Foreign-born Group Research Articles

Reliability and validity of the Patient Health Questionnaire-4 scale and its subscales of depression and anxiety among US adults based on nativity

BackgroundThe burdens of anxiety and depression symptoms have significantly increased in the general US population, especially during this COVID-19 epidemiological crisis. The first step in an effective treatment for anxiety and depression disorders is screening. The Patient Health Questionnaire-4 (PHQ-4, a 4-item measure of anxiety/depression) and its subscales (PHQ-2 [a 2-item measure of depression] and Generalized Anxiety Disorder [GAD-2, a 2-item measure of anxiety]) are brief but effective mass screening instruments for anxiety and depression symptoms in general populations. However, little to no study examined the psychometric properties (i.e., reliability and validity) of the PHQ-4 and its subscales (PHQ-2 and GAD-2) in the general US adult population or based on US nativity (i.e., foreign-born vs. the US-born). We evaluated the psychometric properties of the PHQ-4 and its subscales in US adults, as well as the psychometric equivalence of the PHQ-4 scale based on nativity.MethodsWe conducted a cross-sectional survey of 5,140 adults aged ≥ 18 years. We examined the factorial validity and dimensionality of the PHQ-4 with confirmatory factor analysis (CFA). A multiple-group confirmatory factor analysis (MCFA) was used to evaluate the comparability of the PHQ-4 across nativity groups. Reliability indices were assessed. Also, the scales’ construct validities were assessed by examining the associations of both the PHQ-4 and its subscales’ scores with the sociodemographic characteristics and the 3-item UCLA Loneliness scale.ResultsThe internal consistencies were high for the PHQ-4 scale (α = 0.92) and its subscales of PHQ-2 (α = 0.86) and GAD-2 (α = 0.90). The CFA fit indices showed evidence for the two-factor structure of the PHQ-4. The two factors (i.e., anxiety and depression) were significantly correlated (r = 0.92). The MCFA demonstrated measurement invariance of the PHQ-4 across the nativity groups, but the model fits the data better in the foreign-born group. There were significant associations of the PHQ-4 scale and its subscales’ scores with the sociodemographic characteristics and the UCLA Loneliness scale (all p < 0.001).ConclusionsThe PHQ-4 and its subscales are reliable and valid measures to screen anxiety and depression symptoms in the general US adult population, especially in foreign-born individuals during the COVID-19 pandemic.

Physical activity and TV viewing parenting practices for toddlers among South Asian and white families in the UK: born in Bradford 1000 study

BackgroundChildren of South Asian (SA) origin in the UK have lower levels of physical activity (PA), compared to their White counterparts. Parents play an important role in establishing PA habits among young children. The aim of this study was to compare PA and television (TV) viewing parenting practices for young children between SA British (SAB) and White British (WB) parents living in the UK.MethodsWe conducted a secondary analysis of the Born in Bradford (BiB) 1000 study, using survey data at child ages 24 and 36 months. The study sample included three groups of mothers (n = 1,149): foreign-born SAB (n = 458), UK-born SAB (n = 276), and WB (n = 455). Mothers completed a survey about parenting practices (i.e., PA supports, PA restrictions, TV viewing restrictions) at child age 24 months and child PA and TV viewing behaviors at child ages 24 and 36 months. Parenting practices were compared among the three groups. Multivariable linear regression analyses compared children’s weekly walking frequency and daily TV viewing hours by parenting practices in the three groups.ResultsThe foreign-born SAB group showed the lowest frequencies of PA-supportive parenting practices (verbal encouragement: 3.7 ± 3.1 times/week; logistic support: 1.5 ± 1.8 times/week) and the highest frequencies of PA-restrictive parenting practices (7.8 ± 7.7 times/week) among the three groups (p < 0.01). Children of Foreign-born SAB mothers had the most frequent TV watching during a mealtime (4.0 ± 3.1 times/week) among the three groups (p < 0.01). Less frequent PA-supportive parenting practices and SA ethnicity were associated with lower walking frequency at 24 and 36 months of age among children (p < 0.01). More frequent exposure to TV at mealtimes and SA ethnicity were associated with higher TV viewing time at 24 and 36 months of age among children (p < 0.01).ConclusionsThis study demonstrated that SAB parents, particularly those who are foreign-born, apply parenting practices for their young children that are less supportive of PA and more supportive of TV viewing, and their children have lower PA and higher TV viewing time, compared with their WB counterparts.

Digital Ethnic Enclaves: Mate Preferences and Platform Choices Among Chinese Immigrant Online Daters in Vancouver

In light of the growing racialized immigrant population in Canada and advances in dating technologies, this study examines Chinese immigrants' partner preferences and mate selection processes through the lens of online dating. We draw on in-depth interviews with 31 Chinese immigrants who have used online dating services in Metro Vancouver to search for different-sex partners. Chinese immigrant online daters show strong preferences for dating Chinese. They emphasize permanent residency status and similarity in age at arrival when evaluating potential partners. Given their preferences, Chinese immigrants strategically choose the dating platforms they primarily use. Men exhibit higher selectivity in their preferences and choices of platforms. Notably, platforms catering to Chinese users create "digital ethnic enclaves" where Chinese immigrant daters congregate. The findings illuminate the intersection of race, gender, immigrant status, and age at arrival in shaping divergent experiences of mate selection and immigrant assimilation in the digital era.

A Retrospective Study on Clinical Assessment of Cognitive Impairment in a Swedish Cohort: Is There Inequality Between Natives and Foreign-Born?

People with a migration background are underrepresented in dementia research and disfavored in assessment and treatment, and many foreign-born individuals with dementia remain undiagnosed. The aim of this study was to examine whether there is inequality in the clinical assessment of dementia between native and foreign-born individuals in Sweden. Information was gathered retrospectively from a cohort of 91 native and 36 foreign-born patients attending four memory clinics in Skåne, Sweden. Data included information on cognitive test results, cerebrospinal fluid biomarkers, scores at structural imaging scales of global cortical atrophy (GCA), medial temporal lobe atrophy (MTA) and the Fazekas scale, laboratory measures of thyroid-stimulating hormone, calcium, albumin, homocysteine, hemoglobin, cobalamin (vitamin B12), and folate (vitamin B9), contact with health care, and treatment. Foreign-born patients had lower educational level and scored lower on Mini-Mental State Examination and Clock Drawing Test (p &lt; 0.001-0.011). Relatives initiated contact with health care to a higher extent in the foreign-born group (p = 0.031). Foreign-born patients had less white matter lesions (p = 0.018). Additionally, Alzheimer's disease (AD) biomarkers were significantly less used in foreign-born patients to support an AD diagnosis (p = 0.001). No significant differences were found for scores on GCA and MTA, laboratory measures, or initiated treatment. Although native and foreign-born patients were predominantly homogenous regarding examined variables, differences in the diagnostic process and underlying biological correlates of dementia exist and need to be further investigated in a larger sample.

Drum Rhythms and Golden Scriptures: Reasons for Mormon Conversion Within Haiti's Culture of Vodou

Drum Rhythms and Golden Scriptures: Reasons for Mormon Conversion Within Haiti's Culture of Vodou

The human capital and income of immigrants: evidence from Russia

ABSTRACT This study examines how immigration flows caused by the disintegration of states and globalisation change the composition of the labour force and how human capital is transferred from countries of the former Soviet Union to Russia. We estimate the contribution of imperfect human capital transferability to explaining the immigrant–native income differentials by using the Russian Longitudinal Monitoring Survey of 2009–2012. The findings reveal that the income of foreign-born people who moved before the disintegration of the USSR is not significantly different from the income of native-born citizens. In contrast, foreign-born groups who immigrated to Russia after the disintegration of the USSR have lower incomes than the native-born group. In addition, the income premium on education and labour experience received in host countries of the foreign-born group is lower compared to the income premium on education and labour experience received in Russia. An important factor explaining the difference in income between natives and foreign-born people who moved to Russia after the collapse of the USSR is the imperfection in the mechanism of human capital transferability.

Disparities in diabetes between US-born and foreign-born population: using three diabetes indicators

ABSTRACT We investigated disparities in diabetes between the US-born and foreign-born populations using three diabetes measures: diagnosed diabetes, undiagnosed diabetes, and total diabetes, either diagnosed or undiagnosed diabetes. We analyzed adults aged 30–84 years drawn from the National Health and Nutrition Examination Survey 2009–2018 (n = 21,390). Of cohorts in 2009–2018, foreign-born adults had significantly higher age-standardized prevalence of diagnosed (12.6% vs. 10.6%) and undiagnosed diabetes (4.5% vs. 2.6%), and total diabetes (17.1% vs. 13.2%) than US-born adults. Results from logistic and multinomial regressions adjusting for age, sex, race/ethnicity, limited access to healthcare and BMI showed that the foreign-born had significantly higher odds of total diabetes (OR: 1.25, 95% CI: 1.04–1.50) and undiagnosed diabetes (OR: 1.83, 95% CI: 1.44–2.32) compared to the US-born. There was no significant difference in diagnosed diabetes by nativity (OR: 1.12, 95% CI: 0.96–1.53). Our results show that foreign-born adults were at higher risk of diabetes than US-born adults, and the difference by nativity was largely attributable to BMI and racial/ethnic composition. In addition, we demonstrated the importance of choosing measures of diabetes in studying diabetes mainly due to the foreign-born group’s high prevalence of undiagnosed diabetes, which biases the prevalence of diabetes downward when diagnosed diabetes is used.

Obstetric comorbidity scores and disparities in severe maternal morbidity across marginalized groups

A recently developed obstetrical comorbidity scoring system enables the comparison of severe maternal morbidity rates independent of health status at the time of birth hospitalization. However, the scoring system has not been evaluated in racial-ethnic and socioeconomic groups or used to assess disparities in severe maternal morbidity. This study aimed to evaluate the performance of an obstetrical comorbidity scoring system when applied across racial-ethnic and socioeconomic groups and to determine the effect of comorbidity score risk adjustment on disparities in severe maternal morbidity. We analyzed a population-based cohort of live births that occurred in California during 2011 through 2017 with linked birth certificates and birth hospitalization discharge data (n=3,308,554). We updated a previously developed comorbidity scoring system to include the International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modifications diagnosis codes and applied the scoring system to subpopulations (groups) defined by race-ethnicity, nativity, payment method, and educational attainment. We then calculated the risk-adjusted rates of severe maternal morbidity (including and excluding blood transfusion-only cases) for each group and estimated the disparities for these outcomes before and after adjustment for the comorbidity score using logistic regression. The obstetric comorbidity scores performed consistently across groups (C-statistics ranged from 0.68 to 0.76; calibration curves demonstrated overall excellent prediction of absolute risk). All non-White groups had significantly elevated rates of severe maternal morbidity before and after risk adjustment for comorbidities when compared with the White group (1.3% before, 1.3% after) (American Indian-Alaska Native: 2.1% before, 1.8% after; Asian: 1.5% before, 1.7% after; Black: 2.5% before, 2.0% after; Latinx: 1.6% before, 1.7% after; Pacific Islander: 2.2% before, 1.9% after; and multi-race groups: 1.7% before, 1.6% after). Risk adjustment also modestly increased disparities for the foreign-born group and government insurance groups. Higher educational attainment was associated with decreased severe maternal morbidity rates, which was largely unaffected by comorbidity risk adjustment. The pattern of results was the same whether or not transfusion-only cases were included as severe maternal morbidity. These results support the use of an updated comorbidity scoring system to assess disparities in severe maternal morbidity. Disparities in severe maternal morbidity decreased in magnitude for some racial-ethnic and socioeconomic groups and increased in magnitude for other groups after adjustment for the comorbidity score.

Abstract 2352: Place of birth influences the metabolomic profile and preliminary effectiveness of a weight loss intervention among Hispanic men from the ANIMO pilot study

Abstract Background: The effect of intrinsic and extrinsic factors (e.g. the environment and genetics) on the metabolome may have implications for disease risk, health disparities, and effectiveness of clinical interventions. Purpose: This study investigated whether plasma metabolomic profiles differ between U.S. born and foreign-born Hispanics participating in a weight loss intervention. Secondarily, we sought to examine if country of origin had an effect on the intervention effectiveness. Methods: Participants were overweight and obese Hispanic men (N=42) aged 18 to 64 years enrolled in a 24-week weight loss intervention. Metabolomic profiles were acquired from plasma using ultra performance liquid chromatography-mass spectroscopy (UPLC-MS) at baseline, 12 and 24 weeks. Models were visualized using supervised orthogonal projections to latent structures-discriminant analysis (OPLS-DA); R2X cut points of 0.75, 0.50, and 0.25 were used to describe substantial, moderate, or weak levels of predictive accuracy, respectively. Score plots (S-plots) were utilized to select metabolites that influenced the OPLS-DA model. Progenesis QI was used for peak integration and metabolite identification in addition to the Human Metabolite Data Base (HMDB). The effect of place of birth on weight loss was examined using multiple linear regression. Results: Foreign-born participants were older (P = 0.0086), had less education (P &amp;lt; 0.001), were mostly Spanish-preferred speakers (P &amp;lt; 0.001), and had less acculturation (P &amp;lt; 0.001) compared to U.S. born participants. The metabolome between U.S. born vs foreign-born were moderately (R2X =0.65), weakly (R2X= 0.33), and substantially (R2X =0.79) different at baseline, 12 weeks, and 24 weeks. Endogenous metabolites such as alpha-keto and amino acids, phospholipids, fatty acids, as well as some dietary compounds were characteristic of the foreign-born participants, but not the U.S. born, at baseline. Post-intervention, metabolites from dietary sources (cereals, herbs and spices, mushrooms, chives, onions, and beer), and lipids (diacylglycerols, cholesteryl and glycerolipids) where characteristic of the foreign-born group, whereas saponins and metabolites from green vegetables, avocados, alcoholic beverages, coffee, and green tea were characteristic of the U.S. born group. Models comparing study arm or weight loss status were weak. At 24 weeks, U.S. born participants had more weight loss than foreign born (P = 0.023). Conclusion: Plasma metabolomic profiles from Hispanic men differ by country of origin. Analyses to determine whether the greater intervention benefit among U.S. born Hispanic males can be explained by their baseline metabolome are pending. Future studies should determine factors that influence differences in metabolomic profiles in order to tailor interventions. Citation Format: Melissa Lopez-Pentecost, David O. Garcia, Xiaoxiao Sun, Cynthia A. Thomson, H-H. Sherry Chow, Wade M. Chew, Jessica A. Martinez. Place of birth influences the metabolomic profile and preliminary effectiveness of a weight loss intervention among Hispanic men from the ANIMO pilot study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2352.

Out-mobility from Stockholm’s immigrant-dense neighbourhoods – a study of two cohorts

ABSTRACT The central themes of this study are how housing tenure affects moving away from neighbourhoods with differing degrees of immigrant concentration in Stockholm and, comparing two cohorts, how the relationship between housing tenure, ethnic background and residential mobility develops over time. The findings reveal that the effect of housing tenure on moving varies marginally between neighbourhood types, and differences between housing tenures are reduced over time. Residential mobility is increasingly associated with higher income levels and members of the non-western, foreign-born group are less likely to move when the housing market is increasingly owner dominated. These ethnic hierarchies also apply to residential sorting. The sorting of out-movers from neighbourhoods with high concentrations of immigrants is increasingly affected by income. However, the non-western, foreign-born group is also increasingly dependent on housing assets in order to leave immigrant-dense neighbourhoods, which is not the case for other groups. The results show a shift in the necessary resources for residential mobility trajectories for those at the bottom end of the ethnic hierarchy and indicate that the place-stratification framework needs to differentiate between different types of assets and population groups to enable a better understanding of residential sorting in a changing housing market.

Complexities of Polish migrant's citizenship attributions in the context of Brexit and the Scottish Independence Referendums

This article focuses on the experiences of Scotland's largest foreign-born minority group, namely Poles, in the run-up to the Scottish Independence Referendum in 2014 and subsequently the UK's EU Referendum. Through exploring Polish migrant residents initial responses and experiences with regard to both referendums, this article (1) outlines perspectives on blurred and contested boundaries and formations of citizenships and (2) the implications of complex and changing relations between citizenship attributions (e.g. political participation, legal status of citizenship and sense of belonging) on the process of citizenship formation. This article therefore offers a greater understanding of the transformation of traditional state-centric concepts of citizenship rights into the shifting borders and character of citizenship formation during the times of political uncertainties.

Doing the Month: Traditional Asian Postpartum Practices at a Federally Qualified Health Center [31A

INTRODUCTION: “Doing the month” (DTM) is a traditional Asian month-long postpartum practice. Although there are varying levels of adherence, in its strictest form, women are not allowed to shower, leave the house, or brush their teeth. METHODS: A cross-sectional survey was developed in consultation with a psychometrician to determine the estimated prevalence of women who have participated in DTM. Female patients in a federally qualified health center's waiting room were surveyed in Cantonese, Mandarin, Vietnamese, and English. This study was approved by the UC Berkeley Institutional Review Board. RESULTS: One hundred fifty-four respondents participated; mean age was 40.1. Without prompting, 37.7% responded that they had heard of DTM. After an explanatory paragraph, 76.6% participants reported they had heard of DTM. Out of patients that have children, 60.7% “did the month” after giving birth. Likert-type scale questions showed that respondents believed DTM was stressful but enjoyable and helpful for recovery from childbirth. CONCLUSION/IMPLICATIONS: The majority of immigrant Asian women at this FQHC had heard of and participated in DTM. Asian immigrants are projected to become the largest foreign-born group in the U.S. by 2055. DTM is a common practice that providers should be aware of in order to promote postnatal health of both infant and mother. Drinking rice wine, recommended in DTM practices, could affect developing infants and may need to be addressed in breastfeeding patients. Being unable to shower or leave the house for a month may contribute to postpartum infections or depression. Obstetric residencies should include curriculum regarding this practice.

Treatment completion for latent tuberculosis infection in Norway: a prospective cohort study

BackgroundSuccessful treatment of latent tuberculosis infection (LTBI) is essential to reduce tuberculosis (TB) incidence rates in low-burden countries. This study measures treatment completion and determinants of non-completion of LTBI treatment in Norway in 2016.MethodsThis prospective cohort study included all individuals notified with LTBI treatment to the Norwegian Surveillance System for Infectious Diseases (MSIS) in 2016. We obtained data from MSIS and from a standardized form that was sent to health care providers at the time of patient notification to MSIS. We determined completion rates. Pearson’s chi squared test was used to study associations between pairs of categorical variables and separate crude and multivariable logistic regression models were used to identify factors associated with treatment completion and adverse drug effects.ResultsWe obtained information on treatment completion from 719 of the 726 individuals notified for LTBI treatment in 2016. Overall, 91% completed treatment. Treatment completion was highest in the foreign-born group [foreign-born, n = 562 (92%) vs Norwegian-born, n = 115 (85%), p = 0.007]. Treatment completion did not differ significantly between prescribed regimens (p = 0.124). Adverse events were the most common reason for incomplete treatment. We found no significant differences in adverse events when comparing weekly rifapentine (3RPH) with three months daily isoniazid and rifampicin (3RH). However, there were significantly fewer adverse events with 3RPH compared to other regimens (p = 0.037). Age over 35 years was significantly associated with adverse events irrespective of regimen (p = 0.024), whereas immunosuppression was not significantly associated with adverse events after adjusting for other variables (p = 0.306). Treatment under direct observation had a significant effect on treatment completion for foreign-born (multivariate Wald p-value = 0.017), but not for Norwegian-born (multivariate Wald p-value = 0.408) individuals.ConclusionsWe report a very high treatment completion rate, especially among individuals from countries with high TB incidence. The follow-up from tuberculosis-coordinators and the frequent use of directly observed treatment probably contributes to this. Few severe adverse events were reported, even with increased age and in individuals that are more susceptible. While these results are promising, issues of cost-effectiveness and targeting treatment to individuals at highest risk of TB are important components of public health impact.

Towards TB Elimination in Aotearoa/New Zealand: Key Informant Insights on the Determinants of TB among African Migrants.

Migrants living in low incidence countries, including New Zealand (NZ), are disproportionately affected by tuberculosis (TB). This foreign-born group poses important challenges to achieving the national TB elimination targets. Thus, the aim of this study was to contribute to the understandingof factors that influence the incidence of TB among African migrants living in NZ. We employed a semi-structured interview approach to explore the perceptions of NZ-based African community leaders, health professionals and a non-governmental TB support organisation about the wider determinants of TB. The findings, though not completely generalizable, suggest that many NZ-based Africans endure a difficult process of integration, perceive themselves as least susceptible to TB and have low awareness about available health services. Furthermore, the cost of general practitioner (GP) services, mistrust of health professionals, TB stigma and the NZ immigration policy were indicated as important barriers to TB services. Strategies to address TB among migrants must therefore be more holistic and not be centred on a fragmented approach that overemphasises the biomedical approaches, as the incidence of TB is more likely the outcome of a complex interplay of several underlying factors.

Acculturation is associated with higher prevalence of cardiovascular disease risk-factors among Chinese immigrants in Australia: Evidence from a large population-based cohort.

Background Acculturation is associated with increased prevalence of cardiovascular disease (CVD) risk-factors among immigrants in Western countries. Little is known about acculturation effects on CVD risks among Chinese immigrants, one of the fastest growing populations in Western countries. In this study, we aim to examine the association between acculturation and CVD risk-factors among Chinese immigrants, Australia's third-largest foreign-born group. Methods We accessed a subsample of Chinese immigrants ( n = 3220) within the 45-and-Up Study (2006-2009). Poisson regression model with a robust error variance examined the association between acculturation and CVD risk-factors, and prevalence ratios were reported, adjusted for socio-demographic characteristics. Indicators of acculturation included age at migration, length of Australian residence and language spoken at home. The outcomes were self-reported CVD diagnosis and six risk-factors (hypertension, diabetes, high cholesterol, smoking, overweight/obesity, physical inactivity). Results Mean age of Chinese participants was 58.9-years (SD = 10.7) and 55.5% were women. Chinese migrating to Australia aged <18 years were significantly more likely to report diabetes (prevalence ratio = 1.71; p < 0.01), overweight/obesity (prevalence ratio = 1.49; p < 0.001) and ≥ 3 CVD risk-factors (prevalence ratio = 1.47; p < 0.05) compared with those who migrated after 18-years-old. Chinese immigrants who lived in Australia for ≥ 30 years were significantly more likely to have diabetes (prevalence ratio = 1.84; p < 0.01) and ≥ 3 CVD risk-factors (prevalence ratio = 1.84; p < 0.01). There were no significant differences by language spoken at home. The association between indicators of acculturation and CVD risk-factors appeared to differ by sex. Conclusion Greater acculturation was associated with adverse CVD risk-factors among Chinese immigrants in Australia.

A Comprehensive Health Profile of Guyanese Immigrants Aged 18-64 in Schenectady, New York.

Guyanese immigrants are the 5th largest foreign-born group in NY State, but sparse literature is available on their health status and health needs. A community-based health interview survey of Schenectady NY residents aged 18-64 (N = 1861) was analyzed. Bivariate comparisons between Guyanese respondents and White, Black, and Hispanic respondents were made for each variable to identify disparities. As predominantly low SES immigrants, Guyanese adults were less likely to be covered by health insurance, have a usual place for care, and receive cancer screenings. They were more likely to engage in alcohol binge drinking, but generally in good overall physical and mental health and less likely to smoke or report disability. Stable family structure and supportive interpersonal relationships are major assets of this group. Improved access to affordable health insurance, linkages to primary care, targeted cancer screening programs, and culturally-sensitive behavioral health services are recommended for Guyanese immigrants.

Geographic Access to Food Shelves among Racial/ethnic Minorities and Foreign-born Residents in the Twin Cities, Minnesota

Place-based disparities in access to affordable food sources (e.g. supermarkets) have been well documented, but geographic access to emergency food sources (e.g. food panties, also known as food shelves) is unknown. This study examined the geography of emergency food in the Twin Cities, Minnesota. US Census and American Community Survey data were used to estimate the average distance to the closest food shelf according to area racial/ethnic composition and foreign-born group composition. In adjusted models, areas with the highest proportion of minority groups had shorter distances to the nearest food shelf (0.13–1.03 log-transformed miles, p < 0.05), as did census tracts with more residents born in East Africa and Latin America (0.29–0.31 log-transformed miles, p < 0.001). Areas with more racial/ethnic minorities and foreign-born groups may have access to emergency food, but efforts are needed to evaluate the healthfulness and culturally relevance of these offerings.

Stakeholder citizenship: the complexities of Polish migrants’ citizenship attachments in the context of the Scottish independence referendum

This article focuses on the experiences of Scotland’s largest foreign-born minority group, namely Poles, in the run-up to the Scottish independence referendum in 2014. We draw on 20 in-depth interviews to explore our participants’ intentions and justifications for voting (or not) in the referendum. We found that our participants tended to emphasise the jus domicili principle when justifying their eligibility to vote in the referendum. However, our participants extended the jus domicili principle in their justifications to also include the intention to stay in Scotland as a central aspect of their continuing stake in (and right to vote in the referendum to determine) Scotland’s future. Through exploring our participants’ justifications for voting in the referendum, we were able to examine and better understand how migrants constitute their citizenship through articulating their substantive attachments (social, economic and relational or familial) in their adoptive country and in their country of origin.

Child Support in Immigrant Families

In this study, we use nationally representative data from the U.S. Current Population Survey-Child Support Supplement (N = 28,047) to examine differences in nonresident fathers’ material contributions between children of native and foreign-born mothers. We focus on contributions provided through the formal child support system (whether the mother has a child support agreement and the amount received), as well as support provided informally (the amount of informal cash and whether she receives any in-kind support). We control for a variety of individual and household characteristics, including whether the nonresident father lives in a different state or in a different country. We find that foreign-born mothers are much less likely to have a child support agreement than native-born mothers, but have similar amounts of formal support, once an agreement is in place. Compared to native-born mothers, foreign-born mothers are also much less likely to receive in-kind support, but this difference is completely explained by fathers’ distance from the child. Foreign-born mothers do not differ at all on the amount of informal cash support received from fathers. Nonresident fathers’ residence outside the U.S. is an important mechanism through which nativity affects the likelihood of having a child support order and receiving any in-kind support, but not the amount of formal support (given an order) or the amount of informal cash support. Aggregate comparisons mask important differences within the foreign-born group by mothers’ and children’s citizenship status, years in the U.S., and region of origin.

Emergency department utilization rates and modalities among immigrant population. A 5-year survey in a large Italian urban emergency department

The rates and modalities of healthcare services utilization for migrant population may differ from natives, since the health needs of the former are influenced by some factors such as health status, self-perceived needs, healthseeking behavior, language barriers and cultural differences. Only scarce and often conflicting data have been published so far on migrants’ utilization of healthcare services in Europe, and even less data are available on emergency departments (EDs). The aim of this cross-sectional study was to compare utilization rates and modalities of presentation to the large urban ED of the University Hospital of Parma, Italy (averaging 85,000 visits per year), by Italian native and foreign-born populations during 2008-2012. Throughout the study period 424,466 ED visits were recorded, 64,435 (15.4%) of which by foreign-born patients. A significant difference between utilization rates was observed for all the triage-codes, with higher rates for foreign-born low-acuity codes (green plus white codes: 87.5 vs 73.9, P&lt;0.0001) and lower rates for high-acuity codes (yellow plus red codes: 12.5 vs 26.1%, P&lt;0.0001). The utilization rate was 253.9 visits per 1000 inhabitants for the Italian-native group and 309.7 per 1000 for the foreign-born group (odds ratio 1.23; 95% CI: 1.01-1.48; P=0.034). Different modalities of presentation were also observed, with a high rate of selfreferrals (82.3 vs 71.4%, P&lt;0.001). The results of this study suggest that a better knowledge of available Italian healthcare services among immigrants is advisable and should be encouraged.