Foreign Born Research Articles

Cleveland’s Multicultural Librarian: Eleanor (Edwards) Ledbetter, 1870–1954

Eleanor (Edwards) Ledbetter, who served immigrant populations in Cleveland throughout most of the Progressive Era and the Great Depression, was one of the first librarians to advocate for multiculturalism (then called cultural pluralism) as opposed to Americanism. In providing multicultural and multilingual library services for immigrants, Ledbetter was active locally as librarian at the Broadway Branch of the Cleveland Public Library and member of the Cleveland Americanization Committee and nationally as chair of the American Library Association’s Committee on Work with the Foreign Born. She was recognized internationally as a bibliographer of Polish literature and translator of Czech folktales, for which she was awarded honors by the Polish and Czechoslovak governments, and as an unofficial ambassador for the American public library in eastern and southeastern Europe, specifically the countries of the former Yugoslavia.

Health inequalities among workers with a foreign background in Sweden: do working conditions matter?

Employment and working conditions are key social determinants of health, yet current information is lacking regarding relationships between foreign background status, working conditions and health among workers in Sweden. This study utilized cross-sectional data from the 2010 Swedish Level of Living Survey (LNU) and the Level of Living Survey for Foreign Born Persons and their Children (LNU-UFB) to assess whether or not health inequalities exist between native Swedish and foreign background workers and if exposure to adverse psychosocial and physical working conditions contributes to the risk for poor health among foreign background workers. A sub-sample of 4,021 employed individuals aged 18–65 was analyzed using logistic regression. Eastern European, Latin American and Other Non-Western workers had an increased risk of both poor self-rated health and mental distress compared to native Swedish workers. Exposure to adverse working conditions only minimally influenced the risk of poor health. Further research should examine workers who are less integrated or who have less secure labor market attachments and also investigate how additional working conditions may influence associations between health and foreign background status.

Reduced Prevalence of Allergic Disease in Foreign Born American Children Is Reversed After US Residence

Lower prevalence of allergic disease in specific racial/ethnic groups has been reported. We studied the association between birthplace and the prevalence of allergic disease in children. We used the 2007–2008 National Survey of Children’s Health with a representative sample of 91,642 children age 0–17 years to determine if there is an association between birthplace and duration of residence in the US and prevalence of allergic disease, including asthma, eczema, hay fever and food allergy. Children born outside the US had lower odds of any allergic disorder compared with those born in the US (logistic regression, OR=0.48, CI95=0.38–0.61, P<0.0001), including ever-asthma (OR=0.53, CI95=0.39–0.72, P<0.0001), current-asthma (OR=0.34, CI95=0.23–0.51, P<0.0001), eczema (OR=0.43, CI95=0.30–0.61, P<0.0001), hay fever (OR=0.39, CI95=0.27–0.55, P<0.0001) and food allergy (OR=0.60, CI95=0.37–0.99, P=0.045). These associations remained significant in multivariate models that included age, sex, race/ethnicity, household income, residence in metropolitan areas and history of moving to a new US residence. Children born outside the US whose parents were also born outside the US had significantly lower odds of any atopic disorders than those whose parents were born in the US (P=0.005). Children born outside the US who lived in the US for >10 years compared with 0–2 years had higher odds of developing an allergic disorder (aOR= 3.04, CI95=1.08–8.60, P=0.03), including eczema (aOR=4.93, CI95=1.18–20.62, P=0.03) and hay fever (aOR=6.25, CI95=1.70–22.96, P=0.006), but not asthma or food allergy (P≥0.06). Loss of childhood protection from allergic disease after prolonged US residence of foreign born children implies environmental factors promote development of allergic disease.

HIV diagnosis and utilisation of HIV-related medical care among foreign-born persons in New York City, 2001–2009

ObjectivesTo measure trends in HIV diagnoses among foreign-born (FB) New Yorkers and compare the epidemic in FB with that in non-FB (NFB).MethodsNew York City (NYC) HIV/AIDS surveillance registry data were...

The Awakening of the Social Conscience: Jane Maud Campbell, 1869–1947

Jane Maud Campbell’s career demonstrated her commitment and passion for library services with immigrants and minorities as one of the first advocates for multiculturalism in librarianship. She began her career working in the Newark Public Library and soon was employed as the librarian of the Passaic Public Library. She was the first woman employed by a state library commission to serve the needs of immigrants in Massachusetts. A prolific writer and champion of immigrants’ rights within the American Library Association, she served for a brief time on the ALA Committee on Work with the Foreign Born in its initial years. She spent the later years of her career as a public librarian in Lynchburg, Virginia, during a period of segregation in the South. She worked around the edges of the law to make library service available to the African American community of Lynchburg.

Characteristics of Foreign-Born HIV Infected Individuals and Differences by Region of Origin and Gender

To compare foreign-born (FB) and US-born (USB) patients (pts) in a US HIV care program. Retrospective review. Data were collected on all FB and a random sample of 5% of USB pts in an HIV clinic in Colorado, USA. Comparisons were made between FB pts and USB pts and among FB pts by global region of origin and sex. Among 150 FB and 59 USB pts, FB pts were younger (40 vs. 45 years), proportionately more female (39 vs. 17%), with heterosexual sex as HIV risk factor (69 vs. 23%) and reported substance use less (6 vs. 38%) (All p ≤ 0.001) compared to USB pts. Age and substance differences persisted between FB and USB women. Significant differences also existed between FB and USB pts in reason for HIV test, tuberculosis and mental health diagnoses, and diagnosis of >1 co-morbidity, but not in mean CD4 cell count (502 vs. 569), antiretroviral therapy (ART) (92 vs. 90%), or alcohol use (29 vs. 37%). Compared to FB women, FB men were more commonly men that have sex with men, from Latin America/Caribbean, have HIV testing for illness, and have had a concomitant HIV and AIDS diagnosis while FB women were more commonly refugees, heterosexual and from Africa. Differences exist between FB and USB HIV-infected pts, and among FB pts themselves. HIV care and prevention programs must recognize and address these dissimilarities in order to maximize clinical outcomes, improve linkage to and continuity in care and optimize resource allocation.

Prevalence of chronic hepatitis B among foreign-born persons living in the United States by country of origin

Estimates of the prevalence of chronic hepatitis B (CHB) in the United States differ significantly, and the contribution of foreign-born (FB) persons has not been adequately described. The aim of this study was to estimate the number of FB persons in the United States living with CHB by their country of origin. We performed a systematic review for reports of HBsAg seroprevalence rates in 102 countries (covering PubMed from 1980 to July 2010). Data from 1,373 articles meeting inclusion criteria were extracted into country-specific databases. We identified 256 seroprevalence surveys in emigrants from 52 countries (including 689,078 persons) and 1,797 surveys in the general populations of 98 countries (including 17,861,035 persons). Surveys including individuals with lower or higher risk of CHB than the general population were excluded. Data were combined using meta-analytic methods to determine country-specific pooled CHB prevalence rates. Rates were multiplied by the number of FB living in the United States in 2009 by country of birth from the U.S. Census Bureau to yield the number of FB with CHB from each country. We estimate a total of 1.32 million (95% confidence interval: 1.04-1.61) FB in the United States living with CHB in 2009; 58% migrated from Asia and 11% migrated from Africa, where hepatitis B is highly endemic. Approximately 7% migrated from Central America, a region with lower CHB rates, but many more emigrants to the United States. This analysis suggests that the number of FB persons living with CHB in the United States may be significantly greater than previously reported. Assuming 300,000-600,000 U.S.-born persons with CHB, the total prevalence of CHB in the United States may be as high as 2.2 million.

The "Latina epidemiologic paradox" revisited: the role of birthplace and acculturation in predicting infant low birth weight for Latinas in Los Angeles, CA.

The "Latina epidemiologic paradox" refers to the observation that despite socioeconomic disadvantages, Latina mothers in the United States (US) have a similar or lower risk for delivering an infant with low birth weight (LBW) compared to non-Latina White mothers. An analogous paradox may exist between foreign-born (FB) and US-born (USB) Latinas. Our goal was to assess differences in LBW in USB Latinas, FB Latinas, and non-Latina Whites in Los Angeles County in 2003 using birth records and survey data. Using logistic regression, we estimated associations between LBW and birthplace/ethnicity in a birth cohort and nested survey responder group and between LBW and acculturation in responders to a follow-up survey. USB Latinas and FB Latinas had a higher prevalence of LBW infants compared to Whites (odds ratio [OR] = 1.34, 95% confidence interval [CI] = (1.17, 1.53) and OR = 1.32, 95% CI = (1.18, 1.49), respectively); when we adjusted for additional maternal risk factors these point estimates were attenuated, and interval estimates were consistent with a modest positive or inverse association. Among Latinas only, LBW was more common for high-acculturated FB and USB Latinas compared to low-acculturated FB Latinas, and there was limited evidence that environmental or behavior risk factors had less impact in low-acculturated Latinas. In summary, adjusting only for demographics, Latinas in our study were more likely to have LBW infants compared to Whites, in contrast to the Latina paradox hypothesis. Furthermore, adjusting for environmental or behavioral factors attenuated the positive association, but there was little evidence that Latinas had a lower prevalence of LBW regardless of the variables included in the models. Finally, among Latinas, there was limited evidence that associations between known risk factors and LBW were modified by acculturation.

US. Data Sources on the Foreign Born and Immigration

Migration data can be divided into two broad types: “stock” or census and survey data and “flow” or administrative data. Both stock and flow data are valuable resources for analyzing the migration process. In the statistical system of the United States, the U.S. Census Bureau is the primary source for census and survey data on the foreign born. The Department of Homeland Security and the U.S. State Department provide several different administrative sources for studying immigration. The goal of this study is to review the best sources of government data available for analyzing (1) the size, distribution, and characteristics of the foreign-born population and their households and (2) the level of immigration into the United States, and the distribution and characteristics of immigrants by status.

Health Care Practices of the Foreign Born Asian Indians in the United States. A Community Based Survey

Although successful utilization of medical and preventive care by members of the non-US born communities is an important public health concern, our knowledge regarding health practices of different ethnic subgroups is limited. In the present study, participants of the health fairs organized during South Asian cultural and religions events were asked anonymously to complete the South Asian Total Health Initiative (SATHI) health survey questionnaire to evaluate their health-related practices, self-health perception, and satisfaction with medical care. Among 1,250 surveyed, 1,016 foreign born Asian Indians adults that represented the fastest growing subgroups of the South Asian born nationals in the US were included in the analysis. We found that the majority reported healthy behavior (exercise activities and abstinence from alcohol or tobacco), high self-health perception, satisfaction with medical care, and compliance with annual routine medical examinations that was directly associated with the annual house income. Approximately 40% of women complied with breast and cervical cancer screenings and less than 20% of men complied with prostate cancer screening guidelines. Presence of chronic conditions (mostly cardiovascular pathology and/or diabetes) that were reported by approximately half of the participants negatively impacted their self-health perception. In conclusion, positive self-reported health perception and compliance with routine health examinations of the surveyed foreign born Asian Indians was reported along with an increased rate of chronic morbidity and underutilization of specific preventive services. Observed discrepancy between self-health perception and health status highlights the need to enhance utilization of preventive services among the non-US born Asian Indian community.

Educating Foreign Born African Students in U.S. Schools

The number of people, particularly students in U.S. schools, who were born in Africa increased significantly over the past decade. The 2010 U.S. Census report puts the African immigrant population in the U.S. at 2.1 million people. The largest foreign born African populations were from East Africa (Somalia, Kenya and Ethiopia) and West Africa (Nigeria and Ghana). The states with the highest concentrations of African populations were New York, Minnesota, Ohio, California and Texas.This guide offers educators who work with this population some of the most important cultural insights that educators need to understand in order to be more effective in working with African students.

Foreign Born Status and HIV/AIDS: A Comparative Analysis of HIV/AIDS Characteristics Among Foreign and U.S. Born Individuals

The purpose of this study was to observe differences in HIV characteristics between the foreign and U.S. born HIV population. The study sample consisted of individuals, ≥13 years of age, who have been diagnosed with HIV and are patients of the Lexington Bluegrass Care Clinic. For the comparison analysis, the sample was divided into two groups (n = 1070), foreign born and U.S. born. Compared to U.S. born patients, foreign born patients were younger at the time of their HIV diagnosis (31 years vs. 36 years, P = 0.005), of Hispanic origin (63.1% vs. 1.1%, P < 0.001), and reported heterosexual contact as their mode of transmission (67.7% vs. 33.9% P < 0.001). Foreign born patients enrolled into care at a much lower CD4+ count and compared to the U.S. born, they were more likely to be classified as late testers (53.9% vs. 32.8%, P = 0.006). There were many differences found between foreign born and U.S. born HIV patients. Upon enrolling into care, foreign born individuals were more likely to have multiple OI's and have an AIDS diagnosis. In regards to testing, foreign born individuals were more likely to have tested late for HIV compared to their U.S. born counterparts.

Knowledge, Attitudes, and Practices of US Travelers to Asia Regarding Seasonal Influenza and H5N1 Avian Influenza Prevention Measures

International travel is a potential risk factor for the spread of influenza. In the United States, approximately 5%-20% of the population develops an influenza-like illness annually. The purpose of this study was to describe the knowledge, attitude, and practices of US travelers to Asia regarding seasonal influenza and H5N1 avian influenza (AI) prevention measures. We surveyed travelers to Asia waiting at the departure lounges of 38 selected flights at four international airports in New York, Chicago, Los Angeles, and San Francisco. Of the 1,301 travelers who completed the pre-travel survey, 337 also completed a post-travel survey. Univariate and multivariate logistic regression were used to calculate prevalence odds ratios (with 95% CI) to compare foreign-born (FB) to US-born travelers for various levels of knowledge and behaviors. Although the majority of participants were aware of influenza prevention measures, only 41% reported receiving the influenza vaccine during the previous season. Forty-three percent of participants reported seeking at least one type of pre-travel health advice, which was significantly higher among US-born, Caucasians, traveling for purposes other than visiting friends and relatives, travelers who received the influenza vaccine during the previous season, and those traveling with a companion. Our study also showed that Asians, FB travelers, and those working in occupations other than health care/animal care were less likely to recognize H5N1 AI transmission risk factors. The basic public health messages for preventing influenza appear to be well understood, but the uptake of influenza vaccine was low. Clinicians should ensure that all patients receive influenza vaccine prior to travel. Tailored communication messages should be developed to motivate Asians, FB travelers, those visiting friends and relatives, and those traveling alone to seek pre-travel health advice as well as to orient them with H5N1 AI risk factors.

A systematic review of road traffic injury risks for immigrant populations

IntroductionThere are currently some 200 million migrants and immigrants worldwide, majority of these coming from low and middle-income countries (LMICs), where risks for road traffic injury (RTI) are high. The...

Health Issues Among Foreign Born Uninsured Children Visiting an Inner City Pediatric Emergency Department

To study the demographic and socio-economic characteristics of foreign born children visiting an inner city pediatric emergency department (PED) and to assess their access to care, unmet health care needs, barriers to care and follow-up care. A cross-sectional study was conducted in October and November 2006; parents of children visiting an inner city PED underwent face-to-face interview regarding their socio-economic status, access to health care, unmet medical needs and barriers to care. A follow-up telephonic interview was conducted within 1 week of the ED visit to assess compliance with follow-up care. 385 patients (Mean age 4.63 years, 51.9% male) were enrolled prospectively. 297 (77%) children had health insurance and 88 (23%) were uninsured. 38 (43%) uninsured children were foreign born. Of those uninsured, 53 (60%) were uninsured for >a year and 35 (40%) had been uninsured part year. Compared with insured children, fewer uninsured children had a regular place for medical care (89 vs. 46%, P < 0.001), a regular Primary Care Provider (95 vs. 68%, P < 0.001), and regular dental care (46 vs. 26%, P < 0.001). Almost one-third of parents of uninsured children reported a perceived barrier to care (31 vs. 8%, P < 0.001). Uninsured children, who were foreign born, were older (mean age 8.9 vs. 4.9 years, P < 0.001), primarily Spanish speaking (95 vs. 76%, P < 0.02), poorer, with household income less than 100% of the Federal poverty level and had poorer access to care. They also used the PED as their primary source of care more frequently (87 vs. 66%, P < 0.03). In a multivariate logistic regression analysis, children with no health insurance, and those children who were foreign born were more likely to have poor access to care with odds ratio (95% CI) of 0.19 (0.08-0.46) and 0.35 (0.13-0.95), respectively. Significant proportions of uninsured children visiting our PED are born in Mexico and from low income immigrant families, many do not qualify for public insurance, have poor access to care, and use the PED for their healthcare needs. This is likely to be a growing problem in certain regions of the country requiring targeted health policy intervention.

Is There a Healthy Foreign Born Effect for Childhood Obesity in the United States?

Objective of the study was to explore factors associated with early childhood obesity and assess whether having a foreign born mother is protective against childhood obesity. Data sources include 9months and 4years parent interviews and direct assessments of possessive children's weight and height (4years) or length (9months) from the Early Childhood Longitudinal Study-Birth Cohort. Subjects were children with anthropometric measures who lived with their mothers (n=9,700 at 9months and 8,200 at 4years). Overweight is defined as a weight-for-length ratio at or above the 95th percentile at 9months; obesity is defined as a body mass index at or above the 95th percentile at 4years. The prevalence of overweight/obesity was 15.4% at 9months and 18.0% at 4years. After adjustment for potential confounders, having a foreign-born mother was not associated with the odds of overweight at 9months or 4years. At 9months and 4years, low birth weight, pre-pregnancy weight and weight gain during pregnancy were protective of overweight. In addition to these factors, at 4years, excessive weight gain in the first 9months was the strongest predictors for obesity. Living in a safe neighborhood and ever having breastfed were protective against obesity. Having a foreign born mother is not protective of early childhood obesity. A focus on health of women prior to conception and on women's and infants' health in the perinatal period are key to addressing childhood obesity.

The Role of Patient Activation on Patient–Provider Communication and Quality of Care for US and Foreign Born Latino Patients

Previous research has shown positive effects of patient activation on healthcare outcomes, but there is practically no information on the generalization of these findings for Latino patients. Little data are available on whether patient activation is associated with healthcare outcomes for Latino patients and whether activation varies by language proficiency and nativity status. We examined the levels of activation by characteristics of Latino patients (e.g. nativity, language, health status). We investigated whether patient activation relates to the quality of care received and enhanced doctor-patient communication for Latino patients. We conducted analyses of 1,067 US born and foreign born Latinos who participated in the second wave of the PEW/RWJF Hispanic Healthcare Survey during 2008. Participants were self-identified Latinos (18+) with a doctor visit, living in the contiguous United States who could be contacted by telephone. US born Latinos had significantly (P < 0.001) greater patient activation scores than foreign born Latinos (75 versus 70). Latinos classified as bilingual and those reporting excellent health evidenced higher mean activation scores as compared to Spanish-speaking Latinos and those reporting fair or poor health. After adjusting for demographics, health status, other language and service use factors, patient activation was strongly associated with self-reported quality of care and better doctor-patient communication among both US and foreign born Latino respondents. Interventions that augment patient activation could increase quality of care and improved patient-provider communication, potentially reducing health care disparities for Latinos.

Treatment and outcomes of gastric cancer among United States‐born and foreign‐born Asians and Pacific Islanders

The authors investigated whether stage at diagnosis, cancer treatments, and survival of Asian and Pacific Islander (API) gastric cancer patients in the United States vary by birthplace. The authors studied 6454 API and 10,099 non-Hispanic white (NHW) patients diagnosed with gastric cancer from the Surveillance, Epidemiology, and End Results program between 1992 and 2005. In descriptive analyses, stage, receipt of adequate lymph node examination (ALNE), and surgery were compared among US-born APIs, foreign-born (FB) APIs, and NHWs. Multivariate polytomous logistic and proportional hazards regression models were used to assess differences in cancer stage and survival, respectively, adjusted for clinical and demographic factors. As a group, APIs were more likely than NHWs to present with earlier-stage diagnoses and receive surgery and ALNE (P < .001). However, FB (adjusted odds ratios [aOR], 0.79; 95% confidence interval [CI], 0.73-0.86) but not US-born APIs (aOR, 1.05; 95% CI, 0.92-1.20) were significantly more likely to present at earlier stages than NHWs. Compared with NHW patients, FB and US-born APIs were more likely to receive surgery (adjusted risk ratio [aRR], 1.06; 95% CI, 1.03-1.09 and aRR, 1.09; 95% CI, 1.03-1.14, respectively) and ALNE (aRR, 1.29; 95% CI, 1.19-1.41 and aRR, 1.14; 95% CI, 1.00-1.32, respectively). In fully adjusted models, FB (adjusted relative hazard ratios [aHR], 0.86; 95% CI, 0.82-0.90) but not US-born APIs (aHR, 0.96; 95% CI, 0.89-1.04) had more favorable survival than NHWs. The earlier-stage diagnosis, more complete surgical treatment, and improved survival of Asians and Pacific Islanders with gastric cancer may result from less aggressive tumors or more prompt recognition and thorough evaluation of early symptoms. Further study of these factors could improve outcomes for all patients with gastric cancer.

Anal HPV genotypes and related displasic lesions in Italian and foreign born high-risk males

Anal intraepithelial neoplasia and anal cancer are closely related to infection from high-risk Human Papilloma Virus (HPV) genotypes. Since HPVs involved in disease progression are reported to vary by geographical regions, this study focuses on HPV genotypes spectrum in 289 males attending a Sexual Transmitted Diseases (STD) unit according to their nationality. Anal cytology, Digene Hybrid Capture Assay (HC2) and HPV genotyping were evaluated in 226 Italian (IT) and 63 foreign born (FB) subjects, recruited between January 2003 and December 2006. FB people were younger (median 32y-IQR 27–35 vs 36y-IQR 31–43, respectively; Mann–Whitney test p < 0.0001) and had a higher rate of abnormal results (≥atypical squamous cells of undetermined significance (ASCUS)) on anal cytology (95.0% vs 84.04%) ( p = 0.032; OR 3.61; 95% CI 1.04–1.23). HPV-16 is by far the most common genotype found in anal cytological samples independently from nationality while differences in distribution of other HPV genotypes were observed. The probability of infection from high-risk HPVs was higher in FB (OR 1.69; 95% CI 1.07–2.68) and is due to a higher rate of HPV-58 (OR 4.98; 95% CI 2.06–12.04), to a lower rate of HPV-11 (OR 0.35; 95% CI 0.16–0.77), to the presence of other high-risk genotypes (HPV-45, HPV-66, HPV-69). Multiple infections rate was high and comparable between IT and FB people. The relative contribution of each HPV genotype in the development of pre-neoplastic disease to an early age in the FB group cannot be argued by this study and more extensive epidemiological evaluations are needed to define the influence of each genotype and the association with the most prevalent high-risk HPVs on cytological intraepithelial lesions development.

Immigration and the Foreign Born

Immigration and the Foreign Born