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Special Issue "Refugee Health"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: closed (30 July 2017)

Special Issue Editors

Guest Editor
Prof. Dr. Jimmy T. Efird

Center for Health Disparities, Brody School of Medicine, and College of Nursing, East Carolina University, 600 Moye Blvd, Greenville, NC 27834, USA
Website | E-Mail
Co-Guest Editor
Dr. Pollie Bith-Melander

Alternative Family Services, 401 Roland Way, Suite 100, Oakland, CA 94621, USA
E-Mail
Phone: (510) 499-6925

Special Issue Information

Dear Colleagues,

We are organizing a Special Issue on refugee health in the International Journal of Environmental Research and Public Health. The venue is a peer-reviewed scientific journal that publishes articles and communications in the interdisciplinary area of environmental health sciences and public health. For detailed information on the journal, we refer you to http://www.mdpi.com/journal/ijerph.

The focus on refugee health comes at a time of global unrest and has increasingly become a topic of discourse. Refugees are displaced individuals, owing to fear of persecution, war, violence, oppression, or exploitation. Originating from various regions of the world, refugees frequently have unique health issues and disease risks, which often are poorly prepared for and understood by receiving healthcare providers and responding governmental agencies.

We look forward to a wide range of topic submissions, including, but not limited to: health screening exams; community-based, multi-lingual health education and resources for refugees; health disparities; disease tracking and reporting systems; response to disease outbreaks; refugee utilization or lack thereof of healthcare resources/insurance; barriers to healthcare; health selection of refugees; health trajectory of refugees; hematologic genetic disorders; chronic health issues; mental health issues; abuse, discrimination, exploitation; infectious diseases; environmental exposure related diseases; hygiene and sanitation; healthy lifestyle choices; illegal activity/injury (assault, rape, battery); assimilation analysis; and healthcare concerns relating to economic challenges, language barriers, the struggles of a cultural transition, geographic origin and refugee camp/living conditions.

This Special Issue is open to original research, review articles, short reports, brief commentary, case reports, meta-analyses, simulation studies, and epidemiologic models related to refugee health. The listed keywords suggest just a few of the many possibilities.

Prof. Dr. Jimmy T. Efird
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • refugee health
  • health disparities
  • public health
  • war
  • violence
  • discrimination
  • oppression
  • exploitation
  • disease screening
  • health insurance
  • mental health
  • lifestyle
  • infectious disease
  • barriers to healthcare
  • trauma and refugees

Published Papers (23 papers)

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Research

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Open AccessArticle Development and Preliminary Validation of Refugee Trauma History Checklist (RTHC)—A Brief Checklist for Survey Studies
Int. J. Environ. Res. Public Health 2017, 14(10), 1175; doi:10.3390/ijerph14101175
Received: 28 July 2017 / Revised: 23 September 2017 / Accepted: 30 September 2017 / Published: 4 October 2017
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Abstract
A high proportion of refugees have been subjected to potentially traumatic experiences (PTEs), including torture. PTEs, and torture in particular, are powerful predictors of mental ill health. This paper reports the development and preliminary validation of a brief refugee trauma checklist applicable for
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A high proportion of refugees have been subjected to potentially traumatic experiences (PTEs), including torture. PTEs, and torture in particular, are powerful predictors of mental ill health. This paper reports the development and preliminary validation of a brief refugee trauma checklist applicable for survey studies. Methods: A pool of 232 items was generated based on pre-existing instruments. Conceptualization, item selection and item refinement was conducted based on existing literature and in collaboration with experts. Ten cognitive interviews using a Think Aloud Protocol (TAP) were performed in a clinical setting, and field testing of the proposed checklist was performed in a total sample of n = 137 asylum seekers from Syria. Results: The proposed refugee trauma history checklist (RTHC) consists of 2 × 8 items, concerning PTEs that occurred before and during the respondents’ flight, respectively. Results show low item non-response and adequate psychometric properties Conclusion: RTHC is a usable tool for providing self-report data on refugee trauma history surveys of community samples. The core set of included events can be augmented and slight modifications can be applied to RTHC for use also in other refugee populations and settings. Full article
(This article belongs to the Special Issue Refugee Health)
Open AccessArticle Trauma Affecting Asian-Pacific Islanders in the San Francisco Bay Area
Int. J. Environ. Res. Public Health 2017, 14(9), 1053; doi:10.3390/ijerph14091053
Received: 23 June 2017 / Revised: 28 August 2017 / Accepted: 9 September 2017 / Published: 12 September 2017
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Abstract
Trauma is a transgenerational process that overwhelms the community and the ability of family members to cope with life stressors. An anthropologist trained in ethnographic methods observed three focus groups from a non-profit agency providing trauma and mental health services to Asian Americans
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Trauma is a transgenerational process that overwhelms the community and the ability of family members to cope with life stressors. An anthropologist trained in ethnographic methods observed three focus groups from a non-profit agency providing trauma and mental health services to Asian Americans living in the San Francisco Bay Area of United States. Supplemental information also was collected from staff interviews and notes. Many of the clients were immigrants, refugees, or adult children of these groups. This report consisted of authentic observations and rich qualitative information to characterize the impact of trauma on refugees and immigrants. Observations suggest that collective trauma, direct or indirect, can impede the success and survivability of a population, even after many generations. Full article
(This article belongs to the Special Issue Refugee Health)
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Open AccessArticle Factors Affecting Depressive Symptoms among North Korean Adolescent Refugees Residing in South Korea
Int. J. Environ. Res. Public Health 2017, 14(8), 912; doi:10.3390/ijerph14080912
Received: 4 July 2017 / Revised: 1 August 2017 / Accepted: 8 August 2017 / Published: 14 August 2017
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Abstract
We examined factors affecting the depressive symptoms and the relationship between depression and quality of life among 131 North Korean adolescent refugees aged 12–24 years. We compared sociodemographic, social, and individual characteristics and perceived the quality of life between participants with and without
[...] Read more.
We examined factors affecting the depressive symptoms and the relationship between depression and quality of life among 131 North Korean adolescent refugees aged 12–24 years. We compared sociodemographic, social, and individual characteristics and perceived the quality of life between participants with and without depression. Thirty-seven refugees (28.2%) had clinically significant depressive symptoms. The refugees with depression were younger (t = 2.67; p = 0.009), more likely to be male (χ2 = 6.98; p = 0.009), and more likely to have a Chinese father (χ2 = 9.05; p = 0.003) than those without depression. The refugees with depression had lower levels of psychological social support (t = 2.96; p = 0.004) and resilience (t = 4.24; p < 0.001) and higher levels of alcohol problems (t = −2.08; p = 0.043), aggression (t = −3.15; p = 0.003), and post-traumatic stress disorder (PTSD; t = −2.89; p = 0.004). They also reported lower levels of life satisfaction (t = 3.31; p = 0.001) and had a more negative view of their future (t = 2.68; p = 0.010). Interventions to increase resilience, to decrease the impact of traumatic events, and to provide psychological support may be helpful for North Korean adolescent refugees at risk of depression. Full article
(This article belongs to the Special Issue Refugee Health)
Open AccessArticle How Do Countries’ Health Information Systems Perform in Assessing Asylum Seekers’ Health Situation? Developing a Health Information Assessment Tool on Asylum Seekers (HIATUS) and Piloting It in Two European Countries
Int. J. Environ. Res. Public Health 2017, 14(8), 894; doi:10.3390/ijerph14080894
Received: 6 June 2017 / Revised: 25 July 2017 / Accepted: 3 August 2017 / Published: 8 August 2017
Cited by 1 | PDF Full-text (864 KB) | HTML Full-text | XML Full-text
Abstract
Background: Accurate data on the health status, health behaviour and access to health care of asylum seekers is essential, but such data is lacking in many European countries. We hence aimed to: (a) develop and pilot-test an instrument that can be used to
[...] Read more.
Background: Accurate data on the health status, health behaviour and access to health care of asylum seekers is essential, but such data is lacking in many European countries. We hence aimed to: (a) develop and pilot-test an instrument that can be used to compare and benchmark the country health information systems (HIS) with respect to the ability to assess the health status and health care situation of asylum seekers and (b) present the results of that pilot for The Netherlands (NL) and Germany (DE). Materials and Methods: Reviewing and adapting existing tools, we developed a Health Information Assessment Tool on Asylum Seekers (HIATUS) with 50 items to assess HIS performance across three dimensions: (1) availability and detail of data across potential data sources; (2) HIS resources and monitoring capacity; (3) general coverage and timeliness of publications on selected indicators. We piloted HIATUS by applying the tool to the HIS in DE and NL. Two raters per country independently assessed the performance of country HIS and the inter-rater reliability was analysed by Pearson’s rho and the intra-class correlation (ICC). We then applied a consensus-based group rating to obtain the final ratings which were transformed into a weighted summary score (range: 0–97). We assessed HIS performance by calculating total and domain-specific HIATUS scores by country as well as absolute and relative gaps in scores within and between countries. Results: In the independent rating, Pearson’s rho was 0.14 (NL) and 0.30 (DE), the ICC yielded an estimated reliability of 0.29 (NL) and 0.83 (DE) respectively. In the final consensus-based rating, the total HIATUS score was 47 in NL and 15 in DE, translating into a relative gap in HIS capacity of 52% (NL) and 85% (DE) respectively. Shortfalls in HIS capacity in both countries relate to the areas of HIS coordination, planning and policies, and to limited coverage of specific indicators such as self-reported health, mental health, socio-economic status and health behaviour. The relative gap in the HIATUS component “data sources and availability” was much higher in Germany (92%) than in NL (28%). Conclusions: The standardised tool (HIATUS) proved useful for assessment of country HIS performance in two countries by consensus-based rating. HIATUS revealed substantial limitations in HIS capacity to assess the health situation of asylum seekers in both countries. The tool allowed for between-country comparisons, revealing that capacities were lower in DE relative to NL. Monitoring and benchmarking gaps in HIS capacity in further European countries can help to strengthen HIS in the future. Full article
(This article belongs to the Special Issue Refugee Health)
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Open AccessArticle Early Marriage and Barriers to Contraception among Syrian Refugee Women in Lebanon: A Qualitative Study
Int. J. Environ. Res. Public Health 2017, 14(8), 836; doi:10.3390/ijerph14080836
Received: 16 June 2017 / Revised: 19 July 2017 / Accepted: 21 July 2017 / Published: 25 July 2017
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Abstract
The Syrian conflict has displaced five million individuals outside their country with Lebanon hosting the largest numbers per capita. Around 24% of Syrian refugees fleeing to Lebanon are women of reproductive age (15–49). Yet, a better understanding of the sexual and reproductive health
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The Syrian conflict has displaced five million individuals outside their country with Lebanon hosting the largest numbers per capita. Around 24% of Syrian refugees fleeing to Lebanon are women of reproductive age (15–49). Yet, a better understanding of the sexual and reproductive health needs of Syrian refugee women in Lebanon is required to improve provided services. Eleven focus group discussions were conducted in four regions of Lebanon with 108 Syrian refugee women of reproductive age. Thematic analysis was used to examine the data. Interviewed women were mainly adults. They believed that, in Lebanon, they were subjected to early marriage compared to the norm in Syria due to their financial situation and uncertainty. Cost was reported as the main barrier to use contraception in Lebanon but some Syrian refugee women were not aware of free services covering sexual and reproductive health. In general, marriage, pregnancy, and family planning behavior of Syrian refugee women in Lebanon slightly differed from those in Syria pre-conflict in terms of age of marriage, conception subsequent to marriage, and contraception method. Hence, interventions to increase awareness of subsidized sexual and reproductive health services, including free contraceptives at primary health care centers, and those targeting protection from early marriage of Syrian refugee women in Lebanon are strongly recommended. Full article
(This article belongs to the Special Issue Refugee Health)
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Open AccessArticle The Effects of the Refugee Crisis on Age Estimation Analysis over the Past 10 Years: A 16-Country Survey
Int. J. Environ. Res. Public Health 2017, 14(6), 630; doi:10.3390/ijerph14060630
Received: 20 April 2017 / Revised: 31 May 2017 / Accepted: 31 May 2017 / Published: 13 June 2017
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Abstract
Dental age estimation (AE) tests are routinely done on living and deceased persons. There is anecdotal evidence suggesting an increase in age estimations due to the refugee crisis. Our aim is to determine the reasons and methods for performing dental AE tests in
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Dental age estimation (AE) tests are routinely done on living and deceased persons. There is anecdotal evidence suggesting an increase in age estimations due to the refugee crisis. Our aim is to determine the reasons and methods for performing dental AE tests in both living and deceased individuals. Global trends in AE over the past 10 years were also investigated. A database of all forensic laboratories was obtained and an electronic questionnaire was sent to all of them. The questionnaire was self-developed and included questions on the reasons for performing AE tests, the preferred methods used in living and deceased individuals, and the people/organizations who requested these AE tests. The number of tests performed annually varied between 0 and 500 and the majority were on asylum seekers, refugees, and for adoption cases. Most units used multiple techniques to determine the age among the living, but seldom used more than three techniques for the deceased. The majority of tests were requested by coroners and the legal fraternity. There has been an increase in the number of dental AEs carried out and this has been mostly due to asylum seekers and refugees. The most common techniques for the living were variations of Demirjian’s technique while country specific techniques were used for the deceased. Full article
(This article belongs to the Special Issue Refugee Health)
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Open AccessFeature PaperArticle High Manifestations of Mental Distress in Arabic Asylum Seekers Accommodated in Collective Centers for Refugees in Germany
Int. J. Environ. Res. Public Health 2017, 14(6), 612; doi:10.3390/ijerph14060612
Received: 29 March 2017 / Revised: 1 June 2017 / Accepted: 2 June 2017 / Published: 7 June 2017
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Abstract
The number of asylum seekers in Germany has significantly increased in the last two years. Coming from regions of political conflict and war, the refugees have often experienced traumatic events which designate them as a high risk group for mental disorders. In a
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The number of asylum seekers in Germany has significantly increased in the last two years. Coming from regions of political conflict and war, the refugees have often experienced traumatic events which designate them as a high risk group for mental disorders. In a sample of Arabic speaking asylum seekers in collective accommodation centers in Erlangen, Germany, we estimated the extent of posttraumatic stress, depression, and anxiety. A further objective of the study was to test the comprehensibility and cultural appropriateness of the Arabic translations of the questionnaires in this sample. Between August and September 2016, 56 Arabic speaking asylum seekers placed among three collective accommodation centers in Erlangen completed self-report questionnaires assessing posttraumatic stress disorder (Essen Trauma-Inventory, ETI), and symptoms of depression (Patient Health Questionnaire—depression module, PHQ-9) and anxiety (Generalized Anxiety Disorder, GAD-7). The prevalence of participants with personally and/or witnessed traumatic events was 80.4% (n = 45). About one-third of the examinees (35.7%, n = 20) endorsed symptoms of PTSD (posttraumatic stress disorder). The total score for depression in this sample was M = 11.9 (SD = 7.9, range: 0–27). Moderate to severe depression (PHQ-9 score ≥ 15) was found in 35.7% (n = 20) of our sample and severe depression (PHQ-9 score ≥ 20) was found in 23.2% (n = 13). The total score for anxiety was M = 8.8 (SD = 6.9, range: 0–21), with 26.8% (n = 15) of the sample showing symptoms of severe anxiety (GAD-7 score ≥ 15). No significant difference between women and men with respect to frequency and symptom scores of PTSD, depression, and anxiety was found. Amongst asylum seekers of the presented sample, the rates of traumatic events as well as the prevalence of possible PTSD, depression, and anxiety were significantly higher than in the German population. This indicates that the refugee population is in need of culturally sensitive psychological interventions. However, more studies are required to improve the understanding of mental health among this particularly vulnerable population. Full article
(This article belongs to the Special Issue Refugee Health)
Open AccessArticle Immunization Strategies Targeting Newly Arrived Migrants in Non-EU Countries of the Mediterranean Basin and Black Sea
Int. J. Environ. Res. Public Health 2017, 14(5), 459; doi:10.3390/ijerph14050459
Received: 8 February 2017 / Revised: 19 April 2017 / Accepted: 21 April 2017 / Published: 25 April 2017
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Abstract
Background: The World Health Organization recommends that host countries ensure appropriate vaccinations to refugees, asylum seekers and migrants. However, information on vaccination strategies targeting migrants in host countries is limited. Methods: In 2015–2016 we carried out a survey among national experts
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Background: The World Health Organization recommends that host countries ensure appropriate vaccinations to refugees, asylum seekers and migrants. However, information on vaccination strategies targeting migrants in host countries is limited. Methods: In 2015–2016 we carried out a survey among national experts from governmental bodies of 15 non-EU countries of the Mediterranean and Black Sea in order to document and share national vaccination strategies targeting newly arrived migrants. Results: Four countries reported having regulations/procedures supporting the immunization of migrants at national level, one at sub-national level and three only targeting specific population groups. Eight countries offer migrant children all the vaccinations included in their national immunization schedule; three provide only selected vaccinations, mainly measles and polio vaccines. Ten and eight countries also offer selected vaccinations to adolescents and adults respectively. Eight countries provide vaccinations at the community level; seven give priority vaccines in holding centres or at entry sites. Data on administered vaccines are recorded in immunization registries in nine countries. Conclusions: Although differing among countries, indications for immunizing migrants are in place in most of them. However, we cannot infer from our findings whether those strategies are currently functioning and whether barriers to their implementation are being faced. Further studies focusing on these aspects are needed to develop concrete and targeted recommendations for action. Since migrants are moving across countries, development of on-line registries and cooperation between countries could allow keeping track of administered vaccines in order to appropriately plan immunization series and avoid unnecessary vaccinations. Full article
(This article belongs to the Special Issue Refugee Health)
Open AccessArticle A Cross-Sectional Study on Selected Correlates of High risk Sexual Behavior in Polish Migrants Resident in the United Kingdom
Int. J. Environ. Res. Public Health 2017, 14(4), 422; doi:10.3390/ijerph14040422
Received: 16 February 2017 / Revised: 2 April 2017 / Accepted: 10 April 2017 / Published: 14 April 2017
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Abstract
Objective: To assess the correlates of the high risk sexual behaviors of Polish migrants in the United Kingdom (UK) after 2004, and to compare such behaviors before/after immigration. Methods: In 2013, a cross-sectional study was conducted through the use of a
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Objective: To assess the correlates of the high risk sexual behaviors of Polish migrants in the United Kingdom (UK) after 2004, and to compare such behaviors before/after immigration. Methods: In 2013, a cross-sectional study was conducted through the use of a Computer-assisted web interviewing surveying technique with the use of a self-administered questionnaire. Results: Among 408 respondents (56.9% women), with a median age of 32 years, significantly more admitted to having unprotected sexual contact with a casual partner while in the UK (p < 0.0001) than while in Poland; more were engaged in sex after the use of recreational drugs and alcohol (p < 0.0001 and p = 0.001 respectively). Being a male was associated with greater odds of unprotected sex, sex after the use of alcohol, and having multiple partners. Being single and having only been a resident for a short time in the UK, presenting a lower self-esteem, were predictors of unprotected sex. A total of 19.6% of the respondents admitted to having been tested while in Poland, a lower (p < 0.0001) frequency than while in the UK (49.5%); this referred to both genders; 1.2% (95% CI: 0.79–2.83%) reported that they were HIV positive. Conclusions: Migration can create a vulnerability to STIs, especially for single male migrants with low self-esteem, staying in the UK for less than two years. The results point to strengthening strategies which help reduce high risk sexual behavior among Polish migrants, and to introduce interventions to promote an awareness of HIV sero-status. Full article
(This article belongs to the Special Issue Refugee Health)
Open AccessArticle Health of the Elderly Migration Population in China: Benefit from Individual and Local Socioeconomic Status?
Int. J. Environ. Res. Public Health 2017, 14(4), 370; doi:10.3390/ijerph14040370
Received: 22 January 2017 / Revised: 12 March 2017 / Accepted: 30 March 2017 / Published: 1 April 2017
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Abstract
The study aims to estimate the relationship between the individual/local socioeconomic status and the health of internal elderly migrants in China. A multilevel logistic model was used to estimate this association. The estimations were undertaken for 11,111 migrants aged over 60 years, using
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The study aims to estimate the relationship between the individual/local socioeconomic status and the health of internal elderly migrants in China. A multilevel logistic model was used to estimate this association. The estimations were undertaken for 11,111 migrants aged over 60 years, using nationally representative data: the 2015 Migrant Dynamics Monitoring Survey (MDMS), which was carried out in China. Odds ratios with 95% confidence intervals were reported. Both the household income per capita and the area-level average wage were positively associated with migrants’ self-reported health; however, public service supply was not significantly related to their health. In addition, given the household income, migrants living in communities with a higher average wage were more likely to report poor health. Migrants’ health benefited from individual socioeconomic status, but not from the local socioeconomic status, which the migrants cannot enjoy. This study highlights the importance of multilevel and non-discriminatory policies between migrants and local residents. Full article
(This article belongs to the Special Issue Refugee Health)
Open AccessArticle Smoking Trends among U.S. Latinos, 1998–2013: The Impact of Immigrant Arrival Cohort
Int. J. Environ. Res. Public Health 2017, 14(3), 255; doi:10.3390/ijerph14030255
Received: 31 October 2016 / Accepted: 25 February 2017 / Published: 2 March 2017
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Abstract
Few studies examine nativity disparities in smoking in the U.S., thus a major gap remains in understanding whether immigrant Latinos’ smoking prevalence is stable, converging, or diverging, compared with U.S.-born Latinos. This study aimed to disentangle the roles of period changes, duration of
[...] Read more.
Few studies examine nativity disparities in smoking in the U.S., thus a major gap remains in understanding whether immigrant Latinos’ smoking prevalence is stable, converging, or diverging, compared with U.S.-born Latinos. This study aimed to disentangle the roles of period changes, duration of U.S. residence, and immigrant arrival cohort in explaining the gap in smoking prevalence between foreign-born and U.S.-born Latinos. Using repeated cross-sectional data spanning 1998–2013 (U.S. National Health Interview Survey), regressions predicted current smoking among foreign-born and U.S.-born Latino men and women (n = 12,492). We contrasted findings from conventional regression analyses that simply include period and duration of residence effects, to two methods of assessing arrival cohort effects: the first accounted for baseline differences in smoking among arrival cohorts, while the second examined smoking probabilities by tracking foreign-born arrival cohorts as they increase their duration of U.S. residence. Findings showed that Latino immigrants maintained lower prevalence of current smoking compared with U.S.-born Latinos over the period 1998–2013, and that longer duration of U.S. residence is associated with lower odds of smoking among men. Two findings are particularly novel: (1) accounting for immigrant arrival cohort dampens the overall protective effect of duration of residence among men; and (2) the earliest arrival cohort of Latino immigrant men experienced the steepest decline in smoking over duration of U.S. residence. Results have methodological and theoretical implications for smoking studies and the Latino mortality paradox. Full article
(This article belongs to the Special Issue Refugee Health)
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Open AccessArticle Determinants of Health Care Services Utilization among First Generation Afghan Migrants in Istanbul
Int. J. Environ. Res. Public Health 2017, 14(2), 201; doi:10.3390/ijerph14020201
Received: 29 October 2016 / Revised: 24 January 2017 / Accepted: 13 February 2017 / Published: 17 February 2017
Cited by 1 | PDF Full-text (306 KB) | HTML Full-text | XML Full-text
Abstract
There is insufficient empirical evidence on the correlates of health care utilization of irregular migrants currently living in Turkey. The aim of this study was to identify individual level determinants associated with health service and medication use. One hundred and fifty-five Afghans completed
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There is insufficient empirical evidence on the correlates of health care utilization of irregular migrants currently living in Turkey. The aim of this study was to identify individual level determinants associated with health service and medication use. One hundred and fifty-five Afghans completed surveys assessing service utilization including encounters with primary care physicians and outpatient specialists in addition to the use of prescription and nonprescription medicines. Multivariate logistic regression analyses were employed to examine associations between service use and a range of predisposing, enabling, and perceived need factors. Health services utilization was lowest for outpatient specialists (20%) and highest for nonprescription medications (37%). Female gender and higher income predicted encounters with primary care physicians. Income, and other enabling factors such as family presence in Turkey predicted encounters with outpatient specialists. Perceived illness-related need factors had little to no influence on use of services; however, asylum difficulties increased the likelihood for encounters with primary care physicians, outpatient services, and the use of prescription medications. This study suggests that health services use among Afghan migrants in Turkey is low considering the extent of their perceived illness-related needs, which may be further exacerbated by the precarious conditions in which they live. Full article
(This article belongs to the Special Issue Refugee Health)
Open AccessArticle Building Responsive Health Systems to Help Communities Affected by Migration: An International Delphi Consensus
Int. J. Environ. Res. Public Health 2017, 14(2), 144; doi:10.3390/ijerph14020144
Received: 17 November 2016 / Revised: 14 January 2017 / Accepted: 19 January 2017 / Published: 3 February 2017
Cited by 2 | PDF Full-text (1237 KB) | HTML Full-text | XML Full-text
Abstract
Persons affected by migration require health systems that are responsive and adaptable to the needs of both disadvantaged migrants and non-migrant populations. The objective of this study is to support health systems for populations affected by migration. Materials and Methods: An international Delphi
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Persons affected by migration require health systems that are responsive and adaptable to the needs of both disadvantaged migrants and non-migrant populations. The objective of this study is to support health systems for populations affected by migration. Materials and Methods: An international Delphi consensus process was used to identify policy approaches to improve health systems for populations affected by migration. Participants were leading migrant health experts from Americas, Europe, Middle East, Asia, and Australasia. We calculated average ranking scores and qualitatively analyzed open-ended questions. Results: Participants identified the following key areas as priorities for policy development: health inequities, system discrimination, migrant related health data, disadvantaged migrant sub-groups, and considerations for disadvantaged non-migrant populations. Highly ranked items to improve health systems were: Health Equity Impact Assessment, evidence based guidelines, and the International Organization for Migration annual reports. Discussion: Policy makers need tools, data and resources to address health systems challenges. Policies need to avoid preventable deaths of migrants and barriers to basic health services. Full article
(This article belongs to the Special Issue Refugee Health)
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Open AccessArticle Recruitment of Refugees for Health Research: A Qualitative Study to Add Refugees’ Perspectives
Int. J. Environ. Res. Public Health 2017, 14(2), 125; doi:10.3390/ijerph14020125
Received: 17 November 2016 / Revised: 3 January 2017 / Accepted: 19 January 2017 / Published: 29 January 2017
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Abstract
Research is needed to understand refugees’ health challenges and barriers to accessing health services during settlement. However, there are practical and ethical challenges for engaging refugees as participants. Despite this, there have been no studies to date specifically investigating refugee perspectives on factors
[...] Read more.
Research is needed to understand refugees’ health challenges and barriers to accessing health services during settlement. However, there are practical and ethical challenges for engaging refugees as participants. Despite this, there have been no studies to date specifically investigating refugee perspectives on factors affecting engagement in health research. Language-concordant focus groups in British Columbia, Canada, with four government-assisted refugee language groups (Farsi/Dari, Somali, Karen, Arabic) inquired about willingness to participate in health research. Twenty-three variables associated with the willingness of refugees to participate in health research were elicited. Variables related to research design included recruitment strategies, characteristics of the research team members and the nature of the research. Variables related to individual participants included demographic features such as gender and education, attitudes towards research and previous experience with research. This research can be used to increase opportunities for refugees’ engagement in research and includes recommendations for subgroups of refugees that may have more difficulties engaging in research. Full article
(This article belongs to the Special Issue Refugee Health)
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Open AccessArticle Maternal and Child Health of Internally Displaced Persons in Ukraine: A Qualitative Study
Int. J. Environ. Res. Public Health 2017, 14(1), 54; doi:10.3390/ijerph14010054
Received: 14 November 2016 / Revised: 30 December 2016 / Accepted: 3 January 2017 / Published: 9 January 2017
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Abstract
Due to the conflict that started in spring 2014 in Eastern Ukraine, a total of 1.75 million internally displaced persons (IDPs) fled the area and have been registered in government-controlled areas of the country. This paper explores perceived health, barriers to access to
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Due to the conflict that started in spring 2014 in Eastern Ukraine, a total of 1.75 million internally displaced persons (IDPs) fled the area and have been registered in government-controlled areas of the country. This paper explores perceived health, barriers to access to healthcare, caring practices, food security, and overall financial situation of mothers and young children displaced by the conflict in Ukraine. This is a qualitative study, which collected data through semi-structured in-depth interviews with nine IDP mothers via Skype and Viber with a convenience sample of participants selected through snowball technique. Contrary to the expectations, the perceived physical health of mothers and their children was found not to be affected by conflict and displacement, while psychological distress was often reported. A weak healthcare system, Ukraine’s proneness to informal payments, and heavy bureaucracy to register as an IDP were reported in our study. A precarious social safety net to IDP mothers in Ukraine, poor dietary diversity, and a generalized rupture of vaccine stocks, with halted or delayed vaccinations in children were identified. Increasing social allowances and their timely delivery to IDP mothers might be the most efficient policy measure to improve health and nutrition security. Reestablishment and sustainability of vaccine stocks in Ukraine is urgent to avoid the risks of a public health crisis. Offering psychological support for IDP mothers is recommended. Full article
(This article belongs to the Special Issue Refugee Health)
Open AccessArticle Gendered Sources of Distress and Resilience among Afghan Refugees in Northern California: A Cross-Sectional Study
Int. J. Environ. Res. Public Health 2017, 14(1), 25; doi:10.3390/ijerph14010025
Received: 25 October 2016 / Revised: 21 December 2016 / Accepted: 23 December 2016 / Published: 28 December 2016
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Abstract
Recent studies have emphasized the influence of resettlement factors on the mental health of refugees resettling in developed countries. However, little research has addressed gender differences in the nature and influence of resettlement stressors and sources of resilience. We address this gap in
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Recent studies have emphasized the influence of resettlement factors on the mental health of refugees resettling in developed countries. However, little research has addressed gender differences in the nature and influence of resettlement stressors and sources of resilience. We address this gap in knowledge by investigating how gender moderates and mediates the influence of several sources of distress and resilience among 259 Afghan refugees residing in Northern California (USA). Gender moderated the effects of four factors on levels of distress. Intimate and extended family ties have little correlation with men’s distress levels, but are strongly associated with lower distress for women. English ability is positively associated with lower distress for women, but not men. In terms of gender ideology, traditionally oriented women and egalitarian men have lower levels of distress. And experiencing greater dissonant acculturation increases distress for men, but not women. The influence of gender interaction terms is substantial and patterns may reflect difficulty adapting to a different gender order. Future studies of similar populations should investigate gender differences in sources of distress and resilience, and efforts to assist new arrivals might inform them of changes in gender roles they may experience, and facilitate opportunities to renegotiate gender roles. Full article
(This article belongs to the Special Issue Refugee Health)
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Open AccessArticle Association between Suicide Ideation and Attempts and Being an Immigrant among Adolescents, and the Role of Socioeconomic Factors and School, Behavior, and Health-Related Difficulties
Int. J. Environ. Res. Public Health 2016, 13(11), 1070; doi:10.3390/ijerph13111070
Received: 10 September 2016 / Revised: 24 October 2016 / Accepted: 25 October 2016 / Published: 1 November 2016
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Abstract
The risk of suicide behaviors in immigrant adolescents varies across countries and remains partly understood. We conducted a study in France to examine immigrant adolescents’ likelihood of experiencing suicide ideation in the last 12 months (SI) and lifetime suicide attempts (SA) compared with
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The risk of suicide behaviors in immigrant adolescents varies across countries and remains partly understood. We conducted a study in France to examine immigrant adolescents’ likelihood of experiencing suicide ideation in the last 12 months (SI) and lifetime suicide attempts (SA) compared with their native counterparts, and the contribution of socioeconomic factors and school, behavior, and health-related difficulties. Questionnaires were completed by 1559 middle-school adolescents from north-eastern France including various risk factors, SI, SA, and their first occurrence over adolescent’s life course (except SI). Data were analyzed using logistic regression models for SI and Cox regression models for SA (retaining only school, behavior, and health-related difficulties that started before SA). Immigrant adolescents had a two-time higher risk of SI and SA than their native counterparts. Using nested models, the excess SI risk was highly explained by socioeconomic factors (27%) and additional school, behavior, and health-related difficulties (24%) but remained significant. The excess SA risk was more highly explained by these issues (40% and 85%, respectively) and became non-significant. These findings demonstrate the risk patterns of SI and SA and the prominent confounding roles of socioeconomic factors and school, behavior, and health-related difficulties. They may be provided to policy makers, schools, carers, and various organizations interested in immigrant, adolescent, and suicide-behavior problems. Full article
(This article belongs to the Special Issue Refugee Health)
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Open AccessArticle Return Migrants’ Experience of Access to Care in Corrupt Healthcare Systems: The Bosnian Example
Int. J. Environ. Res. Public Health 2016, 13(9), 924; doi:10.3390/ijerph13090924
Received: 18 August 2016 / Revised: 8 September 2016 / Accepted: 13 September 2016 / Published: 19 September 2016
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Abstract
Equal and universal access to healthcare services is a core priority for a just health system. A key societal determinant seen to create inequality in access to healthcare is corruption in the healthcare system. How return migrants’ access to healthcare is affected by
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Equal and universal access to healthcare services is a core priority for a just health system. A key societal determinant seen to create inequality in access to healthcare is corruption in the healthcare system. How return migrants’ access to healthcare is affected by corruption is largely unstudied, even though return migrants may be particularly vulnerable to problems related to corruption due to their period of absence from their country of origin. This article investigates how corruption in the healthcare sector affects access to healthcare for refugees who repatriated to Bosnia, a country with a high level of corruption, from Denmark, a country with a low level of corruption. The study is based on 18 semi-structured interviews with 33 refugees who returned after long-term residence in Denmark. We found that the returned refugees faced greater problems with corruption than was the case for those who had not left the country, as doctors considered them to be better endowed financially and therefore demanded larger bribes from them than they did from those who had remained in Bosnia. Moreover, during their stay abroad the returnees had lost the connections that could have helped them sidestep the corruption. Returned refugees are thus particularly vulnerable to the effects of corruption. Full article
(This article belongs to the Special Issue Refugee Health)
Open AccessArticle Seroprevalence of Antibodies against Measles, Rubella and Varicella among Asylum Seekers Arriving in Lower Saxony, Germany, November 2014–October 2015
Int. J. Environ. Res. Public Health 2016, 13(7), 650; doi:10.3390/ijerph13070650
Received: 23 May 2016 / Revised: 20 June 2016 / Accepted: 23 June 2016 / Published: 30 June 2016
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Abstract
The number of asylum seekers arriving in Germany has increased rapidly since 2014 and cases of vaccine-preventable diseases at reception centres were reported. Asylum seekers 12 years and older arriving in Lower Saxony were serologically screened for antibodies against measles, rubella and varicella
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The number of asylum seekers arriving in Germany has increased rapidly since 2014 and cases of vaccine-preventable diseases at reception centres were reported. Asylum seekers 12 years and older arriving in Lower Saxony were serologically screened for antibodies against measles, rubella and varicella between November 2014 and October 2015. We calculated the seroprevalence from the screening data by disease, country of origin and age group and compared them to literature-based herd immunity thresholds in order to identify immunisation gaps. In total, 23,647 specimens were included in our study. Although the vast majority of asylum seekers tested positive for antibodies against measles, rubella and varicella, the seroprevalences were not sufficient to ensure herd immunity. The seroprevalences varied substantially between countries of origin and increased with age. Immunisation of asylum seekers against measles, rubella and varicella is needed and the detailed information on seroprevalences among subgroups of asylum seekers can be used for targeted immunisations at reception centres. Full article
(This article belongs to the Special Issue Refugee Health)

Review

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Open AccessReview Refugee Policy Implications of U.S. Immigration Medical Screenings: A New Era of Inadmissibility on Health-Related Grounds
Int. J. Environ. Res. Public Health 2017, 14(10), 1107; doi:10.3390/ijerph14101107
Received: 23 July 2017 / Revised: 21 September 2017 / Accepted: 22 September 2017 / Published: 24 September 2017
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Abstract
Refugees frequently face extended delays in their efforts to enter the United States (U.S.) and those who are successful, in many cases, encounter overwhelming obstacles, inadequate resources, and a complex system of legal barriers. Travel restrictions based on equivocal health concerns and a
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Refugees frequently face extended delays in their efforts to enter the United States (U.S.) and those who are successful, in many cases, encounter overwhelming obstacles, inadequate resources, and a complex system of legal barriers. Travel restrictions based on equivocal health concerns and a drop in refugee admittance ceilings have complicated the situation. The authors retrieved and analyzed peer-reviewed journal articles, government agency press releases, media postings, epidemiologic factsheets, and relevant lay publications to critically assess U.S. policy regarding refugee resettlement based on health-related grounds. While refugees arguably exhibit an increased incidence of measles and tuberculosis compared with the U.S. population, the legitimacy of the medical examination will be undermined if other diseases that are endemic to refugee populations, yet currently deemed admissible, are used to restrict refugees from entering the U.S. This paper addressees the historic refugee policy of the U.S. and its consequent effect on the health of this vulnerable population. The needs of refugees should be carefully considered in the context of increased disease burden and the associated health care challenges of the country as a whole. Full article
(This article belongs to the Special Issue Refugee Health)
Open AccessReview Trapped in Statelessness: Rohingya Refugees in Bangladesh
Int. J. Environ. Res. Public Health 2017, 14(8), 942; doi:10.3390/ijerph14080942
Received: 8 July 2017 / Revised: 16 August 2017 / Accepted: 19 August 2017 / Published: 21 August 2017
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Abstract
The Rohingya people are one of the most ill-treated and persecuted refugee groups in the world, having lived in a realm of statelessness for over six generations, and who are still doing so. In recent years, more than 500,000 Rohingyas fled from Myanmar
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The Rohingya people are one of the most ill-treated and persecuted refugee groups in the world, having lived in a realm of statelessness for over six generations, and who are still doing so. In recent years, more than 500,000 Rohingyas fled from Myanmar (Burma) to neighboring countries. This article addresses the Rohingya refugee crisis in Bangladesh, with special emphasis on the living conditions of this vulnerable population. We reviewed several documents on Rohingya refugees, visited a registered refugee camp (Teknaf), collected case reports, and conducted a series of meetings with stakeholders in the Cox’s Bazar district of Bangladesh. A total of 33,131 registered Rohingya refugees are living in two registered camps in Cox’s Bazar, and up to 80,000 additional refugees are housed in nearby makeshift camps. Overall, the living conditions of Rohingya refugees inside the overcrowded camps remain dismal. Mental health is poor, proper hygiene conditions are lacking, malnutrition is endemic, and physical/sexual abuse is high. A concerted diplomatic effort involving Bangladesh and Myanmar, and international mediators such as the Organization of Islamic Countries and the United Nations, is urgently required to effectively address this complex situation. Full article
(This article belongs to the Special Issue Refugee Health)
Open AccessReview Factors Influencing the Accuracy of Infectious Disease Reporting in Migrants: A Scoping Review
Int. J. Environ. Res. Public Health 2017, 14(7), 720; doi:10.3390/ijerph14070720
Received: 16 May 2017 / Revised: 22 June 2017 / Accepted: 30 June 2017 / Published: 5 July 2017
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Abstract
We conducted a scoping review of literature to improve our understanding of the accuracy of infectious disease monitoring in migrants in the Europe. We searched PubMed for papers relevant to the topic including: case reports, observational and experimental studies, reviews, guidelines or policy
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We conducted a scoping review of literature to improve our understanding of the accuracy of infectious disease monitoring in migrants in the Europe. We searched PubMed for papers relevant to the topic including: case reports, observational and experimental studies, reviews, guidelines or policy documents; published after 1994. We identified 532 papers, 27 of which were included in the review. Legislation and right to access health care influence both the accuracy of rates and risk measures under estimating the at risk population, i.e., the denominator. Furthermore, the number of reported cases, i.e., the numerator, may also include cases not accounted for in the denominator. Both biases lead to an overestimated disease occurrence. Restriction to healthcare access and low responsiveness may cause under-detection of cases, however a quantification of this phenomenon has not been produced. On the contrary, screening for asymptomatic diseases increases ascertainment leading to increased detection of cases. Incompleteness of denominator data underestimates the at-risk population. In conclusion, most studies show a lower probability of under-reporting infectious diseases in migrants compared with native populations. Full article
(This article belongs to the Special Issue Refugee Health)
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Other

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Open AccessCommentary Leveraging the Domain of Work to Improve Migrant Health
Int. J. Environ. Res. Public Health 2017, 14(10), 1248; doi:10.3390/ijerph14101248
Received: 7 August 2017 / Revised: 1 September 2017 / Accepted: 14 September 2017 / Published: 19 October 2017
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Abstract
Work is a principal driver of current international migration, a primary social determinant of health, and a fundamental point of articulation between migrants and their host society. Efforts by international organizations to promote migrant health have traditionally focused on infectious diseases and access
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Work is a principal driver of current international migration, a primary social determinant of health, and a fundamental point of articulation between migrants and their host society. Efforts by international organizations to promote migrant health have traditionally focused on infectious diseases and access to healthcare, while international labor organizations have largely focused on issues of occupational health. The underutilization of the domain of work in addressing the health of migrants is truly a missed opportunity for influencing worker well-being and reducing societal economic burden. Understanding of the relationships among migration, work, and health would facilitate further integration of migrant health concerns into the policy agenda of governments and international agencies that work at the nexus of labor, health and development. The domain of work offers an opportunity to capitalize on the existing health and development infrastructure and leverage technical resources, programs and research to promote migrant health. It also provides the opportunity to advance migrant health through new and innovative approaches and partnerships. Full article
(This article belongs to the Special Issue Refugee Health)
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