U.S. policy dictates that immigration enforcement should not take place in or near "sensitive locations," such as healthcare facilities, but Border Patrol agents are often required to accompany detained border crossers to hospitals for medical care. There is little understanding of the presence of Border Patrol agents within healthcare facilities. This study is the first to examine the presence of Border Patrol agents in healthcare settings and its possible impact on the willingness of undocumented individuals to access healthcare. We conducted interviews with 57 emergency medical services (EMS) personnel working in one county in South Texas. Interviews were held between November 2023- January 2024. Interview transcripts were coded using NVivo 14 and thematic analysis was performed on the transcript data. There is a regular, highly visible Border Patrol presence in healthcare settings in the community of study. In many cases, participants stated that they saw Border Patrol agents every time they brought a patient to the hospital. Hospitals are listed as sensitive locations for immigration enforcement, but policies that require agents to accompany detained border crossers result in a near constant presence of Border Patrol agents in hospitals. The regular, visible presence of Border Patrol agents at hospitals in the study community may deter community residents without legal status from seeking healthcare.

Xenophobia among healthcare professionals can significantly impact the quality of care provided to immigrant and refugee populations, particularly in countries with high influxes such as Türkiye. This study evaluated xenophobia among resident physicians at Pamukkale University Hospital and identified factors influencing these attitudes. This cross-sectional study involving 271 resident physicians at Pamukkale University Hospital was conducted between August 1 and August 20, 2022. The participants were randomly selected and stratified by department. Data were collected via a 38-item questionnaire, including the 11-item Xenophobia Scale. Descriptive statistics, the Mann‒Whitney U test, the Kruskal‒Wallis test, and multiple linear regression analysis were used for data analysis. The mean xenophobia scale score among participants was 57.53 (SD = 7.82), indicating high levels of xenophobic attitudes. The significant factors associated with higher xenophobia scores included being from a surgical department (B = 0.571, p < 0.001) and lacking foreign nationals in their close environment (B = 0.724, p < 0.001). Additionally, 58.7% of the resident physicians opposed providing free healthcare services to refugees, and 10.0% indicated that they might delay providing health services to these patients because of their status. Additionally, 7.7% of the resident physicians admitted to discriminating against migrant/refugee patients. The study reveals pervasive xenophobic attitudes among resident physicians in Türkiye, which are influenced by departmental affiliation and the social environment. These findings underscore the need for targeted interventions to address xenophobia in healthcare settings, including cultural competence training and policy changes, to ensure equitable healthcare access for all patients.

Underserved communities were disproportionately affected during the coronavirus (COVID-19) pandemic. Limited data exist on the impact of COVID-19 among refugee populations because refugee status is not often classified in electronic medical record (EMR) systems, unlike race or primary language. The study aim was to evaluate the PCR-based prevalence of SARS-CoV-2 in a delivering population over the first 2 years of the pandemic by refugee status, ethnicity, insurance, and vaccination status. A cross-sectional study examined parturient patients admitted to an urban safety-net hospital from May 2020 to May 2022 who were tested for SARS-CoV-2on admission. Percentages and prevalence ratios of SARS-CoV-2 between refugee status, insurance type, vaccination status, and race/ethnicity were calculated across four time periods, corresponding with variant surges of the pandemic. 3,502 patients delivered, 476 (13.6%) were refugees. Self-pay (46.4%) and Medicaid (46.4%) were the most frequent insurance types with a Hispanic predominance (64.5%) by race/ethnicity. Only 12.8% of patients received at least one vaccine before delivery: 13.2% in non-refugees versus 10.3% refugees 192 (5.5%) of the mothers tested positive during the study period with 6.1% refugees positive versus 5.4% among non-refugees, (prevalence ratio, 1.13; P = 0.53, 95% confidence interval [0.77, 1.66]). Positive tests ranged between 4.7% and 6.3% across insurance types and between 4.4% and 7.5% across race/ethnicity categories. The highest prevalence ratio (refugee/non-refugee) of 2.01 was during the Delta Surge (P = 0.12, 95% confidence interval [0.84, 4.82]) and the lowest prevalence ratio of 0.64 was during the Omicron Surge (P = 0.21, 95% CI [0.32, 1.30]). Among refugees when examined by primary language, 51.7% of positive tests were from those speaking languages of the African Great Lakes region (Kinyarwanda, Kirundi, Swahili, Kiswahili). We observed only small differences in SARS-CoV-2 prevalence between refugees and non-refugees or in vaccination status. Variations in prevalence ratio were seen by refugee status by variant surge. Subsets of the refugee population, when grouped by language/region, appeared to be more affected. This warrants future research on the impact of the SARS-CoV-2 pandemic on specific refugee communities, rather than refugee communities as a heterogenous unit.

The COVID-19 pandemic disproportionately affected African, Caribbean, and Black (ACB) people in Canada. Despite higher SARS-CoV-2 exposure risks, likelihood of being quarantined, and risk of severe disease outcomes, little is known about the pandemic's effects on this community's mental health. This study aims to identify factors associated with changes in ACB Canadians' mental health during the pandemic and provide guidance for improved access to mental health resources. Data was collected from May to July 2021 using a cross-sectional, national, online survey. Eligible participants for this community-based study were ACB adults residing in Canada. Survey measures included demographics, pandemic-related experiences, mental health status, and access to mental health services. Bivariate analyses and multinomial logistic regression examined associations between variables. Among the 1,556 participants, 25.4% reported improved mental health and 33.1% reported worsened mental health since the pandemic's onset. Improved mental health was associated with younger age, receiving at least one pandemic-related benefit, and living in a home that became safer. In contrast, worsened mental health was associated with younger age, working less, the pandemic having a major impact on ability to pay bills, not receiving pandemic-related benefits, home becoming less safe, and increased substance use. Barriers to accessing mental health services included difficulty getting an appointment, cost, pandemic measures, and lack of culturally competent care. These insights underscore the positive impact of pandemic-related emergency relief, the challenges in accessing mental health services, and the gaps in culturally competent mental health care.

Since the Syrian civil war, Türkiye has received more than 3.6 million Syrian people who sought protection and have been provided a temporary state protection status, making the country the largest host country in the world. This study aimed to investigate depression and anxiety levels of Syrian people accommodated in a relatively developed part of a south-eastern city, Şanlıurfa. Adaptation of the Refugee Health Screener (RHS-15) scale, an objectively designed screening tool for prevalent mental disorders among refugees, is another distinctive feature of this investigation. Using a snowball sampling method, 454 Syrian people aged 18 or older were administered four inventories in their Arabic and Turkish, including the Refugee Health Screener-15 (RHS-15), Beck Anxiety Scale (BAI), Beck Depression Inventory-II (BDI), and Post Migration Living Difficulties Checklist (PMLD). Using a path analysis model, the mediating role of the RHS-15 was examined in the effect of the PMLD, which is considered one-dimensional, on the BAI and BDI variables. The study showed low levels of depression (8.51 ± 2.96) and anxiety (7.86 ± 2.43) that corresponded well to low RHS-15 (6.36 ± 2.31) and PMLD (15.64 ± 2.83) scores. In path analysis, the RHS variable has a significant direct effect on the BAI and BDI variables, with an increase in the RHS variable correlated with an increase in the BAI variable and BDI variable, respectively. The RHS-15 scores were significantly higher among married participants, those with poor financial status, those having 3-4 children and those with physical problems. A more reflective population sample would provide better insight into depression and anxiety levels of Syrian people accommodated in Türkiye.

Higher concentrations of heavy metals were reported mainly among adult Asian persons compared to other racial/ethnic groups in earlier NHANES cycles' studies. We aimed to examine concentrations of metals among Asian children/adolescents compared to children/adolescents identifying with other racial/ethnic groups, considering socio-demographic factors and potential mediation by fish/shellfish consumption. Using NHANES data (2015-2018), 5293 participants (1-19 years) with blood/urinary measurements of lead, cadmium, mercury and arsenic were included. Survey-weighted adjusted generalized linear models assessed differences in log-transformed metal concentrations between Asian and non-Asian participants, considering potential effect measure modification by parental education. Causal mediation effects of recent fish/shellfish consumption were estimated. Log-transformed metal concentrations were higher among Asian than among non-Asian children/adolescents. Lower parental education was associated with higher concentrations of cadmium and methylmercury among Asian participants, and effect measure modification was suggested. Proportions of the mercury exposure disparity mediated by recent fish/shellfish consumption were 9.1% (95% CI 2.6, 17.3%) for fish, and 5.7% (0.5, 12.0%) for shellfish, with similar findings for methylmercury. Overall, Asian identification was associated with higher toxic metal exposure, and among Asian children/adolescents those with parents with lower education were particularly affected. Dietary fish/shellfish intake explained a portion of the disparities. Prevention efforts should identify sources of elevated metal exposure focusing children and adolescents while considering diverse backgrounds and dietary habits including high fish consumption.

Brazilians are a rapidly growing immigrant population in the United States (U.S.), yet little is known about their mental health and access to mental healthcare. Our goal was to access associations between the pursuit of- and access to-mental healthcare with mental health status and socio-demographic characteristics among Brazilian immigrant women. We conducted an online survey of Brazilian women aged 18 or older who reported being born in Brazil and currently residing in the U.S. We recruited respondents via Brazilian cultural media, community organizations serving Brazilian immigrants, and social media. We assessed respondents' perceived access to mental healthcare, self-reported mental health (CES-D-10), and socio-demographic characteristics and conducted multivariable logistic regression. Our analysis included 351 participants. Half (52%) had CES-D-10 scores indicating high levels of depressive symptomatology. A third (33%) reported seeking care for their mental health in the past 12 months, 87% of whom reported obtaining care. Results of multivariable logistic regression determined that respondents who sought mental healthcare were more likely to have higher CES-D-10 scores (OR = 1.09, 95% CI 1.03-1.15), very low incomes (<$10,000 per year; OR = 0.34, 95% CI 0.12-0.96), and were marginally more likely to have a primary care provider (OR = 2.11, 95% CI 1.00, 4.46). We found that despite a high level of depressive symptomology, only one-third reported accessing care. While difficulty accessing care for mental issues is a widespread issue, our findings suggest that efforts are needed to ameliorate mental health issues for Brazilian women to reduce systemic, interpersonal, and individual barriers to seeking care among the 13% who sought healthcare but were unable to receive it.

The mental health of asylum seekers and refugees (ASRs) is a pressing global concern, with complex trauma histories and environmental stressors contributing to heightened vulnerability. This study investigates the mental health and service utilization patterns of ASRs in Hong Kong, where unique policy landscapes pose additional challenges to this population. A cross-sectional survey was conducted with 100 ASRs in Hong Kong. Participants completed measures assessing displacement-related stressors, trauma exposure, mental health symptoms (depression, anxiety, stress, PTSD/CPTSD), and mental health service utilization. Participants reported high levels of displacement-related stressors and trauma exposure. The majority exhibited symptoms of depression, anxiety, and stress, with a significant proportion screening positive for PTSD/CPTSD. Despite high mental health needs, their service utilization rates were low. Trauma exposure and displacement-related stressors were significantly associated with poorer mental health outcomes, but not with service utilization. ASRs in Hong Kong face significant mental health challenges, influenced by both pre- and post-migration factors. Findings underscore higher rates of mental distress in the present sample compared to prior studies in ASRs and other local surveys. While trauma-informed care is crucial, efforts to improve mental health service access and reduce systemic barriers are needed with targeted strategies and policy changes.

We investigated whether ethnocultural inequality in rates of gestational diabetes was prevalent in Canada. We compared the Anglophone minority with the Francophone majority in Quebec. We conducted a retrospective cohort study of 853,595 pregnancies between 2008 and 2020 in Quebec, Canada. The exposure was ethnocultural status, with patients classified as either Anglophone or Francophone based on the maternal language. The outcome was gestational diabetes. We calculated risk ratios (RR) and 95% confidence intervals (CI) for the association between ethnocultural status and risk of gestational diabetes using log-binomial regression models adjusted for maternal age, parity, comorbidity, education, country of origin, material deprivation, urban residence, and time period. Anglophones had a higher rate of gestational diabetes compared with Francophones (99.0 vs 81.0 per 1000 pregnancies; RR 1.07, 95% CI 1.05-1.10). Anglophones aged less than 25 years (RR 1.31, 95% CI 1.21-1.41), living in rural areas (RR 1.73, 95% CI 1.64-1.82), lacking a high school diploma (RR 1.48, 95% CI 1.37-1.61), or with material disadvantage (RR 1.33, 95% CI 1.27-1.39) had greater risks of gestational diabetes compared with Francophones. Risk of gestational diabetes among Anglophones increased over time, especially among disadvantaged subgroups of the population. The findings suggest that the Anglophone ethnocultural minority in Quebec has an increasing risk of gestational diabetes over time compared with the Francophone majority. Risks are particularly elevated for Anglophones from disadvantaged subgroups of the population.

Healthcare providers (HCPs) play a critical role in the care of women with experience of FGM/C although there is limited research on knowledge about FGM/C among HCPs in Canada and USA. Research evidence suggests that many women with experience of FGM/C have negative care experiences. We sought to investigate the knowledge, attitudes, and practices of Canadian and USA HCPs regarding FGM/C, along with women's healthcare experiences with FGM/C in both countries. We conducted a scoping review guided by Arksey & O'Malley's framework. We exported 4054 peer-reviewed records from Embase, Global Health PubMed, Medline, and Scopus databases. After screening titles, abstracts and full texts using inclusion criteria such as publication between 2000 and 2023, a focus on FGM/C and studies conducted in USA and Canada, we included 13 articles in the final review. Care provider studies revealed that HCPs reported a desire for more knowledge and training to enable them to provide high-quality care for women with FGM/C. Majority of the studies have revealed reliance of HCPs on informal learning channels to gain knowledge on FGM/C. Findings reveal that many women with experiences of FGM/C have reported insensitive comments from HCPs including some nurses' unsympathetic behavior toward FGM/C related postpartum discomfort. In some studies, majority of the women felt their doctors were unable to care for them while other women noted that shame and discomfort deterred them from further care seeking. HCPs play an important role in caring for FGM/C patients. Nonetheless HCPs often receive no training or training that is inadequate (insufficient to make providers feel confident to provide care) on how to provide high-quality, culturally competent care leading to poor experiences for women. This necessitates concerted efforts to provide high-quality training of HCPs for better care for women with FGM/C.

One Midwest, non-profit clinic aimed to increase access to contraceptive services by improving their care delivery process through the implementation of a population-specific, contraception education program. The program included patient education, timely follow-up appointments, and free contraception. In this quality improvement project, a total of twenty-two mostly Spanish-speaking women signed up for a group education session that lasted thirty minutes and was offered monthly. The session was led by a female, bilingual provider and focused on contraception benefits, side effects, and common myths. After the session, the clinic offered same-day initiation of contraception for oral contraceptives, Depo-Provera injections, and Nexplanon implants. In this clinic, offering the class in conjunction with immediate initiation of the chosen birth control method decreased the average time to care delivery, showing a positive impact on access to these essential services.

A growing body of evidence suggests that leisure-time physical activity (LTPA) impacts one's mental health (MH) positively. The suggested MH benefits of LTPA may present a promising avenue to promote the MH of immigrants/refugees, who often face various stressors that may impede their MH. The CAN-HEAL study aimed to examine LTPA needs as they pertain to MH among Arab Canadians. The study adopted a collaborative community-based participatory research and integrated knowledge translation approach. Three methods were triangulated: qualitative interviews, Photovoice and a quantitative survey. A combination of sampling strategies (convenience, purposive and snowball) was utilized to recruit 60 socio-demographically diverse Arab Canadian participants. The study was informed by an integrated bio-psycho-socio-cultural framework. Although participants were knowledgeable of recommendations and MH benefits of LTPA, a high prevalence of physical inactivity (87%) was found. Intersections between age, gender, socio-economic and employment status, length of residency, and immigration status were associated with substantial LTPA inequities and negative MH within Arab communities. Older adults and low-income participants reported significantly lower LTPA levels than younger adults and those with higher income. Female participants reported lower LTPA levels than their male counterparts. Study findings demonstrate that the LTPA-MH relationship among Arab Canadians is multi-faceted, with various LTPA-related bio-psycho-socio-cultural pathways/mechanisms influencing Arab Canadians' MH. Intersectoral collaboration is required to implement a co-created community- and political-level action plan to address LTPA inequities and achieve health equity for Arab Canadians and other similar vulnerable groups.

U.S. immigrant parents encounter various challenges during the migration and resettlement process, such as acculturative stress and dissonance in parenting practices between the cultures in the U.S. and those in their country of origin. Although studies have established a link between increased perceived stress and reduced parenting self-efficacy in U.S.-born parents, which could be alleviated by levels of parental empowerment, little is known about this pathway in the context of migration. Guided by the Family Adjustment and Adaptation Response Model and with a focus on low-income immigrant parents of young children, we examined (1) the association between perceived stress and parenting self-efficacy, and (2) whether parental empowerment constitutes a buffer between perceived stress and parenting self-efficacy. Participants included foreign-born, low-income parents (n = 680) with preschool-aged children enrolled in Head Start of Greater Boston. Linear regression models were conducted to examine the relationship between perceived stress and parenting self-efficacy. An interaction term between perceived stress and empowerment was included to test the moderating effect of each dimension of parental empowerment (i.e., resource empowerment, critical awareness, and relational empowerment). Results showed higher perceived stress was associated with lower parenting self-efficacy and this relationship was moderated by relational empowerment. Findings suggest that relational empowerment can be an important resource for immigrant parents with high stress and a protective factor to improve self-efficacy in their parenting. These results pose important implications regarding how healthcare professionals and clinicians may support parents, for example, through the development of culturally sensitive parenting interventions and the creation of safe environments for parent-to-parent relationships.

The lack of health insurance coverage is one of the most serious challenges confronting refugees and an important public policy issue. This study examines how refugees' human and social capital is linked to their health insurance coverage. This study uses the 2020 Annual Survey of Refugees public use data file to test the relationship between refugees' human and social capital and their health insurance coverage. 770 refugees who entered the U.S. between 2015 and 2019 are included in the sample. Health insurance coverage is measured in three different levels: no coverage at all, coverage with a gap, and coverage all year long. This study employs an ordered probit regression. The findings show that refugees' human capital, regardless of whether it is from refugees' home country or the U.S., is not associated with health insurance coverage. However, refugees' social capital, in terms of their involvement in religious organizations and their informal bridging network with people from a different culture, is positively associated with coverage. The analysis also reveals a gap in coverage once the initial government assistance ends, and refugees' paid employment and household income are negatively associated with health insurance coverage. The findings suggest that refugees' social capital in the new country plays an important role in obtaining the necessary information for healthcare access while the positive impacts of human capital on healthcare access may not apply to the refugee population. Therefore, resettlement programs should place an emphasis on helping refugees build and enhance social connections with people of diverse cultural backgrounds.

Contraceptive use is the most effective means of preventing unintended pregnancies among sexually active individuals. Foreign-born women are less likely to use contraception when compared to US-born women. However, there are limited studies focused on understanding factors that influence contraceptive use among foreign-born women in the US. This study aimed to explore the factors associated with contraceptive use in the early reproductive lives of foreign-born women in the US. This study utilized the 2017-2019 National Survey on Family Growth to conduct a cross-sectional secondary data analysis. Analyses were restricted to observations from 708 women who identified as foreign-born, were aged 15-49 years, and provided information about their first pregnancies. Chi-square tests and multivariable logistic regression were used to assess the factors influencing contraceptive use. 70.9% of the participants had used a form of contraception in the period leading to their first pregnancy. Multivariable regression analysis identified significant predictors of contraceptive use: educational level, age, religion, income levels, health insurance, and race/ethnicity. Those with a religious affiliation and were 25 years and above had greater odds of contraceptive use while non-Hispanic blacks and non-Hispanic other/multiple race participants had lower odds of contraceptive use. Based on the predictors identified, public health interventions should be tailored to address specific socio-demographic factors that influence contraceptive decisionmaking among foreign-born women in the US. Additionally, understanding the disparities in contraceptive use across racial/ethnic backgrounds underscores the need for culturally sensitive approaches that acknowledge and respect diverse beliefs surrounding contraception.

Based on the Reserve Capacity Model, this study examined the effect of SES(socioeconomic status) on health status on the health status of menopausal mothers of multicultural families, focusing on mediating effects of self-esteem, assimilation, integration, separation, marginalization, and daily life stress. This is a cross-sectional survey study with secondary analysis of national data on 683 perimenopausal mothers in multicultural families from the 9th Multicultural Adolescents Panel Study surveyed by the Korea Youth Policy Institute in 2019. The subjects were women aged 45-55 years and foreign nationals by origin. For path analysis using observed variables, the Mplus 8.4 program was used. Self-esteem and integration were positively related to health status and negatively related to marginalization and daily life stress. Health status was higher when self-esteem and integration were high, and work-life stress and marginalization were low. To improve the perceived health status of menopausal women in multicultural families, rather than simply focusing on SES through support for employment status and income, it is necessary to improve self-esteem by resolving difficulties caused by SES and cultural adaptation to relieve stress in daily life and to provide multidimensional coping resources that can improve health by lowering risk.

Immigrants intended to more rely on self-medication because of the difficulty of accessing formal healthcare in host countries. Negative consequences could occur when self-medication was inappropriate. This study aimed to systematically explore the prevalence, sources and determinants of immigrants' self-medication and the extent of their inappropriate self-medication episodes. PubMed, Scopus, SpringerLink, and ScienceDirect were used for data searching. The search date was 10th June 2023, with no beginning date to limit searching articles. Thirty-two studies were included. The prevalence of immigrants' self-medication presented from 18 studies ranged between 20.2% and 94.6%. Major sources of immigrants' self-medication were commonly obtained from their home countries, local markets or shops, and informal networks. The determinants of immigrants' self-medication were systematically collated into four themes: (1) illness and self-medication perception, (2) access to healthcare and medication, including 6 dimensions: accessibility, availability, affordability, acceptability, awareness and accommodation, (3) worry, and (4) predisposing factors of immigrants. About 46% of immigrant's self-medication episodes were inappropriate, especially antibiotic use. About 66% of the included studies described antibiotic self-medication. Prevalence rates of self-medication among different immigrantsvaried based on different time frames, context of diseases and migrated countries. Immigrants' cultural health belief, facing significant worry about job security, legal status, and cultural barriers influenced their self-medication. When immigrants have greater availability, accommodation, awareness, accessibility, acceptability, and affordability of health services in host countries, they are less likely to use self-medication. The predisposing factors like age, income, work status and immigrants' language also influenced their self-medication.

Cervical cancer is a significant global health issue, ranking as the second most prevalent cancer among women of reproductive age. While prevention strategies like HPV vaccination and screening have made it highly preventable, these benefits are mostly seen in high-HDI nations. In contrast, LMICs lag behind, with Afghanistan facing a growing crisis due to war, poverty, and lack of awareness. The recent influx of Afghan evacuees to the U.S. poses a risk of introducing undiagnosed cases. Addressing this requires collaborative efforts to raise awareness, promote screening, and vaccination among Afghan women, leveraging culturally sensitive approaches and community partnerships to improve health outcomes.