Haitian Immigrants Research Articles

Presentation, Treatment, and Outcomes of Haitian Women With Breast Cancer in Miami and Haiti: Disparities in Breast Cancer-A Retrospective Cohort Study.

PurposeWe compared a cohort of Haitian immigrants with residents in Haiti with breast cancer (BC) to evaluate the effects of location on presentation, treatment, and outcomes.Patients and MethodsParticipants were Haitian women with BC living in Miami who presented to the University of Miami/Jackson Memorial Hospital and women with BC living in Haiti who presented to the Innovating Health International Women’s Cancer Center. The primary outcome was the relationship between location, cancer characteristics, and survival. The secondary objective was to compare our results with data extracted from the SEER database. Cox regression was used to compare survival.ResultsOne hundred two patients from University of Miami/Jackson Memorial Hospital and 94 patients from Innovating Health International were included. The patients in Haiti, compared with the patients in Miami, were younger (mean age, 50.2 v 53.7 years, respectively; P = .042), presented after a longer duration of symptoms (median, 20 v 3 months, respectively; P < .001), had more advanced stage (44.7% v 25.5% with stage III and 27.6% v 18.6% with stage IV BC, respectively), and had more estrogen receptor (ER) –negative tumors (44.9% v 26.5%, respectively; P = .024). The percentage of women who died was 31.9% in Haiti died compared with 17.6% in Miami. Median survival time was 53.7 months for women in Haiti and was not reached in Miami. The risk of death was higher for women in Haiti versus women in Miami (adjusted hazard ratio, 3.09; P = .0024).ConclusionWomen with BC in Haiti experience a significantly worse outcome than immigrants in Miami, which seems to be related to a more advanced stage and younger age at diagnosis, more ER-negative tumors, and lack of timely effective treatments. The differences in age and ER status are not a result of access to care and are unexplained.

Aspects phonologiques du créole de Bombita

The Creole of Bombita (CB) is a ‘mixed talk’ that borrows some features from Haitian Creole (HC) and from Dominican Spanish (DS). It is formed from HC but it has some specificities that it doesn’t share with it. It comprises also some features of DS but it functions in a different way in CB. This is why it can be considered as a different way of speaking from HC and DS. In this article, we are interested in studying some phonological specificities of the CB where we came to the fact that its phonological system is almost similar to the one of HC and very close to DS with some differences. We analyze some phenomena such as some ˝diaphonic˝ variants which appears in the substitution of [b] to /v/, [l] to /r/, [w] to /r/. That means the phonemes /v/ and /r/ are realized in some specific contexts which we will put in an obvious place for [b] and for [l] or [w]; the velarization after a nasal vowel in coda; the syncope of the postvocalic consonant [s]. We conclude that the CB is the result of a continuous dialectalization of HC in contact with DS with regard to the new linguistic environment that HC is in familiar terms with since 1930 (date of arrival of the first Haitian immigrants in Bombita).

The Impact of Human and Social Capital on the Employment of Haitian Immigrant Women in the U.S. Labor Force: A Comparative Analysis

Despite the emerging focus on women’s migration and economic integration in the host countries, little is known about the participation of Haitian immigrant women in the U.S. labor force. This study examines the effects of nationality and mediating factors including human and social capital on the economic integration of Haitian women in the U.S. labor force. In order to better understand how Haitian women’s economic integration differs from other immigrants from the Caribbean, their personal income, wage income and hours worked were compared with three other groups of immigrant women: Dominicans, Cubans and Jamaicans. This study relies on secondary data from the American Community Survey (ACS, 2007). ACS is a statistical program that was developed to replace the long form of the decennial census in 2010. The data are nationally representative as they represent all 50 states including District of Columbia, Puerto-Rico and all metropolitan areas. The sample size used was (N=3908) for Haitian women, (N=5540) for Dominicans, (N= 5057) for Jamaicans and (N=8696) for Cubans. Findings indicated that the mean differences of Haitian women when compared to Cubans (-3.493), Dominicans (-1.248) and Jamaicans (-.544) were all negative. This implied that the other groups of women had better employment status than Haitian women. Moreover, since the difference was highest with the Cubans, it can also be drawn that Cubans have the best employment status among the groups.

Abstract C55: Presentation, treatment, and outcomes of Haitian women with breast cancer in Miami and Haiti: Disparities in breast cancer. A retrospective cohort study

Abstract Breast cancer diagnosis and death has risen in low to middle income countries (LMIC) in the past 20 years. Early detection, diagnosis and treatment in the LMIC setting are thought to impact morbidity and survivorship. The population of South Florida is composed of a significant portion of Afro-Caribbean immigrants from LMICs. We compared a cohort of recent Haitian immigrants with residents in Haiti who had a diagnosis of breast cancer to evaluate the effects of geographical location on presentation, treatment and outcomes. Methods: Retrospective cohort study. Participants were Haitian females with breast cancer that were living in Miami and presented to the University of Miami/Jackson Memorial Hospital (UM/JMH) between 2008 and 2014 and patients living in Haiti and presented to the Breast Cancer Treatment program at the Hospital Bernard Mevs Project Medishare (HBMPM) from 2013 to 2015 with a new diagnosis or who had been diagnosed as far back as 2008 and were presenting for continuation of care. The main outcome was the relationship between cohort location and breast cancer characteristics and cancer–specific survival by log-rank. Cox proportional hazards regression was used to compare breast cancer–specific survival overall and analyzed by stage and other significant explanatory factors. Results: 102 patients from UM/JMH and 94 patients from HBMPM were included in the analysis. The cohort in Haiti presented after longer median duration of symptoms (20 vs 3 months, p&amp;lt;0.001) and more advanced stage (31% Vs 20% with locally advance and 27% vs 19% with metastatic disease). The median age of diagnosis was 55 years in Miami compared to 50 years in Haiti (p=0.03). In Miami all patients had estrogen receptor (ER) and her-2 status ascertained at diagnosis, whereas only 52% and 27% of the Haitian cohort had them. Tumor characteristics in Miami vs Haiti in patients with reported status: ER + 74% (n=102) vs 55% (n=49), p=0.02, her-2+ 20% (n=102) vs 28% (n=25), p=0.36, triple negative 27% (n=102) vs 28% (n=25),p=0.49. Treatment modalities and censoring was available for all the patients in Miami and 72 patients in Haiti. In Haiti, radiation therapy was not widely available compared to Miami. Once patients had known ER and her-2 status, there was no difference in treatment with hormonal therapy (p=0.97) but none of the patients in Haiti received her-2 directed therapy (p&amp;lt;0.001). 50% of the patients with unknown ER status in Haiti received Tamoxifen. Twice as many Haitian women died after a median follow-up of 23 months (12% vs 24%), with median survival of 53 months for Haitians in Haiti (not reached for Miami cohort). Breast cancer specific survival was significantly different in the two cohorts (p&amp;lt;0.000). After exploratory analysis, the risk of death was higher for Haitians in Haiti than Haitians in Miami [HR 3.13 (CI 1.50-6.51)] and was higher for more advanced disease [HR 2.58 (CI 1.67-3.99)]. No other variable or interaction reached statistical significance in our model. Conclusion: Haitian women diagnosed with breast cancer in Haiti experience a significantly worse outcome than Haitians living in Miami that appears to be related to a more advanced stage, younger age, more ER negative tumors and lack of timely effective treatments including restricted access to trastuzumab and radiation. In addition there is a difference in the age of breast cancer onset (Caucasian 62, African American 58, Haitian American 55, Haitian 50) and ER positivity (Caucasian 70%, African American 48%, Haitian American 74%, Haitian 55%) depending on race and ethnic group that raises the question of whether there are disparities within subgroups of women of African origin who have breast cancer. Confounding epigenetic-related variables may impact survival and they need further exploration in these populations. Citation Format: Alexandra Gomez, Vincent DeGennaro, Jr., Sophia George, Estefania Santamaria, Gustavo Westin, Gabriel Dieudina, Judith Hurley. Presentation, treatment, and outcomes of Haitian women with breast cancer in Miami and Haiti: Disparities in breast cancer. A retrospective cohort study. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C55.

Global Mental Health: Anthropological Perspectives

Global Mental Health: Anthropological Perspectives

A Pilot Study to Examine the Disparities in Water Quality between Predominantly Haitian Neighborhoods and Dominican Neighborhoods in Two Cities in the Dominican Republic.

Worldwide, diarrheal disease is a leading cause of death affecting over 1.7 million individuals annually. Much of this can be attributed to lack of clean water, sanitation and hygiene. Nearly all of these deaths occur in countries with developing economies. This public health problem is apparent in the island of Hispaniola; the island that is shared by Haiti and the Dominican Republic. Significant gaps in income between the countries have resulted in Haitians migrating into the Dominican Republic. While there has been increased migration into the Dominican Republic, many of the neighborhoods remain segregated. A cross-sectional analysis was conducted at 49 sites in the Dominican Republic. Samples were classified as being from a Haitian neighborhood or Dominican neighborhood and analyzed for microbial contamination. Overall, Haitian neighborhoods were found to have statistically significantly higher levels of contamination of both coliform and E. coli. The odds of having E. coli contaminated water in Haitian neighborhoods are 4.25 times as high as Dominican neighborhoods. The odds of having coliform contaminated water in Haitian neighborhoods are 4.78 times as high as Dominican neighborhoods. This study provides evidence of the disparity in access to clean drinking water for Haitian immigrants and highlights the need for further investigation.

Entre a "fuga" e a "invasão": alteridade e cidadania da imigração haitiana na mídia brasileira

The article analyzes the treatment given to migration of Haitians by the Brazilian media in the first four years of significant presence of the Haitian diaspora in Brazil (2011- 2014). Seeks to understand how are established, in the media, sense of disputes over otherness represented by the presence of these new immigrants, and the impact of media visibility of Haitian immigrants in the public debate on migration policies and processes of citizenship of international migration in Brazil. Using the concept of framing, it was analyzed a corpus of 162 media materials, events and themes mapped in media production about Haitian immigration. It was found the change of framing in the media coverage of this immigration – initially described as “escape” of Haiti and later as “invasion” to Brazil - and the emergence of a debate that rise questions on Brazilian immigration policy and Haitian citizenship processes in Brazil.

Promoting Colorectal Cancer Screening Among Haitian Americans

Few studies have examined colorectal cancer screening among Haitian Americans, although striking disparities in colorectal cancer screening and mortality are well-documented among U.S. Blacks. Race, socioeconomic status, and place of birth are factors associated with colorectal cancer incidence and mortality patterns. In this article, we summarize published studies on colorectal cancer screening among Haitian Americans, identified through bibliographic searches in PubMed and CINAHL through August 2015, and offer recommendations for further research. Only one qualitative study and three quantitative surveys have examined colorectal cancer screening among Haitian Americans. A qualitative study found important differences in perceptions of the curability of colorectal cancer, preventive practices, and preferred sources of information among Haitian Americans and other ethnic subgroups of U.S. Blacks. Awareness of colorectal cancer screening tests, risk perception, healthcare provider recommendation, and self-reported use of screening are suboptimal among Haitian Americans and other subgroups. In preliminary quantitative studies, Haitian immigrants have been found to have lower colorectal cancer screening rates than other groups such as African Americans. Culturally appropriate educational interventions are needed to encourage Haitian American adults aged ≥ 50 years to undergo screening for colorectal cancer and to ensure that they are well informed about the value of healthy eating and physical activity.

Why Hard to Reach Populations are Hard to Reach: Lessons Learned from Accelerometer Data Collection among New Immigrants

The likelihood for becoming overweight and obese increases with length of stay in the US for new immigrants; therefore, it is critical to understand modifiable lifestyle behaviors in order to reduce their risk of this chronic disease. Physical activity patterns of immigrant children are unknown and collection of this information is difficult. This Field Action Report describes the experiences of using accelerometers to collect physical activity data in Brazilian, Haitian and Latino immigrants living in the Greater Boston, MA area, who are enrolled in Live Well, a research study aiming to prevent unhealthy weight gain in these populations. We found that immigrant populations pose unique challenges to data collection, and actively addressing these barriers can improve data quality.

TRABALHADORES MIGRANTES NO NORTE DO RIO GRANDE DO SUL (BRASIL): INTEGRAÇÃO E (DES)RESPEITO AOS DIREITOS DA PERSONALIDADE

This paper deals with the integration of Haitian immigrants along the Brazilian society - specifically the northern region of Rio Grande do Sul - in view of their relationships with the material dimensions and concepts of labor guidelines. In this sense, we intend to demonstrate the factors that boosted the displacement of these immigrants and the process of adaptation in southern Brazil, as well as the extent to which immigration policies threaten the guarantee of human rights of individuals from countries with dependence on historical and intransigence on Civil and Social Fundamental Rights in their country of origin. This condition supports the analysis of the integration policies and denial of Human Rights. Over the last twenty years, Brazil has adopted a number of new policies for the management of trans- boundary movements and immigrants in Brazil, these policies that respond not only to the activism of migrants and their allies, but also to the Brazilian foreign policy strategy. As methodological procedure, this work utilizes the literature, alongside with of the description and interpretation of the reality of the subjects in understanding the theme discussed having used the technique of focal group. To represent the data from a closer perspective of the subject, were used some fragments of interviews and discourse analysis.

An Exploratory Study of Acculturation and Reproductive Health Among Haitian and Haitian-American Women in Little Haiti, South Florida

There is unmet contraceptive need among Haitian immigrants and Haitian-American women (Haitian women). The study explored associations of three measures of acculturation with contraceptive/reproductive health history among Haitian women residing in the Little Haiti community of Miami. This was a cross-sectional, exploratory study among 57 Haitian women. We conducted descriptive univariate analyses, then bivariate analyses to investigate the association of acculturation with reproductive health risk behavior including contraceptive use, tampon use, and parity, as well as interest in a female-initiated barrier contraceptive method. The most commonly ever-used contraceptive methods were male condoms (78.9%) and oral contraceptives (OC 19.3%). Women who primarily spoke Créole at home were less likely than those who did not to use OC (11.9 vs. 42.9%, p=.01). Among women who resided in the U.S. ≥10years, tampon use was 51.9% compared to 16.7% among those who were in the U.S. for less time (p=.005). Among U.S. born women, 60% were tampon users compared to 22.7% among those born in Haiti (p=.05). Women not speaking primarily Créole at home (p=.06) and those born in U.S. (p=.008) had fewer children. Contraceptive use was low among Haitian women but influenced by acculturation, where greater acculturation was associated with protective reproductive health behavior. Despite traditional norms discouraging contraceptive use, and little experience with female barriers, Haitian women indicated an interest in learning about and using a female-initiated barrier contraceptive. Increasing contraceptive uptake of potential multipurpose technologies is a potential point of intervention for decreasing HIV/STI transmission in this at-risk population.

Factors Associated with Human Papillomavirus Vaccine Acceptance Among Haitian and African-American parents of Adolescent Sons

The authors would like to thank Cecilia Marquez, Justine Lavoye, Elaine Shu and Hailey Tipton for their efforts with participant recruitment and data collection. To assess knowledge, attitudes, beliefs and practices related to HPV vaccination among African-Americans and Haitian immigrant parents, and to compare vaccination rates of their sons. We performed semi-structured interviews with parents of boys aged 11-17 who had not yet received the HPV vaccine. We used validated surveys of HPV knowledge, trust in physicians, and intention to vaccinate. We probed participants' thought processes about HPV vaccination, and examined parental attitudes, beliefs, and practices toward HPV vaccination using open-ended questions. We then reviewed medical records to determine whether sons were subsequently vaccinated. 25 African-American and 30 Haitian immigrant parents and legal guardians participated in the study. Haitian immigrants were more likely to be married and to practice a religion than African-Americans. Both groups had limited knowledge of HPV (32% of questions were answered correctly by Haitian immigrants vs. 31% by African-Americans). Sixty-four percent of African-Americans and 79% of Haitians intended to vaccinate their sons, however only 24% of African-American and 20% of Haitian sons received vaccination within 12 months of the interview. Open-ended questions revealed that most African-Americans felt that vaccination fell within the parental role, while some Haitian immigrants felt uncomfortable vaccinating against sexually transmitted infections because they felt children should not be having sex. Both groups wanted more information about HPV vaccines. Improving HPV vaccine rates in Haitian and African-American boys may require culturally competent approaches that address ethnic-specific barriers among their parents.

Health literacy, information seeking, and trust in information in Haitians.

To assess heath literacy, health information seeking, and trust in health-related information among Haitian immigrants seen in primary care. Health literacy was measured by the Brief Health Literacy Screen (BHLS); items on health information use were from the 2007 Health Information National Trends Survey. BHLS scores differed according to age, education, and survey language. Participants with lower levels of health literacy tended to be more likely to place "a lot" or "some" trust in family and friends and religious organizations and leaders as sources of information about health or medical topics. Constructing a culturally-tailored and appropriate intervention regarding health promotion requires understanding how the population accesses and conveys health information.

Realities of the promised land: Life for Haitian immigrants in Brazil is not always as they imagined – especially as some employers deny them rights

Realities of the promised land: Life for Haitian immigrants in Brazil is not always as they imagined – especially as some employers deny them rights

The Influences of Vodou on Medical Pluralism and Treatment-Seeking Behavior among Haitian Immigrants in the United States: Suggestions for Cultural Competency Programs

The Influences of Vodou on Medical Pluralism and Treatment-Seeking Behavior among Haitian Immigrants in the United States: Suggestions for Cultural Competency Programs

Abstract A45: HPV awareness prevents positive infections

Abstract Background: Haitian Immigrant women, the largest growing Black ethnic group in Miami, experience the highest rates of cervical cancer and account for one of the largest populations diagnosed with HIV/AIDS in South Florida. Objective: Using community-based participatory research methods, we examined HPV/cervical cancer knowledge and intervention preferences among HIV positive Haitian women. This data was used to develop and pilot test a culture-specific educational intervention among HIV positive and sexually active HIV negative Haitian women in Miami, Florida. The pilot study was conducted in two phases. Methods: Phase 1: Qualitative, August 2011: Three focus groups with 21 HIV-positive Haitian women living in Miami, Florida were completed in Haitian Kreyol, digitally recorded, and later interpreted and transcribed into English. The first focus group assessed HPV Knowledge; the second session explored HPV considerations specific to HIV positive women, and the third focus group discussed HPV Screening and intervention preferences. Phase 2: Quantitative, July 2012 – Nov 2012: Using feedback from the focus groups, a flip-chart with educational illustrations was developed. Five small group (3-10 participants) HPV/Cervical Cancer education sessions led by a community health worker were conducted with 25 sexually active Haitian women (8 HIV + and 13 HIV –). Surveys assessing HPV/Cervical Cancer knowledge, screening behaviors, and research participation were administered at baseline and 3 months post-study. Results: Three month follow up data was collected on 21 of the 25 women who participated in Phase 2 of the study. Participants' mean age was 52+8yrs, 71% lived in US &amp;gt; 5 years, and 71% were uninsured. At post study, the percent of women answering &amp;gt; 4/6 questions correct increased from 10% to 28% and the number of women who heard of HPV increased from 48% to 81%. All (100%) of participants were willing to participate in a research study. Conclusions: An intensive one time small group educational intervention was associated with small improvements in cervical cancer / HPV knowledge at 3 months. Our findings show strong support for increased clinical research targeting low SES Haitian women. Citation Format: Sonjia Kenya, Marie Fatil, Tulay Koru-Sengul, Erin Kobetz, Olveen Carrasquillo. HPV awareness prevents positive infections. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A45. doi:10.1158/1538-7755.DISP13-A45

Treating AIDS: politics of difference, paradox of prevention

There is an inherently powerful and complex paradox underlying HIV/AIDS prevention - between the focus on collective advocacy mobilised to combat global HIV/AIDS and the staggeringly disproportionate rates of HIV/AIDS in many places. In Treating AIDS , Thurka Sangaramoorthy examines the everyday practises of HIV/AIDS prevention in the United States from the perspective of AIDS experts and Haitian immigrants in South Florida. Although there is worldwide emphasis on the universality of HIV/AIDS as a social, political, economic and biomedical problem, developments in HIV/AIDS prevention are rooted in and focused exclusively on disparities in HIV/AIDS morbidity and mortality framed through the rubric of race, ethnicity and nationality. Everyone is at equal risk for contracting HIV/AIDS, Sangaramoorthy notes, but the ways in which people experience and manage that risk - and the disease itself - is highly dependent on race, ethnic identity, sexuality, gender, immigration status and other notions of difference. Sangaramoorthy documents in detail the work of AIDS prevention programmes and their effect on the health and well-being of Haitians, a transnational community long plagued by the stigma of being stereotyped in public discourse as disease carriers. By tracing the ways in which public knowledge of AIDS prevention science circulates from sites of surveillance and regulation, to various clinics and hospitals, to the social worlds embraced by this immigrant community, she ultimately demonstrates the ways in which AIDS prevention programmes help to reinforce categories of individual and collective difference and how they continue to sustain the persistent and pernicious idea of race and ethnicity as risk factors for the disease.

Definition and management of hypertension among Haitian immigrants: a qualitative study.

Hypertension is a major health concern among Haitian immigrants, one of the largest Caribbean immigrant groups in the United States. Yet, little is known about how Hatian immigrants define and manage hypertension. For this qualitative study, face-to-face semi-structured interviews were conducted with 31 Haitian immigrants in Miami Dade County, Florida. Results indicated that most Haitian immigrants used the Haitian Creole word tansyon to represent hypertension. Tansyon was considered as either a normal condition of the human body or a maladi (illness). Both traditional biomedical and alternative approaches were used to manage hypertension. The findings show that how Haitian immigrants defined hypertension shaped their beliefs about its occurrence and the resulting management strategies used. Those who believed tansyon was a normal body condition did not take any management measures. Awareness and understanding of Haitian immigrants' beliefs about and approaches to hypertension management can enhance culturally sensitive care and improve health outcomes.

Transnationalism and Hypertension Self-Management Among Haitian Immigrants.

Transnationalism--maintenance of transborder activities--has important implications for the health status of contemporary immigrants. Yet little is known about how such interconnectivity interacts with health. In this critical ethnography study, 31 Haitian immigrants discussed the influences of transnationalism on their hypertension management. Transcripts of the semistructured individual interviews were analyzed and coded with the assistance of the Atlas.ti 6 software. Two major themes emerged: social support and financial obligation, both framed within the obligation to send monetary remittances. A duality emerged where social support facilitated hypertension self-management but consequently represented a financial burden. The study evidenced that transnationalism, although positively influencing immigrants' psychosocial well-being can negatively affect their experience with disease management. Health providers are urged to account for this transnationalism-disease management interaction when caring for this immigrant group. Future studies are needed to explore this phenomenon among other immigrant populations.

Narrating Diaspora in Edwidge Danticat's Short-Story Cycle The Dew Breaker

A short-story cycle consisting of nine interconnected stories, Edwidge Danticat's The Dew Breaker (2004) uncovers and creatively maps a Haitian American world whose traumatic experiences remain lar...