Foreign Birth Research Articles

Can a peer-based intervention impact adherence to the treatment of latent tuberculous infection?

To assess the effectiveness of a peer-based intervention on adherence to and completion of latent tuberculous infection (LTBI) treatment. Patients prescribed self-administered LTBI treatment were enrolled in a randomized controlled trial of an experimental, peer-based adherence support intervention. Primary outcomes were treatment adherence and completion. Adherence was assessed through self-report, electronic monitoring devices and clinic visits. Of 250 participants, 70% were male; 71% were Black and 20% Latino; the mean age was 40 years; 67% were foreign-born and 39% were married. No significant baseline differences were noted between the intervention groups. Treatment completion was 61% in the intervention group compared to 57% in the controls (P = 0.482). The corresponding completion rate for other clinic patients was 44%. Foreign birth, marriage and history of mental illness were associated with non-completion of treatment after controlling for the intervention group; increased completion rates were found among foreign-born married persons and older participants. A substantial difference in adherence rates was observed between the intervention groups. Adherence among non-completers decreased early, while adherence among completers remained constant. The peer-based intervention was not significantly associated with LTBI treatment completion, but was associated with greater adherence. Findings suggest the importance of interventions to support adherence that target early non-adherence with LTBI treatment, particularly in the first 2 months, when there is a substantial risk of default.

Acculturation and overweight-related attitudes and behavior among obese hispanic adults in the United States

US Hispanics bear a disproportionate burden of excess body weight and associated morbidity, making obesity prevention and control in this population a public health priority. Development of culturally appropriate weight loss interventions requires understanding the influence of acculturation on attitudes and behavior related to obesity and weight loss. Using data from the National Health and Nutrition Examination Survey (2001-2004), we analyzed the associations of country of birth and language usage with weight perception, weight dissatisfaction, intention to lose weight, and intended weight loss of clinical significance among obese Hispanic adults (>20 years of age; unweighted n = 675) in multivariable logistic regression analyses. US birth was significantly associated with correct weight perception (odds ratio [OR], 4.45; 95% confidence interval [CI], 2.16-9.17) and weight dissatisfaction (OR = 2.95; 95% CI = 1.63-5.35). Compared with Spanish-speaking only, obese Hispanics, bilingual, obese Hispanics were more likely to attempt weight loss (OR = 2.78; 95% CI = 1.43-5.40) and achieve clinically significant weight loss (OR = 3.94; 95% CI = 1.51-10.3). The findings suggest that lack of acculturation as measured by foreign birth and limited English proficiency may contribute to within-ethnicity health inequality among obese Hispanics, even after controlling for a variety of sociodemographic characteristics, including education and income, differential healthcare access and use, and health status. Further studies should examine the underlying mechanisms, thereby informing culturally competent intervention strategies targeted at obese US Hispanics.

Very low food security in young citizen children correlates with mothers’ foreign birth; associations vary by mothers’ length of stay in the US

This study's objective was to test whether very low food security (VLFS) in children, the most severe food insecurity measured in the US, is related to mothers’ foreign birth, & whether mothers’ length of stay (LOS) in the US affects that relationship. Data are from ongoing Children's HealthWatch research on 40,460 children ages <48 months whose mothers were interviewed at pediatric clinics & hospital emergency departments in Baltimore, Boston, Little Rock, Los Angeles, Minneapolis, Philadelphia & Washington, DC June 1998‐December 2011. IRB approval was obtained at each site, & renewed annually. In multivariate logistic regression models adjusted for site & mothers’ characteristics, children of foreign‐born mothers had adjusted odds of having VLFS in children 194% greater than children of US‐born mothers. In models using data stratified by mothers’ LOS in the US, children of mothers in the US >;10 yrs had adjusted odds of VLFS in children 44% lower than children of mothers in the US <5 yrs. The goal of ending child hunger (VLFS in children) in the US by 2015 is unlikely to be achieved without targeted support for families with recent immigrant mothers. This project was supported with a grant from the University of Kentucky Center for Poverty Research through funding by the U.S. Department of Agriculture, Food & Nutrition Service, contract number AG‐3198‐B‐10–0028.

Nutritional correlates of latent tuberculosis infection in the United States (1999–2000)

Nutritional status modulates immune response to infections and can alter risk of infectious diseases, including tuberculosis. We assessed correlations between nutritional status indicators (micronutrient serum biomarkers; anthropometry) and latent tuberculosis infection (LTBI) among participants of the National Health and Nutrition Examination Survey (NHANES) 1999–2000 (n=7386). LTBI was evaluated by mean induration in response to tuberculin skin test (TST). LTBI prevalence was 4.2%, as previously reported (5.1% males, 3.2% females). Positive TST was observed in 0.8% of individuals with low (<10th percentile), 4.0% of those with normal (10–75th percentile), and 5.8% of those with high (>;75th percentile) subscapular skinfold thickness. >; 75th percentile subscapular skinfold thickness was associated with positive TST (>;1.5‐fold increased odds), adjusting for known sociodemographic and health‐related risk factors, including foreign birth, household contact with TB case, and BCG scar. Available micronutrient serum biomarker levels and mid‐upper arm circumference were not associated with TST (p>;0.05), controlling for covariates. Smoking was also positively associated with LTBI (OR 2.09, 95% CI: 1.40–3.11).Grant Funding Source: None

Influence of Patient Characteristics on Assessment of Diabetes Self-Management Support

Factors contributing to patient-reported experiences of diabetes self-management support are not understood well, particularly over time. The aim of the study was to identify the contribution of patient characteristics to patient-reported quality of SMS. Using secondary data from a prospective clinical trial (n = 339) comparing three approaches of providing diabetes self-management support (Group Medical Visits, Automated Telephone Support, and Usual Care) in a diverse, underserved population, the influence of patient characteristics (e.g., age, gender, income, and health status) was examined on Patient Assessment of Chronic Illness Care ratings. At baseline, older age (p = .014), being female (p = .038), and having lower income (p = .001) were associated with lower ratings. Income and interactions involving income combined explained 12% of the variance in baseline ratings. Compared with White patients, African American and Asian patients tended to have higher baseline ratings (p = .076 and p = .045, respectively). Race or ethnicity influenced perceptions throughout the trial, explaining 5% of the variance at baseline and 2% of the variance in 1-year changes in Patient Assessment of Chronic Illness Care ratings. As expected, over 1 year, ratings increased more for patients in both intervention groups compared with the control group (p < .001). Ratings of healthcare quality are influenced by patient characteristics independent of the nature of the care provided. Understanding more precisely how these differences are associated with differences in clinical processes will be particularly important for efforts aiming to integrate patient-reported measures into assessments of healthcare quality during routine clinical care and clinical trials.

The Effect of Nativity, Ethnicity and Race on the Earnings of Cape Verdean Americans

This paper estimates the net effects of nativity, ethnicity and race on the earnings of Cape Verdean Americans, a small, Afro-European group who speak a Portuguese-based Creole. While in their homeland, most Cape Verdeans identify as mestiço, but in America they are usually perceived as black. The data come from the 2000 US Census and the American Community Survey (2000–2007); Native Born Non-Hispanic Whites and African Americans serve as benchmarks. The results show that, controlling for pre-migration education, foreign birth is not a handicap; indeed, for women it is an advantage. Ethnicity too is never a handicap and occasionally an advantage. Race, on the other hand, penalizes males. Native born Cape Verdean men who identify as “Other”, “Black Other” or “Black” earn significantly less than NBNH Whites. On the other hand, regardless of racial identity, Native born Cape Verdean women earn at least as much as NBNH Whites. Finally, one subgroup of native born Cape Verdean men and women, those who identify racially as “Black”, earn slightly more than African Americans.

Pediatric and Adolescent Tuberculosis in the United States, 2008–2010

We examined heterogeneity among children and adolescents diagnosed with tuberculosis (TB) in the United States, and we investigated potential international TB exposure risk. We analyzed demographic and clinical characteristics by origin of birth for persons <18 years with verified case of incident TB disease reported to National TB Surveillance System from 2008 to 2010. We describe newly available data on parent or guardian countries of origin and history of having lived internationally for pediatric patients with TB (<15 years of age). Of 2660 children and adolescents diagnosed with TB during 2008-2010, 822 (31%) were foreign-born; Mexico was the most frequently reported country of foreign birth. Over half (52%) of foreign-born patients diagnosed with TB were adolescents aged 13 to 17 years who had lived in the United States on average >3 years before TB diagnosis. Foreign-born pediatric patients with foreign-born parents were older (mean, 7.8 years) than foreign-born patients with US-born parents (4.2 years) or US-born patients (3.6 years). Among US-born pediatric patients, 66% had at least 1 foreign-born parent, which is >3 times the proportion in the general population. Only 25% of pediatric patients with TB diagnosed in the United States had no known international connection through family or residence history. Three-quarters of pediatric patients with TB in the United States have potential TB exposures through foreign-born parents or residence outside the United States. Missed opportunities to prevent TB disease may occur if clinicians fail to assess all potential TB exposures during routine clinic visits.

S1 High Levels of Latent TB Infection, Blood Borne Viruses and Unmet Need Among Hard to Reach Groups in London: The TB Reach Study

BackgroundUrban homeless people have high levels of disease and often present late for healthcare. Despite high rates of active TB in London’s large homeless population, limited data are available regarding...

Long term follow-up of drug resistant and drug susceptible tuberculosis contacts in a Low incidence setting.

BackgroundStudies examining the transmission of multidrug-resistant tuberculosis (MDR-TB) strains have yielded conflicting results.MethodsWe examined transmission of MDR-TB strains using contact tracing data from a low incidence setting. Contacts of MDR-TB cases diagnosed in British Columbia, Canada, from 1990-2008 were identified through a provincial tuberculosis (TB) registry. Tuberculin skin test (TST) results and TB disease incident rates were determined for contacts. For comparison, TB disease incident rates and TST results were measured in close contacts of isoniazid mono-resistant (HMR-TB) and drug susceptible TB (DS-TB) cases.ResultsOf 89 identified close contacts of MDR-TB patients, 5 patients (6%) developed TB disease and 42 (47%) were TST positive. The incidence rate of TB disease (3%, p = 0.31) and TST positivity (49%, p = 0.82) were similar in contacts of HMR-TB cases. Compared with MDR-TB contacts, DS-TB contacts had lower incidence rate of TB disease (2%, p = 0.04) and TST positivity (32%, p < 0.01). All MDR-TB contacts with culture positive TB diagnosed in follow-up were drug-susceptible; three of six HMR-TB contacts with culture positive TB were HMR-TB. Multivariate analysis demonstrated that contact with MDR-TB (adjusted OR 1.72; 95%CI 1.05-2.81) and HMR-TB (adjusted OR 1.99; 95%CI 1.48-2.67) was associated with TST positivity. In addition, adult age, male gender, BCG positivity, source case sputum smear positivity, foreign birth and fewer contacts per source case were significantly associated with TST positivity in the multivariate model.ConclusionContacts of MDR-TB and HMR-TB patients in a low incidence setting show high rates of TST positivity and TB disease but low rates of drug resistance.

Perinatal Exposures and Kawasaki Disease in Washington State

This study tested the hypothesis that selected perinatal exposures are associated with Kawasaki Disease (KD) in later childhood. A retrospective, population-based, case-control study was performed. Children hospitalized for KD in Washington State from 1987 to 2007 (n = 995) were identified through hospital discharge records and were linked to birth certificates and birth hospitalization discharge records. Controls were randomly selected from remaining birth records. Maternal and infant exposure information was obtained from hospital discharge records. Unconditional logistic regression was used to obtain adjusted relative risk estimates and to explore the effect of gender on observed associations. After adjusting for race, gender and birth year, the following were significantly associated with KD: maternal age ≥35 years (odds ratio [OR] 1.65; [95% confidence interval: 1.20-2.27]); mother of foreign birth (OR 1.36; [1.06-1.75]); maternal Group B streptococcal colonization (OR 0.51; [0.26-0.97]); and early infancy hospitalization (OR 1.42; [1.04-1.93]). Early hospitalization for bacterial illness was associated with a 2.8-fold increased risk of KD (OR 2.84; [1.59-5.06]). There was weak evidence to suggest that the association between early hospitalization and KD varies by gender. This study provides preliminary evidence of association between certain perinatal exposures and KD and raises the possibility of late biological effects of immune exposures during infancy. The association between KD and early infectious exposures deserves further study.

Risk factors for postpartum depression among abused and nonabused women

The objective of the study was to compare risk factors for postpartum depression among women exposed vs not exposed to intimate partner violence and to assess the timing of abuse in relation to postpartum depression. This was a retrospective cohort study utilizing data from the Canadian Maternity Experiences Survey, a telephone survey at 5-10 months postpartum. Survey questions were adapted from the Canadian Violence Against Women Survey and the Edinburgh Post-Natal Depression Scale. Among abused women, younger (15-19 years), and older (35 years old and older), age was associated with postpartum depression, adjusted odds ratio (aOR, 2.29; 95% confidence interval [CI], 1.17-4.51) and (aOR, 2.33; 95% CI, 1.02-5.34) as was unemployment (aOR, 1.41; 95% CI, 1.06-1.84), foreign birth (aOR, 2.04; 95% CI, 1.35-3.09], and low income (aOR, 1.68; 95% CI, 1.25-2.25) among nonabused women. Postpartum depression was significantly associated with abuse occurring only prior to pregnancy (aOR, 3.28; 95% CI, 1.86-5.81), starting postpartum (aOR, 4.76; 95% CI, 1.41-16.02), and resuming postpartum (aOR, 3.81; 95% CI, 1.22-11.88). Among pregnant women, subgroups defined by abuse exposure differ in their risk profile for postpartum depression.

Factors associated with late presentation of HIV infection in Catalonia, Spain

We sought to describe the prevalence, trends and factors associated with late diagnosis of HIV infection between 2001 and 2008 in Catalonia, Spain. Adults over 13 years of age with available CD4 cell counts, who were notified to the Catalonia Voluntary HIV Surveillance System between January 2001 and December 2008, were included in the study. Late presentation for HIV infection was defined as a CD4 cell count <350 cells/μL or with an AIDS-defining condition at presentation. Multivariable logistic regression was used to identify factors independently associated with late diagnosis of HIV. Of the 4651 newly diagnosed HIV-infected individuals with available CD4 counts, 2598 (55.9%) were diagnosed late. The proportion of people with a late diagnosis decreased from 60.4% in 2001 to 50% in 2008, a significant trend (P < 0.001). Older age, male gender, foreign birth, heterosexuality and injecting drug use were independent risk factors for late diagnosis. Strategies to actively promote HIV testing to populations at risk of late diagnosis of HIV or those never attending health systems should be implemented.

People out of place: allochthony and autochthony in the Netherlands' identity discourse — metaphors and categories in action

As with much of Europe, the Netherlands has no explicit ‘race’ discourse; however, the state, through its public policy and administrative practices, does categorise its population along ‘ethnic’ lines, using birthplace — one's own or one's (grand-) parent's — as the surrogate determining factor. The contemporary operative taxonomy has until recently been binary: autochtoon (of Dutch heritage) and allochtoon (of foreign birth). Used earlier at the provincial level in respect of internal migration, the taxonomy was expanded in 1999 to demarcate between ‘Western’ allochtoon and ‘non-Western’ allochtoon, with the latter being further subdivided into first and second generation. Informed by a ‘generative metaphor’ approach (Schon 1979) that links cognition to action, this article subjects the allochtoon/autochtoon binary to metaphor analysis and the Western/non-Western taxonomy to category analysis. The work done by ‘birthplace’ in the term pair suggests that they are, in their everyday usage, surrogates for a race discourse, carrying the same (ancient) assumptions about individual identity and the earth-air-sun-water of the spot on which one was born that underlies definitions-in-use of ‘race’. Their meaning in contemporary policy discourse derives from the interaction of metaphoric and category structures, with implications for policy implementation.

A community-based approach to disseminate health information on the hazards of prenatal mercury exposure in Brooklyn, NY

Exposure to mercury (Hg) in utero can have neurotoxic effects on the developing fetus. Mercury exposure in women of childbearing age has been associated with frequent fish consumption, coastal proximity, foreign birth, and exposure during ritualistic practices. The aim of this study was to identify culturally-appropriate strategies to disseminate messages on the hazards of in utero Hg exposure in fertile and pregnant women in a predominantly urban immigrant community in Flatbush, Brooklyn, following findings from a recent study on mercury exposure in this community. Nineteen key informant interviews were conducted in Flatbush, Brooklyn with community members, medical professionals, fishmongers, and a religious practitioner to solicit feedback on culturally sensitive methods to educate the community on Hg hazards. The main themes identified include clinical integration, where providers integrate the message in routine care; community integration, whereby influential organizations and community members foster message delivery; media usage; and message reinforcement via continuous exposure. It is vital for healthcare providers and public health practitioners to be culturally sensitive in educating their patients on fish selection during pregnancy and safety of handling Hg. Instead of a single approach, a combination of media and educational strategies would help to reinforce the message. These findings form a basis for public health campaigns to apprise other urban immigrant communities of the hazards of in utero Hg exposure.

Area-based socio-economic disadvantage and tuberculosis incidence

To examine neighborhood-level influences on tuberculosis (TB) incidence in a multilevel population-based sample. All incident TB cases in Washington State, United States (n = 2161), reported between 1 January 2000 and 31 December 2008 were identified. Multivariate Poisson analysis was used at the ZIP Code tabulation area (ZCTA) level, which allowed for further exploration of area-specific influences on TB incidence. A significant association was found between indices of socio-economic position (SEP) and TB incidence in Washington State, with a clear gradient of higher rates observed among lower ZCTA socio-economic quartiles. Compared to the wealthiest SEP quartile, the relative incidence of TB in successively lower quartiles was respectively 2.7, 4.1 and 10.4 (P trend <0.001). In multivariate analyses, the addition of area-level race, ethnicity and country of birth significantly attenuated this association (adjusted incidence rate ratios 2.3, 2.6, 5.7; P trend <0.001). This study found a significant inverse association between area measures of socio-economic status (SES) and TB incidence across ZCTAs in Washington State, even after adjusting for individual age and sex and area-based race, ethnicity and foreign birth. These results emphasize the importance of neighborhood context and the need to target prevention efforts to low-SES neighborhoods.

Stroke Incidence in Older US Hispanics: Is Foreign Birth Protective? (S13.006)

Stroke Incidence in Older US Hispanics: Is Foreign Birth Protective? (S13.006)

Risk Factors Associated With Epidural Use

BackgroundIdentify variables associated with intrapartum epidural use.MethodsOdds ratios were calculated to quantify associations between selected variables and epidural use using a population-based case-control study of Washington State birth certificate data from 2009.ResultsNon-Whites had 10 - 45% lower odds of epidural use relative to Whites. Foreign-born women had 25 - 45% lower odds of epidural use compared to their US-born counterparts, except for Asians. Women who smoked or induced labor had higher roughly 2-fold higher odds of epidural use compared with non-smokers or women giving birth spontaneously, respectively. Women without a high school diploma or equivalent had lower odds of epidural use relative to those who graduated. Delivering at perinatal units, rural hospitals, or non-profit hospitals had ~50% lower odds of epidural use compared with secondary/teritiary perinatal units, urban hospitals or for-profit hospitals, respectively. ConclusionSeveral individual and health service-related variables were associated with epidural use. These findings elucidate the clinical relevance of epidural use, and dispariaties in its utilization and in quality of care during delivery.KeywordsEpidural use; Foreign birth; Labor; Racial disparities

Assessment of prenatal mercury exposure in a predominately Caribbean immigrant community in Brooklyn, NY

Prenatal mercury exposure and its fetotoxic effects may be of particular concern in urban immigrant communities as a result of possible contributing cultural factors. The most common source of exposure in these communities is ingestion of fish and shellfish contaminated with methylmercury. Other sources of exposure may occur in ritualistic practices associated with Hispanic and Caribbean-based religions. This study 1) assessed total mercury levels in both random urine specimens from pregnant women, and in cord blood; and 2) examined environmental sources of exposure from a convenience sample in a predominantly Caribbean immigrant population in Brooklyn, New York. A questionnaire designed in collaboration with health professionals from the Caribbean community assessed the frequency of fish consumption, ritualistic practices, occupational exposures, and use of dental amalgams and mercury-containing skin and household products. The geometric mean for total mercury in cord blood was 2.14 μg L(-1) (95%CI: 1.76-2.60) (n = 78), and 0.45 μg L(-1) (95%CI: 0.37-0.55) (n = 183) in maternal urine corrected for creatinine (μg g(-1)). Sixteen percent of cord blood mercury levels exceeded the estimated equivalent of U.S. Environmental Protection Agency's Reference Dose (5.8 μg L(-1) blood). Predictors of cord blood mercury included maternal fish consumption and foreign birth of the mother. Predictors of urine mercury included foreign birth of the mother, number of dental amalgams, and special product use. There were no reports of mercury use in ritualistic practices or in cosmetics; however some women reported use of religious medals and charms. This study characterized risk factors for mercury exposure in a sample of urban, predominantly Caribbean-born blacks. Findings may help target interventions in this population, which might include appropriate fish selection and consumption frequency during pregnancy, and safe handling of mercury-containing products in the home.

Including the third dimension: A spatial analysis of TB cases in Houston Harris County

To reach the tuberculosis (TB) elimination goals established by the Institute of Medicine (IOM) and the Centers for Disease Control and Prevention (CDC), measures must be taken to speed the currently stagnant TB elimination rate and curtail a future peak in TB incidence. Increases in TB incidence have historically coincided with immigration, poverty, and joblessness; all situations that are currently occurring worldwide. Effective TB elimination strategies will require the geographical elucidation of areas within the U.S. that have endemic TB, and systematic surveillance of the locations and location-based risk factors associated with TB transmission. Surveillance data was used to assess the spatial distribution of cases, the yearly TB incidence by census tract, and the statistical significance of case clustering. The analysis revealed that there are neighborhoods within Houston/Harris County that had a heavy TB burden. The maximum yearly incidence varied from 245/100,000-754/100,000 and was not exclusively dependent of the number of cases reported. Geographically weighted regression identified risk factors associated with the spatial distribution of cases such as: poverty, age, Black race, and foreign birth. Public transportation was also associated with the spatial distribution of cases and census tracts identified as high incidence were found to be irregularly clustered within communities of varied SES.

Symptoms of Schizophrenia and Psychosis According to Foreign Birth in a Canadian Sample of Homeless Persons

Objective: The objective of the study was to examine the relationship between foreign birth and symptoms of schizophrenia and psychosis in a clinical sample of homeless persons. Methods: All the charts documented between 2002 and 2007 by a psychiatric outreach team in Ottawa, Canada, were retrospectively reviewed regarding country of birth and psychiatric symptoms identified in a clinical assessment. Data were analyzed by univariate and multivariate logistic regressions. Results: The sample included 552 men and 333 women with data on psychiatric symptoms and country of birth. A total of 106 individuals (12%) were born outside of Canada. This proportion was lower than that observed in the general population of Ottawa or in Canada. Foreign-born individuals were older and had a higher level of education than Canadian-born individuals. Sixteen percent of the sample presented symptoms of schizophrenia, and 15% presented symptoms of psychosis other than schizophrenia. In univariate analyses persons presenting symptoms of schizophrenia or psychosis were more likely to be foreign-born than native-born (odds ratio [OR]=2.92, 95% confidence interval [CI]=1.74–4.90, and OR=4.79, CI=2.92–7.86, respectively). Multivariate analyses gave very similar results (OR=2.62, CI=1.50–4.58, and OR=4.14, CI=2.44–7.03, respectively). A positive trend or significant association was observed for all regions of origin other than the non-Caribbean Americas. Conclusions: This is the first study to report an association between foreign birth and symptoms of schizophrenia and psychosis among homeless persons. These findings are consistent with the increased risk of schizophrenia and psychosis observed among immigrants to European countries. (Psychiatric Services 62:1187–1193, 2011)