Abstract
HPV Vaccination Determinants among Hispanic Migrant Farmworkers as Perceived by Organizational, Community and Societal-Level Stakeholders
Coralia Vazquez-Otero, JD, MPH, CPH1, Nolan Kline, PhD, MPH, CPH2, Elizabeth Lockhart, PhD3, Kristen Wells, B.A., M.P.H., Ph.D.4, Sara Proctor, DW, PA5, Ellen M. Daley, PhD, MPH1, Cathy Meade, PhD, RN, FAAN6, Anna Giuliano, PhD7 and Cheryl Vamos, PhD, MPH3
(1)University of South Florida, College of Public Health, Tampa, FL, (2)Rollins College, Winter Park, FL, (3)University of South Florida, Tampa, FL, (4)San Diego State University, San Diego, CA, (5)Catholic Mobile Medical Services, Catholic Charities Dioceses of St. Petersburg, Dover, FL, FL, (6)Moffitt Cancer Center and Morsani College of Medicine, University of South Florida, Tampa, FL, (7)H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Introduction: Hispanics in the U.S. experience persistent cervical cancer disparities; and subpopulations such as migrant farmworkers are at greatest risk. Cervical cancer is preventable through human papillomavirus (HPV) vaccination, however HPV vaccine rates remain sub-optimal. This study explored stakeholders' perspectives on system-level factors influencing access/uptake of the HPV vaccine among migrant farmworkers.
Methods: The Socio-Ecological Model and community-based processes informed methodology and sampling procedures. In-depth interviews were conducted with stakeholders across organizational, community, and society levels. The interview guide was developed based on predisposing, enabling and reinforcing factors that elicited existing barriers and facilitators to HPV vaccination. Constant comparative analysis was performed to identify emerging themes.
Results: Diverse stakeholders (n=14) (e.g., health administration/providers, school nurses, advocacy groups, pharmaceutical representatives, policymakers) were recruited. Identified barriers included: providers lacking time to discuss vaccination with parents; lack of Spanish-speaking providers; burden on the free/charitable clinics; policies that deny undocumented individuals access to care; lack of school entry vaccine policy; lack of a national database that monitors HPV vaccine uptake; and state-level budget cuts. Facilitators included: parental disposition to receive HPV-related information and vaccine; availability of the vaccine through funded programs; physician recommendation of the vaccine; framing vaccine as cancer prevention; collaboration among agencies; and support from national experts.
Conclusions: Stakeholders' perspectives on HPV vaccination determinants among migrant farmworkers included barriers and facilitators across multiple socio-ecological levels. Future interventions should focus on building consensus among stakeholders to create an integrated approach to HPV vaccination that address multilevel barriers while capitalizing on existing community assets.
Diversity and culture Social and behavioral sciences
Abstract
Iraqi Muslim women with refugee backgrounds and primary health care providers speak about the health care encounter
Debra Penney, CNM, MPH, PhD
University of Utah, Salt Lake, UT
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
This qualitative study explored health disparities for Iraqi Muslim women with refugee backgrounds. Perceptions and experiences of primary health care providers who care for refugees were also part of this study.
The study design was based on critical ethnography and postcolonial feminism that guided semi-structured interviews. Participants were purposefully selected from 4 urban clinics and included 15 Iraqi Muslim women patients with refugee backgrounds and 10 primary health care providers. All 10 provider and 5 patient interviews were conducted in English; 10 Iraqi patient interviews were conducted in Arabic, transcribed in Arabic, and translated into English for analysis. Through analysis and interpretation of the data, themes emerged from the categories for each participant group.
Results indicated that Iraqi Muslim women faced barriers to health access that were rooted in both the health system and health providers. Both participant groups had expectations of the health encounter that were constructed on culturally-based perceptions and expectations. The health encounter is limited by time and inadequate interpretive services that narrow opportunities for clear communication and understanding between provider and patient. These factors combined with individual perceptions and expectations open an avenue for misinterpretation, misdiagnosis, and stereotyping.
Recommendations are given for improving health services to refugees or others with cultural and language differences. These include comprehensive changes to the usual confines of the health encounter and avenues for increasing awareness and education of state agencies, health administration, and health providers about the barriers faced by Iraqi Muslim women. Future research is recommendations are briefly addressed.
Diversity and culture
Abstract
Acculturation and Physical Activity Level of Hispanic adolescents from the NHANES National Youth Fitness Survey
Eveleen Sng, M.S., P.A.P.H.S. and Paul Loprinzi, Ph.D.
University of Mississippi, University, MS
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Participation in physical activity (PA) among adolescents lowers the risk for various chronic diseases. Yet, few adolescents in the U.S., particularly minority adolescents, meet guidelines of recommended PA (60 minutes daily). Acculturation has been shown to affect PA among adults but is less investigated among Hispanic adolescents. Thus, the aim of this study was to examine the associations between acculturation and PA utilizing a nationally representative sample from the 2012 NHANES National Youth Fitness Survey. A final sample of 119 (weighted sample 3.3 million) adolescents (12-15 years) completed acculturation (language as a proxy measure) and PA questionnaires (# of days engaging in 60 min/day). Regarding acculturation, four groups were created: 1) only Spanish/little English, 2) equal English/Spanish, 3) more English than Spanish, and 4) only English. After adjustments, and compared to only Spanish/little English, those who spoke equal English/Spanish (β=-.92, p=.05) and more English than Spanish (β=-.99, p=.04) engaged in fewer days of PA. These findings are, generally, in contrast to adult studies, which show that greater acculturation is associated with more PA. Here, we demonstrate that, among adolescents, greater acculturation is associated with less PA. These findings suggest that, to help assimilate into the American culture, Hispanic adolescents may be engaging more in sedentary behaviors like playing video games/watching TV to become more ‘American'. Implications of this study include the identification of a population (i.e., Hispanics with greater acculturation) that is at risk of consequences linked with inadequate PA. Thus, intervention programs targeting acculturated Hispanic adolescents may be needed.
Diversity and culture Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs
Abstract
Is there a relationship between tumor morbidity and international immigrant status? Analysis from hospital records in Chile in 2012
Marcela Oyarte, Ms(c) Epidemiology, Iris Delgado, Ms biostatistics and Baltica Cabiesses, Doctor in philosophy and health science
Facultad de Medicina, ClÃnica Alemana – Universidad del Desarrollo, Santiago, Chile, Santiago, Chile
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Introduction: In Chile migration has increased reaching 2.7% of the total population in 2014. Chile has few official statistics regarding the prevalence of diseases or health conditions in immigrants. Regarding access to and use of health services, most of the evidence comes from primary care, and virtually the health situation of immigrant secondary care population is currently unknown. We analyzed the relationship between tumor morbidity and migrant status in the general population to Chile in 2012.
Methodology: Prevalence study based on data from national hospital discharges in 2012. We compared standardized prevalence rates of tumor diagnosis (ICD-10 C00-D48) for Chilean and immigrant populations. We also stratified by age, sex and type of hospitalization. Prevalence rates were estimated using as the numerator the number of hospital discharges and as the denominator the number of people of same age and sex groups using CASEN 2013 survey dataset.
Results: We found a similar overall prevalence of tumors between Chilean and immigrants. Less than 4% of diagnosis ended in death (1.7% deaths among immigrants; malignant tumors) and 3.6% deaths in Chilean (91.6% malignant tumors). We found differences in types of tumors: digestive organs (19.8% immigrants, 23.9% Chilean), lymphatic tissue, blood-forming organs and related tissues (18.9% immigrants, 18.1% Chilean) and breast (17.8% immigrants, 10.7% Chilean). Besides, 22.3% of immigrant cases reported no healthcare provision versus only 1.1% of Chileans.
Conclusions: The overall prevalence of tumors was quite similar between Chilean and immigrants, but with significant differences in type of tumor, malignancy and healthcare provision entitlement.
Diversity and culture Epidemiology Other professions or practice related to public health Provision of health care to the public Public health or related public policy Public health or related research
Abstract
Church-based social ties and suicidal ideation among North Korean refugees in South Korea: Exploring variations by gender
Mee Young Um, PhD1, Eric Rice, PhD1, Lawrence Palinkas, PhD1 and Hee Jin Kim, PhD2
(1)University of Southern California, Los Angeles, CA, (2)Myongji University, Yongin, Gyeonggi-do 449-728, Korea, Republic of (South)
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: The risk of suicide among North Korean (NK) refugees living in South Korea (SK) is three times higher than their host country counterparts, where the rate has remained the highest among all OECD countries since 2002. However, factors predicting suicidality in this population are not well known. Previous studies of other populations found that church-based social interactions reduce suicidal behaviors. Churches in SK provide tailored worship services and financial aid to NK refugees. Thus, we examined whether having emotionally close church-based ties reduced suicidal ideation in men and women. Methods: 405 NK refugees in SK (men=132, women=273) completed a self-administered survey during April-May, 2014. Past-year suicidal ideation was assessed by a 5-item scale and was dichotomized for the analysis. Emotionally close church-based ties were measured by self-nominations of church-based ties who are emotionally close to the participant. Gender-stratified multivariable logistic regressions were performed. Results: 31.4% of NK refugees contemplated suicide, and 13.6% men and 18.3% women had at least one emotionally close church-based tie in their networks. These social ties were a protective factor for women (OR=0.41, 95%CI=0.17-0.98), whereas they were a risk factor for men (OR=4.58, 95%CI=1.24-16.92). A significant interaction term (OR=10.97, 95%CI=2.50-48.18) confirmed gender differences. Discussion: Women might receive comfort from these relationships, whereas men might become distressed about being financially dependent on others, which contradicts cultural expectations of a traditional man's role. These findings have implications for practitioners serving vulnerable populations and underscore the importance of understanding the cultural context of social networks when conducting research.
Diversity and culture Other professions or practice related to public health Program planning Public health or related research Social and behavioral sciences
Abstract
Cultural Factors Associated with the Ebola Outbreak in West Africa: African immigrants' Perceptions
Ogbochi McKinney, DrPH, MPH, MPA, MCHES and Dominick Sturz, DrPH, MPH
California Baptist University, Riverside, CA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: The recent Ebola outbreak affected multiple countries in West Africa and beyond. Through contact with infected persons, the virus spread for the first time to developed countries, affecting- either directly or indirectly, some of the African immigrants living in the U.S. These effects compel the need for research concerning African immigrants' perceptions of the outbreak. The purpose of this study is to explore African immigrants' perceptions of the Ebola outbreak in West Africa. Methodology: Qualitative data was gathered through the use of a semi-structured interview guide. Participants included eight African immigrants living in California. Some of the key measures include media outlets used to get information on Ebola, cultural beliefs/barriers, and demographic factors. The data was analyzed using content and thematic analysis, organized into reoccurring themes, and categorized. The transcribed interviews were manually coded. Results: Of the eight participants, 63% were 18-34 years old, 75% were female, and 75% had a post-graduate degree. Media outlets utilized by participants to obtain relevant information included the CDC, WHO, and NIH, internet sources, TV, and NPR. Participants identified certain cultural beliefs and barriers that may have exacerbated the spread of Ebola virus. These included burial practices, close contact with relatives, traditional healers, eating habits, language barriers, and tribal beliefs. Conclusions: Collaborative research efforts are needed to combat the global threat of an Ebola pandemic. Further research focusing on African immigrants' perceptions, cultural beliefs, and barriers that possibly exacerbate the spread of Ebola may assist this collaborative effort in the U.S. and beyond.
Assessment of individual and community needs for health education Diversity and culture Public health or related research
Abstract
Relationship between tattoo removal and jail recidivism among Mexican migrants
Pedro Kremer, MD, MSC, MPH1, Victoria D. Ojeda, PhD, MPH2, Jose Luis Burgos, MD, MPH3, Adriana Vargas-Ojeda, MD, PhD4, Israel de Alba-Cruz, MD5, Joanna Arlyn Castañeda Córdova, Medical Student, MD.6, Miguel Pinedo, PhD, MPH7 and Natalie Ferraiolo8
(1)San Diego State University / University of California San Diego, San Diego, CA, (2)University of California, San Diego School of Medicine, La Jolla, CA, (3)UCSD School of Medicine, La Jolla, CA, (4)Facultad de Medicina y Psicología, UABC, Tijuana, Mexico, (5)Universidad Autónoma de Baja California, Tijuana, Mexico, (6)Universidad Autonoma de Baja California, Tijuana, Mexico, (7)Alcohol Research Group & UC Berkeley, Emeryville, (8)University of California, San Diego School of Medicine, San Diego, CA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background. Social stigma among deportees and ex-prisoners is related to individuals' history and also to physical characteristics. Tattoos may reflect present or past social affiliations (i.e., gang involvement), or exposure to harmful settings (e.g., prison). Those who remove their tattoos may experience lower re/incarceration and improved health status.
Study Objectives. To describe the characteristics of Mexicans who underwent laser tattoo removal, and to assess whether use of this service decreased the risk for jail recidivism and improved perceived health and quality of life status.
Methods. 90 individuals (74% former prisoners, 83% previously deported), enrolled in a Tattoo removal program at a free clinic in Tijuana, Mexico. 24 cases (jail recidivism) and 66 controls were included in an observational unmatched case-control analysis, six months after the program was launched. Main outcomes were jail recidivism and perceived health status and quality of life.
Results. 50 subjects had their tattoos removed. 72.5% had at least one very exposed tattoo, and 51.2% had a face tattoo. Half of the tattooed participants had a gang-related tattoo. Adjusted OR for jail recidivism among those who removed tattoos was 0.25 (95% CI 0.07–0.91). Health status and quality of life were not associated to the intervention.
Conclusions. Greater sample sizes are required, but potentially, causality may exist among tattoo removal and jail recidivism. Findings suggest the need for further studies in order to assess the potentially social benefits of tattoo removal in strengthening community re-entry and stigma reduction.
Conduct evaluation related to programs, research, and other areas of practice Social and behavioral sciences
Abstract
Impact of English Proficiency on Contraception Receipt Amongst Low Income California Women, 2013-2014
Sundary Sankaran1, Heike Thiel de Bocanegra, Ph.D., M.P.H.2 and Julie Cross, PhD, MPH1
(1)University of California, San Francisco, San Francisco, CA, (2)University of California, San Francisco, Sacramento, CA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Limited English proficiency may impede access to family planning services amongst low income California women due to language barriers encountered in health care settings. We used data from the 2013 and 2014 cycles of the California Health Interview Survey (CHIS) to compare receipt of contraception among women earning an income of less than 200% of the Federal Poverty Level by English fluency (proficient or limited). The cumulative 2013-2014 sample included 978 limited English women, of whom 70% originated from Latin America. Compared to the English proficient group, this subset had a higher percentage of uninsured women in both years, but there was a significant decrease in the uninsured rate amongst limited English women from 2013 (37%) to 2014 (23%). The effect of English fluency on contraception receipt was not significant in 2013 (adjusted OR 0.7, 95% confidence interval [CI] 0.4, 1.1). However, we did find limited English proficient women in 2014 were significantly less likely than fluent English speakers to report receiving contraception from a medical provider in the last 12 months after adjusting for insurance coverage, yearly doctor visit frequency, age, and parity (adjusted OR 0.5, 95% confidence interval [CI] 0.3, 0.7). This decline in contraception receipt from 2013 to 2014 amongst limited English proficient women demonstrates efforts beyond expansion of medical coverage are needed in order to ensure immigrants benefit from family planning services on par with those received by their English proficient counterparts.
Advocacy for health and health education Assessment of individual and community needs for health education Diversity and culture Provision of health care to the public Public health or related education Social and behavioral sciences
Abstract
Acculturation, Sugar sweetened beverages consumption and obesity among Latino immigrants in New Orleans
Tung-Sung Tseng, DrPH., M.S.1, Yu-Wen Chiu, DrPH, MPH2, Shuang Yang, MS2, Carla Rosales, MPH2, Flor Espinoza, MD, MPH3, Daesy Behrhorst2, Hsu-Yu Chen2 and Chih-Yang Hu, MSPH, ScD2
(1)Louisiana State University Health Sciences Center, New Orleans, LA, (2)Louisiana State University Health Sciences Center - New Orleans, New Orleans, LA, (3)University of Texas Medical Branch, Galveston, TX
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: Intake of Sugar-sweetened Beverages (SSB) is significantly associated with obesity and diabetes in adults. Although the obesity results from multi-factorial causes such as nutrition, physical activity and other biological factors, SSB are likely contributors to excess weight gain. However, the behaviors of consuming sweetened drinks and the associated outcomes have been explored less in Latino immigrants. The purpose of this study was to examine the association of acculturation, SSB consumption and obesity status among Latino immigrants in New Orleans.
Methods: Analysis was performed on 383 Latino immigrants in New Orleans. The chi-square, t- test and multinomial logistic regression were performed to analyze data.
Results: Participants were predominantly young adult (18-39 years old) males (56.4%) with a comparable amount of females (57.7%). The majority of participants were overweight or obese according to their BMI (68.8%). Overall, 36.2% of Latino immigrants consume SSB at least once per day. Compared to those with less SSB consumption, Latino immigrants who consume at least once drink per day have greater odds of obesity (OR=4.37 95%CI 1.01-18.96). Furthermore, highly acculturated male, middle-aged Latino immigrants with an education below the high school level were more likely to be obese than their counterparts.
Discussion/Conclusion: These results highlight that about two-thirds of Latino immigrants in New Orleans are overweight or obese. Also, highly acculturated male Latino immigrants who consume more SSB in New Orleans are more likely to be obese. Future obesity control among Latino immigrants should prioritize a SSB consumption reduction intervention especially in highly acculturated males.
Assessment of individual and community needs for health education Chronic disease management and prevention Diversity and culture Public health or related research Social and behavioral sciences
Abstract
Understanding the Health of Afro-Caribbean Immigrants in the United States: The forgotten group
Doucette Alvarez, MS MPH1 and Lucia Guerra-Reyes, PhD, MPH, MA2
(1)Indiana University-Bloomington, Bloomington, IN, (2)School of Public Health-Bloomington, Indiana University, Bloomington, IN
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background:
The 1.7 million Afro-Caribbean immigrants who live in the US are invisible to public health efforts. Their health concerns are subsumed under data collected for all African-Americans despite having distinct health needs and cultural backgrounds. Public health interventions do not reach this group. Furthermore, immigration status increases their vulnerability; dictating employment prospects and access to health care. Very little is known about the particular health concerns of this population.
Objective: We sought to assess the main areas of health concerns among Afro-Caribbean immigrants in the US.
Methods: We conducted a scoping literature review using: Medline, Web of Science, and Google scholar. We excluded articles that did not pertain to the US, were published earlier than 2000, and did not discuss Afro-Caribbean immigrants. We analyzed the 81 remaining articles to identify: type of study, area of health scholarship; and major findings.
Results: A majority (n=71) were Quantitate studies, 40 of these were analyses of secondary data. Four main areas of health scholarship emerge in this community: HIV, cancer, mental health and cardiovascular disease. Results indicate that language, immigration status and refugee status affect this group's health. Socio-cultural factors, especially the contested meaning of blackness, were central to understanding the scope and nature of health issues.
Discussion: Racial identity is crucial to health outcomes of Afro-Caribbean individuals because many do not identify as African-American. There is a paucity of research on the differences between Afro-Caribbean language groupings. Nuanced approaches are needed to address particularities of those who challenge current race constructs.
Advocacy for health and health education Public health or related research