In this paper, we describe a research protocol for surveying and interviewing Latinx immigrants recently arrived at the US southern border, and we raise important and unique issues that need to be considered with this population. The main objective is to share experiences, challenges, opportunities, and essential considerations (which we call lessons learned) that researchers should take into account when working with this vulnerable study population. The six lessons learned focus on: (1) fostering relationships with community partners; (2) participant consent and compensation; (3) linguistic and cultural fluency of researchers; (4) adapting data collection procedures to the environment and conditions; (5) establishing trust with participants and being trustworthy; and (6) addressing the ethical considerations of research with immigrant populations and the positionality of researchers. This paper provides a unique perspective of working with a vulnerable population that is in transit, often coming from circumstances of danger and risk to their lives, who are now headed towards new and uncertain experiences that may include disadvantage, exclusion or other risks. The lessons learned from the field inform best practices for working with recently arrived Latinx immigrants, with implications for public health research that may extend to other immigrant populations.

In the United States, populations of Latino individuals tend to have better mortality outcomes than socioeconomically similar racial and ethnic comparators; this has been termed the "Latino Paradox". However, advantages from the Latino paradox seem to fade and may be susceptible to other factors (like the COVID-19 pandemic). Quality primary care may improve mortality, but the effect of the intersection of all of these factors in Latino patients is uncertain. There is burgeoning evidence that Latino patients may have more robust utilization of high value primary care services, especially when accessible in a community-oriented fashion. This utilization may become less robust, especially in services that require a more integrated delivery system, as individuals and generations spend more time in the United States. Primary care research may provide additional insights into the underpinnings of the Latino paradox and may complement the public health foundation that has undergirded work on the paradox in the last few decades. Investments in primary care infrastructure and research may be beneficial to the health of Latinos in the United States, and incorporating the needs of this diverse population into primary care system design at scale may pay large dividends for our societal health.

Asylum medicine clinics that train clinicians to conduct forensic medical and mental health evaluations (FME) have proliferated in the United States, but there is still significant unmet need in training. We created a 12-week curriculum to develop the core skills needed to conduct effective, trauma-informed FME. Our course used a "flipped classroom" model; participants reviewed didactics in advance from a national, peer-reviewed training program, the Asylum Medicine Training Initiative, and used in-class time for case-based practice as experiential learning. Participants completed feedback surveys after each session in addition to pre-and post-course assessments. Sixteen clinicians with diverse geographic, professional, and demographic backgrounds participated in the course from January-March 2023. The three key themes that emerged from qualitative feedback were high participant satisfaction with the course model; participant desire for additional opportunities for practice; and participant desire for community-building. Post-course surveys showed that most participants felt only "somewhat comfortable" with the core skills emphasized in the course. Taken together, these findings suggest that curricula in asylum medicine should focus on experiential learning, skills practice, and building longitudinal mentorship. This curriculum is an innovative educational model that differs from the traditional didactic training that has been the mainstay in asylum medicine education. The curriculum is replicable and can be tailored to local environments or broad virtual communities.

Persons deemed a danger to themselves, others, or gravely disabled may receive involuntary psychiatric commitment if family, other residents, law enforcement, or clinicians initiate this process. On September 30, 2005, a Danish newspaper published cartoons depicting the Prophet Muhammad. This publication led to the worst foreign policy crisis in Denmark since World War II. Whereas protests within Denmark against the cartoon remained peaceful, this cartoon controversy-including the attacks on four Danish embassies outside of Denmark-may have reduced societal tolerance for threatening or deviant behavior among non-Western immigrants. We applied Box-Jenkins interrupted time-series methods to test whether this cartoon controversy coincided with greater than expected counts of new involuntary psychiatric commitments among non-Western immigrants. The analytic period spans 48 quarters from January 1995 to December 2006. Findings support the hypothesis in that new involuntary psychiatric commitments rose 43% during the controversy (p <.01). Changes in help-seeking overall for mental health services do not appear to account for this rise in new involuntary commitments. Population-wide controversies may lower societal tolerance for behavior deemed deviant-and in this case, specifically among non-Western immigrants.

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.

As a safety net hospital, Boston Medical Center (BMC) serves a global community of patients and is welcoming new refugee and immigrant patients at an unprecedented rate. Many of these patients are cared for by Family Medicine residents and faculty in both inpatient and outpatient settings. Currently, the care delivered by Family Medicine residents lacks uniformity due to lack of familiarity with the U.S. Centers for Disease Prevention and Control (CDC) guidelines for refugee health, differing levels of faculty preceptor experience, and variable in-house resources for primary care across five residency clinic sites. To address these disparities, a team of Family Medicine residents and faculty designed a multidisciplinary global health educational series with a focus on strengthening resident competencies in refugee and immigrant health care. Refugee and immigrant health is discussed in didactic workshops and residents apply a refugee and immigrant health care map that has been developed for use in their clinics. The primary outcome is self-reported changes in clinical practices while caring for refugee and immigrant patients who are establishing or re-establishing care in the United States. Our goal is to continue improving resident education in order to provide the most equitable care for populations at an increased risk of disparate access to care.

A high prevalence of dental caries is a significant health problem, especially in the pediatric population. Low-income minority groups, including the refugee and immigrant populations, are at higher risk of compromised oral health. It has been suggested that migrant parents do not have enough understanding of oral health, risk factors associated with dental caries, or the progress of dental decay. This systematic review aims to study quantitative literature on oral health interventions, health promotion programs, or behaviour change interventions targeting the parents/ caregivers of culturally and linguistically diverse (CALD) children. A systematic search of electronic databases, including MEDLINE, EMBASE, PUBMED, CINAHL, SCOPUS, WEB OF SCIENCE, COCHRANE, and PROQUEST, was conducted until August 2023. Randomised (RCT) or non-randomised controlled trials (NRCTs) were included. Two reviewers independently assessed the quality of the included studies using the Cochrane Risk of Bias (RoB) 2.0 and ROBINS-I tools. Meta-analysis was performed as appropriate. The initial search from the databases retrieved 2073 articles. After the removal of duplicates, 1683 articles remained. Finally, 69 articles were reviewed in full text, and 15 articles were considered eligible in this review. The RoB assessment for RCTs rated three as low-risk and three as high-risk. The serious RoB in these NRCTs mostly pertained to measurement bias based on self-reporting oral health behaviours. The meta-analysis pooling of results (for RCTs and NRCTs) favoured interventions for CALD parents' oral health knowledge [0.73 (95% CI, 0.08 to 1.38) for RCTs, 1.73 (95% CI; 1.45 to 2.02) for NRCTs] and attitudes [0.86 (95% CI, 0.31 to 1.42)]. Relatively high heterogeneity was observed. Oral health educational interventions can be effective in improving the oral health literacy of CALD parents' oral health knowledge and attitudes, especially when facilitated by lay health advisors. However, the low quality of evidence due to high heterogeneity and high RoB further highlighted the need for well-designed RCTs targeting CALD parents.

Although there is recent growing attention on mental health and mental well-being across the globe, supports in this area of healthcare can be a challenge for immigrant and racialized groups with experiences of hardship across several domains. This study aimed to gather perspectives from immigrants and racialized community members on strategies central to support their mental health and well-being, with the aim of addressing research to practice gaps. The study was co-designed in collaboration with a Community Action Table in Markham, Ontario, a setting with 93% of residents self-identifying as visible minorities. Using a community-focused mixed methods Concept Mapping approach, 68 residents, service providers, and policymakers were engaged through three phases of brainstorming, sorting and rating, and interpretation. Their brainstorming led to 68 statements which they sorted into groups and rated for importance and feasibility to act in next six months. Further analysis led to a 9-cluster concept map comprising of Family Wellness, Awareness & Education, Cultural Sensitivity, Social Service Access, Community Building, Socioeconomic, Food Security, Healthcare Access, and Housing Stability. These clusters are important in advancing knowledge on ways to support and prioritize mental health and well-being of immigrants and racialized communities. Overall, participants viewed mental health and well-being as being closely tied to their living and working conditions while also focusing on family wellness and intergenerational dynamics. Novel insights from this project are important for the planning of mental health and well-being supports for immigrant groups in Canada and can help improve foci across sectors through service implementation.

Diverse social ties are critical facilitators of well-being among older adults. Social ties might be especially important for aging immigrants who face multiple social and economic vulnerabilities over the life course. We investigated social ties (e.g., partners, children, other family, and friends) by immigrant status among older adults in the United States (U.S.). Data come from the 2018 Health and Retirement Study (N = 4,006), a national sample of older adults in the U.S. We used multivariable logistic regression to compare social ties (e.g., partners, children, other family, and friends) by immigrant status. We further explored interactions with sex and race/ethnicity. Older immigrants are more likely to report that they can rely a lot on their partners (aOR = 1.84, 95% CI 1.27, 2.68) but less likely to rely on friends (aOR = 0.72, 95% CI, 0.55, 0.94) compared to non-immigrants. Older immigrants are also less likely to meet frequently with friends (aOR = 0.66, 95% CI, 0.51, 0.86) and with other family (aOR = 0.71, 95%, CI, 0.55, 0.91) compared to non-immigrants. Lastly, older immigrant men are significantly less likely to meet with friends compared to non-immigrant men (aOR = 0.48, 95% CI, 0.32, 0.73). As the older population in the U.S. continues to diversify and immigrant older adults navigate their support options, older immigrants-especially men-may be at risk for less variation in their social support options, particularly from extended family members and friends.

We investigated the relationship between parent and child mental health, including parents' general psychological distress, among refugees resettled in Australia. We utilised longitudinal data from a sample (N = 602 children and 377 parents) of recently settled refugees from the Building a New Life in Australia Survey). Parent psychological distress and post-traumatic stress symptoms (PTSS) were measured by the Kessler 6 and PTSD-8, respectively. Harsh and Warm parenting behaviours were also measured to explore the mechanisms underlying the parent-child mental health relationship. Child mental health was measured using the SDQ. Using path analysis, we found that increases in parent psychological distress directly contribute to harsher parenting practices, which in turn increase child mental health difficulties as reported by parents. Parent psychological distress at Waves 1 and 3 also directly impacted child emotional and conduct difficulties, whilst parent PTSS was indirectly associated with all measured child mental health problems. While both parent PTSS and psychological distress indirectly impacted child mental health, only psychological distress directly impacted on any area of child mental health difficulty and overall explained more variance in the final model. Our findings highlight that non-trauma specific symptoms warrant attention in refugee parents' and children's mental health. Clinicians should assess for general psychological symptoms in addition to trauma-specific symptoms, and we recommend that parental mental health is assessed and treated simultaneously when working with refugee children. Moreover, to reduce the impact of other stressors in refugees' lives, community sector organisations should be resourced adequately to support refugee families in settlement.

Emerging research suggests that the increasing population of Arab immigrants and refugees living in the United States (U.S.) has a greater risk for depression and anxiety than other groups. The purpose of this meta-analysis was to estimate the prevalence of depression and anxiety for Arabs in the U.S., to examine the moderating effects of key demographic variables (gender, immigration status, ethnicity) and study characteristics (research design and quality) on the prevalence of anxiety and depression, and to evaluate the direct effects of additional demographic and study characteristics on prevalence rates. Using guidelines from the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P), we searched PubMed, Embase, CINHAL, ProQuest, and the Web of Science databases for articles published between January 2000 and March 2023. Two reviewers each individually extracted the articles' data and evaluated the reported study's methodological quality using a well-established checklist. Statistical analyses consisted of random effects models to estimate the pooled prevalence of depression and anxiety across all studies, separate random effects models for distinct demographic (e.g., immigration status) and methodologic (e.g., study quality) subgroups that might have unique prevalence rates, and a meta-regression to identify additional variables (e.g., age of individuals) that might influence prevalence rates. Our review included 17 studies with a total sample population size of 22, 558 participants. Results indicated that the estimated prevalence of depression overall was 48% (CI 34, 63%) and 58% (CI 33, 83%) for the prevalence of anxiety. Our subgroup analyses uncovered notable variations in prevalence rates based on gender composition, immigration status, ethnicity, and research quality while results of the meta-regressions demonstrated effects of publication year and age of the Arab individual on the estimated prevalence of depression and anxiety. The high prevalence rates for depression and anxiety identified through this meta-analysis are very concerning and underscore the urgent need to address mental health concerns in Arab communities. Results of subgroup and meta-regression analyses suggest that refugees, individuals from specific countries of origin, and younger Arabic persons may need particular attention by clinicians in screening for and treating their depression and anxiety. Our results also signify the need for further high-quality studies to more rigorously assess prevalence of these mental health problems, since we found evidence of potential publication bias and approximately one third of the studies in the review had less optimal methodological quality based on our evaluation. Ultimately, in-depth research regarding the causes of anxiety or depression among Arab individuals will be essential to the development of culturally competent interventions that may reduce their very high prevalence rates.

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.

Immigration policy, particularly regarding migrants crossing the US-Mexico border, has been a highly debated topic for years. There is a continued debate on how to maintain national security while protecting the health and dignity of migrants. In this commentary, we argue that the Biden Administration's "Proclamation on Securing the Border" issued on June 4, 2024, alongside the Department of Homeland Security (DHS) and Department of Justice's (DOJ) Interim Final Rule, poses a significant threat to the health of migrants seeking asylum at the US-Mexico border by forcing more migrants to wait in encampments in border towns. Specifically, migrants are more likely to face increased exposure to disease, mental health effects, and violence as a result of this proclamation. We call for structural policy reform and propose several alternative policies that can be enacted at the regional and national levels to help maintain the health and dignity of migrants while still prioritizing border security.

As a vulnerable population, immigrants can be disproportionately affected by disasters. Because of their legal and migratory status, immigrants may have different challenges, needs, and possibilities when facing a disaster. Yet, within disaster studies, immigrants are rarely studied alone. Instead, they are often considered part of the large heterogeneous group of racial and ethnic minorities in the United States. This racial classification points to a gap in the literature and in our understanding of how disadvantaged groups may cope with disasters. To address this gap, the current study hypothesizes that: (1) Immigrants have unique experiences and disaster impacts compared to the broader aggregated category of racial and ethnic minorities in the U.S. and (2) There are variations in disaster experiences and impacts across different types of immigrant subgroups beyond refugees. To explore these hypotheses, a study of the literature across six databases from 2018 to 2023was conducted. The review identified a total of 17 articles discussing immigrant experiences during disasters. Major cross-cutting themes on immigrant disaster experiences include fear of deportation, restrictive immigration status, excessive economic burden and labor exploitation, employment rigidity, adverse health outcomes, limited informational resources and limited social capital, selective disaster relief measures, and infrastructural challenges as regards to housing and transportation. Many of the themes identified are unique to immigrants, such as the fear of deportation, restrictive immigration status and visa policies, and selective disaster relief measures.

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.

We investigated the associations between sociodemographic factors, religiosity traits, and the perception of discrimination among Muslim Americans in both everyday life and medical settings. A self-administered web-based questionnaire, comprising validated measures of discrimination and religiosity, was completed by a convenience sample of English-speaking adult Muslim Americans, recruited through both in-person and online channels. Among the 1281 respondents, less than half were born in the USA (46%), and a significant portion displayed visible religious markers, such as wearing a hijab or having a beard (61%). Only 154 (12%) reported never experiencing everyday discrimination, while 358 (28%) reported not experiencing discrimination in medical settings. In a multivariable linear regression model, greater perceived everyday discrimination (β = 1.053, p < 0.01) was positively associated with greater discrimination in medical settings. Participants more comfortable self-identifying as Muslim in hospital settings (β = -0.395, p < 0.05) were less likely to perceive healthcare discrimination. Those visibly expressing their religiosity (β = 0.779, p < 0.01) and those with greater intrinsic religiosity (β = 0.231, p < 0.05) were more likely to encounter everyday discrimination. Conversely, older participants (β = -0.015, p < 0.05), adult immigrants to the US (β = -0.375, p < 0.05), those in better health (β = -0.157, p < 0.05), and those more comfortable identifying as Muslim (β = -0.305, p < 0.05) had lower perceptions of everyday discrimination. This study underscores the significance of the relationship between religiosity characteristics and experiences of both hospital and everyday discrimination for Muslim Americans.

To analyze stigma related to depression, beliefs about psychotropics, and associated factors in a population of Japanese ancestry in Brazil. This cross-sectional study was conducted between March and June, 2022. Beliefs about psychotropics (BMQ-specific) and depression-related stigma (The Stigma Scale) were collected through an online questionnaire. Multiple linear regression analysis was performed to identify the factors associated with these dependent variables. Ninety-three respondents of Japanese ancestry completed the questionnaire. Participants were more focused on the necessity of the prescribed psychotropics than on possible adverse effects. Married individuals (β=-4.68 [95%CI -8.74, -0.63]; p = 0.024) were less concerned with their psychotropics than single individuals, while those undergoing treatment for longer years (β = 6.23 [95%CI 1.35, 11.11]; p = 0.013) perceive a greater necessity for treatment than those who started it recently. In addition, older individuals perceived less necessity for treatment (β=-5.83 [95%CI -10.76, -0.90]; p = 0.021) than younger individuals. Unemployed people (β = 12.09 [95%CI 0.47, 23.70]; p = 0.042) perceived more depression-related stigma than those employed. Aspects of Japanese cultural heritage related to depression and its treatment are still prevalent among people of Japanese ancestry in Brazil. Factors such as age, treatment duration, and marital status affects the perception of beliefs about psychotropics, whereas occupation affects the perception of stigma.

In the United States, it is estimated that 15% of Latinos will experience a depressive or anxiety disorder during their lifetime. Education, prevention programming, and health interventions around topics such as stress, nutrition, mental health, and health maintenance for Latino immigrants are lacking, inadequate, or nonexistent. This type of programming may be protective against depression and anxiety. A total of 19 Latina women completed a five-week, group-based intervention to learn about stress, stress management, nutrition, mental health, and healthy behaviors in a culturally sensitive environment taught by native Spanish speakers. Program evaluation occurred through in-depth interviews and changes in anxiety and depression scores via the Generalized Anxiety Scale and the Patient Health Questionnaire, respectively. The team saw statistically significant decreases in the GAD-7 scores pre- and post-intervention (8.00 versus 5.08, p<0.05), but no differences in the PSS or the PHQ-2 scores. Group-based intervention and education taught by native Spanish speakers may be an acceptable and feasible approach to addressing anxiety in Latina immigrants.

The lack of a cohesive, stakeholder-informed refugee health research agenda has been a barrier to promoting, funding, and conducting health research with refugee populations in North America. A cross-sectional study was conducted among individuals working in refugee health in North America (N = 93) to describe major domains within the field of refugee health research and to develop refugee health research priorities. Open-ended survey questions included: (1) What research topics specific to refugee research would you like to see in an international research agenda? (2) Please describe current and important gaps that you believe exist in refugee research and why? Overarching themes focused on the need for the development of research partnerships with refugee communities that are intentional, effective, and driven by the needs of refugee communities. The survey also identified a need for best practices in creating sustainable, community-based research partnerships (effective models and evidence-based strategies) that translate across 12 domains. The refugee health research priorities for North America described in this manuscript should continue to be modified over time as political, economic, social, and medical contexts change.

Little is known about differences in child developmental vulnerability before school entry according to maternal birthplace and sex. Official immigration records were linked with the Early Development Instrument assessments among children in kindergarten in the province of Manitoba, Canada (2005-2017). Logistic regression was used to estimate odds ratios of vulnerability in five developmental domains associated with maternal birthplace and child sex. Children of immigrant mothers from most birthplaces had higher adjusted odds of developmental vulnerability than non-immigrants in domains related to language and communication skills, except those of the rest of North America & Oceania. Children of Sub-Saharan African mothers were more vulnerable in four domains. Boys were consistently more vulnerable than girls across domains and maternal birthplaces. Children of immigrant mothers exhibited higher developmental vulnerability than non-immigrants in domains related to language and communication skills, potentially reflecting exposure to English and French as second languages.

Research suggests that stress due to racism may underlie the disproportionately high rates of adverse pregnancy outcomes experienced by Black women in the US. Study objectives: (1) Identify forms of systemic racism affecting pregnancy outcomes and (2) increase understanding about the role of racism in adverse pregnancy outcomes for Black women. A systematic review was conducted to explore the relationship between systemic racism and pregnancy outcomes for Black women. Searches were performed using EBSCO Academic Search Complete, CINAHL Complete, and Consumer Health Complete first between January to April 2021 and subsequently between November 2023 to January 2024. Included studies were observational, written in English, had full-text availability, examined at least one form of systemic racism and pregnancy outcome, and reported results for Black women. A meta-analysis was performed using a random effects model, summary effect estimates were pooled by pregnancy outcome. The I statistic was used to measure heterogeneity between studies. A total of 32 studies were included in the review. Significant pooled effects of exposure to systemic racism were observed for preterm birth 0.30 (95% CI 0.12-0.48), small for gestational age 0.31 (95% CI 0.05-0.58), and low birth weight 0.24 (95% CI 0.11-0.37). Among studies that compared results by race, exposure to systemic racism had a significant and rather large effect on preterm birth for Black women (d = 0.62; 95% CI 0.06-0.41). Exposure to systemic racism has a significant effect on preterm birth, small for gestational age, and low birth weight for Black women. Having knowledge of how racism contributes to stress and poor pregnancy outcomes can help health professionals improve delivery of quality care to Black women. Future research should continue identifying forms of racism positively related to adverse pregnancy outcomes.