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Perceptions of tuberculosis among immigrants and refugees: An ethnographic study

Heather A. Joseph, MPH, Robin J. Shrestha-Kuwahara, MPH, Maureen Wilce, MS, and Kelly P. McCarrier, MPH. Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E-10, Atlanta, GA 30333, 404 639-2636, hbj7@cdc.gov

Background: While the overall number of tuberculosis (TB) cases in the U.S. has declined, the percentage of cases among persons born outside the U.S. surpassed that of U.S.-born persons in 2002. The TB case rate among non-U.S.-born persons is eight times higher than that of U.S.-born persons. Methods: In 4 U.S. cities, locally hired bilingual/bicultural researchers conducted 200 in-depth interviews with both TB patients and non-patients from China, Laos, Mexico, Somalia, and Vietnam. Attitudes and beliefs about TB, traditional healing, stigma, TB history, experiences with services, and informational needs were assessed. Staff interviews and clinic observations were conducted. Results: Preliminary results on the data from Chinese, Laotian, and Vietnamese respondents suggest the majority are aware that TB is a lung disease associated with coughing and is “caught from the air.” However, divergent perceptions about transmission and treatment were identified. Potential barriers to care-seeking and treatment initiation emerged, such as fear of rejection, job loss, and shame. Structural issues unrelated to cultural background, such as lack of health insurance and transportation, also emerged as critical barriers to care. Respondents clearly want more TB information, preferring oral and visual formats like local radio, TV, video, and informal talks. Conclusions: Understanding the range of cultural, organizational, and structural issues that emerge from this study will assist local health departments in developing effective, culturally appropriate strategies to better serve these diverse populations.

Learning Objectives: By the conclusion of this session, the participant will be able to

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Risks and Resources for Refugee and Immigrant Health

The 132nd Annual Meeting (November 6-10, 2004) of APHA