13). The prevalence of previously diagnosed diabetes was similar to that of undiagnosed diabetes. Impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG) were present in 16.8% (12.8–20.8%) of women and 29.7% (23.4–35.9%) of men (P = 0.0007). The combined rates of glucose intolerance (diabetes, IGT, and IFG) were 32.3% (27.8–36.7%) for women and 49.8% (43.1–56.4%) for men (P < 0.0001). Among younger adults, the prevalence in men was higher than that in women. As expected, subjects with diabetes or IGT/IFG were older and had greater BMI and waist-to-hip ratios than subjects with normal glucose tolerance. CONCLUSIONS—The prevalence of diabetes and glucose intolerance is extremely high among adult Arab Americans in Michigan and represents a major clinical and public health problem. Community-based intervention programs to prevent and treat diabetes are urgently needed.