"Beyond just the four walls of the clinic": The roles of health systems caring for refugee, immigrant and migrant communities in the United States.

2023

1078980

12/2023

2296-2565

UNLABELLED: This article is part of the Research Topic 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict'.

INTRODUCTION: Refugee, immigrant and migrant (hereafter referred to as "immigrant") communities have been inequitably affected by the COVID-19 pandemic. There is little data to help us understand the perspectives of health systems on their role, in collaboration with public health and community-based organizations, in addressing inequities for immigrant populations. This study will address that knowledge gap.

METHODS: This qualitative study used semi-structured video interviews of 20 leaders and providers from health systems who cared for immigrant communities during the pandemic. Interviewees were from across the US with interviews conducted between November 2020-March 2021. Data was analyzed using thematic analysis methods.

RESULTS: Twenty individuals representing health systems participated with 14 (70%) community health centers, three (15%) county hospitals and three (15%) academic systems represented. The majority [16 health systems (80%)] cared specifically for immigrant communities while 14 (70%) partnered with refugee communities, and two (10%) partnered with migrant farm workers. We identified six themes (with subthemes) that represent roles health systems performed with clinical and public health implications. Two foundational themes were the roles health systems had and in working with communities. On the patient-facing side, health systems played a role in and . On the organizational side, health systems collaborated with public health and community-based organizations, in and to evolving needs throughout the pandemic.

CONCLUSION: Health systems should focus on building trusting relationships, acting intentionally, and partnering with community-based organizations and public health to handle COVID-19 and future pandemics in effective and impactful ways that center disparately affected communities. These findings have implications to mitigate disparities in current and future infectious disease outbreaks for immigrant communities who remain an essential and growing population in the US.

10.3389/fpubh.2023.1078980

Front Public Health

37064664

Increasing COVID-19 Vaccination Coverage for Newcomer Communities: The Importance of Disaggregation by Language.

2023

04/2023

1476-1645

The COVID-19 pandemic has disproportionately affected refugee, immigrant, and migrant populations. Vaccines are essential for decreasing transmission and severity of COVID-19 infection. Understanding differences in vaccination coverage based on preferred language is crucial for focusing efforts to decrease COVID-19-related disparities. Four sites in the Minnesota Center of Excellence in Newcomer Health collaboratively evaluated completion of primary COVID-19 vaccination series on or before December 31, 2021, for patients who were 12 years or older on June 30, 2021, by preferred language. The non-English/non-Spanish speaking population included 46,714 patients who spoke 174 languages; COVID-19 vaccination coverage by language ranged from 26.2% to 88.0%. Stratifying vaccination coverage by specific language is a critical first step toward dismantling disparities and shaping interventions that best meet the needs of communities served.

10.4269/ajtmh.22-0724

Am J Trop Med Hyg

37068751

Pediatric Hospitalizations from Immigration Detention in Texas, 2015-2018.

2021

2021 Dec 28

1097-6833

10.1016/j.jpeds.2021.12.056

J Pediatr

34971657

Acceptance of COVID-19 Vaccine Among Refugees in the United States.

2021

333549211045838

2021 Sep 21

1468-2877

<p><strong>OBJECTIVE: </strong>Little is known about COVID-19 vaccination intentions among refugee communities in the United States. The objective of this study was to measure COVID-19 vaccination intentions among a sample of refugees in the United States and the reasons for their vaccine acceptance or hesitancy.</p>

<p><strong>METHODS: </strong>From December 2020 through January 2021, we emailed or text messaged anonymous online surveys to 12 bilingual leaders in the Afghan, Bhutanese, Somali, South Sudanese, and Burmese refugee communities in the United States. We asked community leaders to complete the survey and share the link with community members who met the inclusion criteria (arrived in the United States as refugees, were aged ≥18, and currently lived in the United States). We compared the characteristics of respondents who intended to receive the COVID-19 vaccine with those of respondents who did not intend to receive the vaccine or were unsure. We then conducted crude and adjusted logistic regression analysis to measure the association between employment as an essential worker and COVID-19 vaccine acceptance.</p>

<p><strong>RESULTS: </strong>Of 435 respondents, 306 (70.3%) indicated that they planned to receive a COVID-19 vaccine. Being an essential worker (adjusted odds ratio [aOR] = 2.37; 95% CI, 1.44-3.90) and male sex (aOR = 1.87; 95% CI, 1.12-3.12) were significantly associated with higher odds of intending to receive a COVID-19 vaccine. Among respondents who intended to receive a COVID-19 vaccine, wanting to protect themselves (68.6%), family members (65.0%), and other people (54.3%) were the main reasons.</p>

<p><strong>CONCLUSION: </strong>Many refugees who responded to the survey, especially those who worked in essential industries, intended to receive a COVID-19 vaccine. Community organizations, health care providers, and public health agencies should work together to ensure that vaccine registration and vaccination sites are accessible to refugees.</p>

10.1177/00333549211045838

Public Health Rep

34546812

Association between Preferred Language and Risk of Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Children in the United States.

2021

2021 Sep 01

1476-1645

<p>The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has had a disproportionate impact on Black, Hispanic, and other individuals of color, although data on the effect of a person's language on SARS-CoV-2 infection are limited. Considering the barriers suffered by immigrants and non-English-speaking families, we tested whether children with a preferred language other than English was associated with SARS-CoV-2 infection. Children from families with a preferred language other than English had a higher predicted probability of SARS-CoV-2 test positivity (adjusted odds ratio, 3.76; 95% CI, 2.07-6.67) during the first wave of the pandemic. This discrepancy continued into the second wave (adjusted odds ratio, 1.64; 95% CI, 1.10-2.41), although the difference compared with families who prefer to speak English decreased over time. These findings suggest that children from non-English-speaking families are at increased risk of SARS-CoV-2 infection, and efforts to reverse systemic inequities causing this increased risk are needed.</p>

10.4269/ajtmh.21-0779

Am J Trop Med Hyg

34469330

A Content Analysis Of US Sanctuary Immigration Policies: Implications For Research In Social Determinants Of Health.

2021

1145-1153

2021 Jul

1544-5208

<p>Restrictive immigration policies are important social determinants of health, but less is known about the health implications and health-related content of protective immigration policies, which may also represent critical determinants of health. We conducted a content analysis of types, themes, and health-related language in 328 "sanctuary" policies enacted between 2009 and 2017 in the United States. Sanctuary policies were introduced in thirty-two states and Washington, D.C., most frequently in 2014 and 2017. More than two-thirds of policies (67.6&nbsp;percent) contained language related to health, including direct references to access to services. Health-related themes commonly co-occurred with language related to supporting immigrants in communities, including themes of antidiscrimination, inclusion, trust, and privacy. Our work provides foundational, nuanced data about the scope and nature of sanctuary policies that can inform future research exploring the impacts of these policies on health and health care.</p>

10.1377/hlthaff.2021.00097

Health Aff (Millwood)

34228526

Caring for Children in Immigrant Families: Are United States Pediatricians Prepared?

2020

391-398

2020 04

1876-2867

<p><strong>OBJECTIVE: </strong>A growing number of children in the United States are from immigrant families. We conducted a national survey to examine pediatricians' self-rated preparedness to care for children in immigrant families.</p>

<p><strong>METHODS: </strong>A 2017 survey of American Academy of Pediatrics members assessed respondent characteristics, formal training in and experience with global, public, or immigrant health, and preparedness to care for children in immigrant families. Descriptive statistics and a multivariable logistic regression model examined associations between characteristics, formal training, experience, and preparedness.</p>

<p><strong>RESULTS: </strong>The survey response rate was 47% (n = 758/1628). One third of respondents (33.6%) reported being unprepared to care for children in immigrant families. In bivariate analyses, respondents who had graduated from medical school outside of the United States, had previous education on immigrant health care, or had recent international global health experience were most likely to report feeling prepared to care for children in immigrant families. Multivariable regression model results indicated that prior education on immigrant health (adjusted odds ratio [AOR] 4.07; 95% confidence interval [CI] 2.68, 6.32), graduation from medical school outside the United States (AOR 2.35; 95% CI 1.22, 4.67), and proficiency in a language other than English (AOR 1.78; 95% CI 1.14, 2.80) were independently associated with preparedness.</p>

<p><strong>CONCLUSIONS: </strong>One in 3 US pediatricians report being unprepared to care for children in immigrant families. Wider implementation of graduate and continuing medical education on immigrant child health is needed to ensure that practicing pediatricians have the appropriate skills and knowledge to care for this patient population.</p>

10.1016/j.acap.2019.11.015

Acad Pediatr

31790799

Discrimination and Stress Among Asian Refugee Populations During the COVID-19 Pandemic: Evidence from Bhutanese and Burmese Refugees in the USA.

2021

2021 Mar 02

2196-8837

<p><strong>OBJECTIVES: </strong>To measure COVID-19 pandemic-related discrimination and stress among Bhutanese and Burmese refugees in the USA and to identify characteristics associated with these two measures.</p>

<p><strong>METHODS: </strong>From 5/15-6/1/2020, Bhutanese and Burmese refugee community leaders were invited to complete an anonymous, online survey and shared the link with other community members who were English-proficient, ≥18 years old, and currently living in the USA. We identified characteristics associated with pandemic-related discrimination and stress applying ordinal logistic regression models.</p>

<p><strong>RESULTS: </strong>Among 218 refugees from 23 states, nearly one third of participants reported experiencing at least one type of discrimination, and more than two-thirds experienced at least one type of pandemic-related stress. Having had COVID-19, having a family member with COVID-19, and being an essential worker were associated with discrimination. Discrimination, financial crisis, and female gender were associated with stress.</p>

<p><strong>CONCLUSIONS: </strong>Reducing pandemic-related discrimination should remain a priority, as should the promotion of social support and coping strategies. Noting that this is a nonrepresentative sample, we recommend that larger national studies tracking experiences with pandemic-related discrimination and stress include Asian American subgroups with limited English proficiency.</p>

10.1007/s40615-021-00992-y

J Racial Ethn Health Disparities

33651371

COVID-19 and Immigrant Essential Workers: Bhutanese and Burmese Refugees in the United States.

2021

117-123

2021 Jan/Feb

1468-2877

<p><strong>OBJECTIVES: </strong>Immigrants are believed to be at high risk of infection with severe acute respiratory syndrome coronavirus 2, the virus that causes coronavirus disease 2019 (COVID-19). A leading suspected risk factor is their role in the essential workforce. We aimed to describe COVID-19-related risk factors among Bhutanese and Burmese refugees in the United States.</p>

<p><strong>METHODS: </strong>We administered an anonymous online survey in May 2020 among community leaders of Bhutanese and Burmese refugees. Using a snowball sampling strategy, we invited community leaders to complete the survey and share the link with others who met inclusion criteria (English proficient, aged ≥18, currently living in the United States). We compared respondents with and without recent COVID-19 and identified risk factors for infection.</p>

<p><strong>RESULTS: </strong>Of 218 refugees in 23 states who completed the survey from May 15 through June 1, 2020, fifteen (6.9%) reported infection with COVID-19. Being an essential worker during the pandemic (odds ratio [OR] = 5.25; 95% CI, 1.21-22.78), having an infected family member (OR = 26.92; 95% CI, 5.19-139.75), and being female (OR = 5.63; 95% CI, 1.14-27.82) were risk factors for infection. Among 33 infected family members, 23 (69.7%) were essential workers.</p>

<p><strong>CONCLUSION: </strong>Although we had a small snowball sample, we found that working in essential industries was associated with an increased risk of COVID-19 infection among Bhutanese and Burmese refugees. We call for larger studies that include Asian immigrant subgroups, as well as immediate attention to protecting immigrant essential workers during the COVID-19 pandemic.</p>

10.1177/0033354920971720

Public Health Rep

33207130

Hepatitis B Evaluation and Linkage to Care for Newly Arrived Refugees: A Multisite Quality Improvement Initiative.

2020

2020 Jul 25

1557-1920

<p>A quality improvement collaborative evaluated Hepatitis B virus (HBV) care for resettled refugees and identified strategies to enhance care. 682 of the 12,934 refugees from five refugee health clinics in Colorado, Minnesota, and Pennsylvania had chronic HBV. Timely care was defined relative to a HBsAg + result: staging (HBV DNA, hepatitis Be antigen, hepatitis Be antibody, alanine transaminase testing) within 14&nbsp;days, comorbid infection screening (hepatitis C virus and HIV) within 14&nbsp;days, and linkage to care (HBV specialist referral within 30&nbsp;days and visit within 6&nbsp;months). Completed labs included: HBV DNA (93%), hepatitis Be antigen (94%), hepatitis Be antibody (92%), alanine transaminase (92%), hepatitis C screening (86%), HIV screening (97%). 20% had HBV specialist referrals within 30&nbsp;days; 36% were seen within 6&nbsp;months. Standardized reflex HBV testing and specialist referral should be prioritized at the initial screening due to the association with timely care.</p>

10.1007/s10903-020-01058-7

J Immigr Minor Health

32712852