Newcomer Health Research Articles

P-51. Influenza Vaccine Effectiveness in Ambulatory Care Settings among Pregnant Persons in the 2023-2024 Influenza Season

Abstract Background Despite increased risk of influenza-associated complications in pregnant people, influenza vaccination coverage has decreased in recent seasons as vaccine confidence has declined. The purpose of this study was to evaluate influenza vaccine effectiveness (VE) against influenza-associated ambulatory encounters among pregnant persons during the 2023-2024 season, and to compare VE in pregnant versus non-pregnant persons. Methods During October 15, 2023 – April 10, 2024, a test-negative, case-control analysis was conducted among pregnant and non-pregnant persons aged 18-49 years with documented female sex. Persons with acute respiratory illness (ARI)-associated emergency department or urgent care visits and who underwent molecular assay testing for influenza at six health systems in the VISION Network were included. VE was estimated using logistic regression comparing the odds of influenza vaccination (≥14 days before the encounter) in influenza positive cases vs influenza negative controls, adjusting for site, age, race/ethnicity, calendar time, and gestational age at encounter (where applicable). Results Among 2,439 ARI encounters in pregnant people, 773 (32%) tested positive and 1,666 (68%) tested negative for influenza; 205 (27%) cases vs 608 (36%) controls were vaccinated. Median gestational age at encounter was 20 weeks (IQR: 11-29). Among 40,374 ARI encounters in non-pregnant people, 10,599 (26%) tested positive and 29,775 (74%) tested negative for influenza; 1,727 (16%) cases vs 8,117 (27%) controls were vaccinated. VE was 46% (95% CI: 33-56) in pregnant people and 53% (95% CI: 50-56) in non-pregnant persons. Conclusion Influenza vaccination during the 2023-2024 season was effective against influenza-associated ambulatory encounters in pregnant people. VE was similar in pregnant and non-pregnant persons of reproductive age. Vaccination was effective in reducing influenza-associated ambulatory encounters by approximately 50%, yet less than half of the population included in this analysis received the current influenza vaccine. Demonstrating that vaccines are effective can help increase vaccine confidence and may lead to increased uptake. Disclosures Sara Y. Tartof, PhD MPH, GSK: Grant/Research Support|Pfizer Inc: Grant/Research Support Lina S. Sy, MPH, Dynavax: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Moderna: Grant/Research Support Nicola P. Klein, MD, PhD, CSL Seqirus: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Merck: Grant/Research Support|Pfizer: Grant/Research Support|Sanofi Pasteur: Grant/Research Support Toan Ong, PhD, Patent Title: Systems and Methods For Record Linkage: PCT/US2018/047961 Patent Title: Systems and Methods For Record Linkage|PCORI: Travel support to attend the PCORI Annual meeting in Washington DC, 2023|Regenstrief Institute: Advisor/Consultant|Regenstrief Institute: Travel support to attend the OHIE 23 meeting in Malawi. Michelle Barron, MD, Innoviva Specialty Therapeutics: Speaker bureau participant Malini DaSilva, MD, MPH, CDC, Vaccine Safety Datalink, Center for Excellence in Newcomer Health: Grant/Research Support Gabriela Vazquez-Benitez, PhD, MSc, Abbvie: Grant/Research Support|Sanofi Pasteur: Grant/Research Support

COVID-19 vaccine uptake among non-US-born populations in the United States, 2020–2022

In the United States (US), COVID-19 vaccination rates among non-US-born individuals (i.e., refugees, immigrants, and migrants [RIM]) are variable. Understanding baseline COVID-19 vaccine coverage among these populations and determining if disparities exist is essential for quality improvement initiatives and public health interventions. Baseline COVID-19 vaccination rates for both primary series and booster doses were calculated at four health systems located in Minnesota, Colorado, and Pennsylvania participating in the Minnesota Department of Health's Center of Excellence in Newcomer Health. Patients aged ≥5years as of 1/1/22, seen for ≥1 primary care visit during 7/1/2019-6/30/22 were included. Descriptive statistics were calculated for three measures of COVID-19 vaccine coverage during 12/14/2020-6/30/2022: 1) initiation of primary series; 2) completion of primary series; 3) completion of first booster. We calculated vaccine coverage rates for the entire population and stratified by subgroup including country of origin, refugee status, and primary language preference. We included 1,624,573 patients eligible for COVID-19 primary series vaccine and 907,749 eligible for COVID-19 booster vaccination. The percent of eligible patients who completed a COVID-19 primary series (63.4%) and booster dose (66.2%) were similar. Completion of the primary series was higher for non-US-born persons (72.7%) compared with US born persons (65.4%), similar among refugees (63.5%) and non-refugees (63.4%), and lower in patients with language preference other than English (62.7%) compared with English preferring patients (63.6%). Booster completion was lower for non-US-born persons (61.8%), refugees (46.7%), and patients with language preference other than English (55.3%) compared with US-born (70%), non-refugees (66.3%), and English preferring patients (67.3%) respectively. This evaluation identified disparities in COVID-19 vaccination rates among non-US-born persons and persons with a language preference other than English living in the US. Targeted outreach efforts may be beneficial in reaching these populations.

A multilingual sexual and reproductive health animation: a novel educational tool for newcomer patients.

Newcomer populations face many barriers accessing healthcare, including language barriers. Language-concordant care has been shown to enhance equity and optimize health outcomes for underserved populations. This paper describes a sexual and reproductive health (SRH) animation for newcomer populations. The animation was created collaboratively by the Department of Obstetrics and Gynaecology Global Health Unit, the Halifax Newcomer Health Clinic, and student volunteers. Integrating this animation into other healthcare settings may help improve inclusion, trust, and patient-centred care for newcomer patients. Institutions may also consider creating further SRH animations based on the needs of the patients they serve.

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

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

Adult newcomers’ perceptions of access to care and differences in health systems after relocation from Syria

BackgroundIn Canada, approximately 13% of the population lives with multiple chronic conditions. Newcomers, including refugees, have the same or higher risk of developing chronic diseases as their host population. In 2015–2016, Canada welcomed almost 40, 000 newcomers from Syria. This study aimed to (1) understand adult newcomer health needs for self-management of non-infectious chronic conditions; and (2) identify strategies to improve access to health care services to meet these needs.MethodsThis study used a qualitative descriptive design. Interviews and focus groups were conducted with consenting newcomers, service providers and community agency administrators. Interview guides were developed with input from community partners and snowball sampling was used.ResultsParticipants included 22 Syrian newcomers and 8 service providers/administrators. Findings revealed the initial year of arrival as one of multiple adjustments, often rendering chronic disease management to a lower priority. Self-care and self-management were not routinely incorporated into newcomer lives though community health agencies were proactive in creating opportunities to learn self-management practices. Gaps in access to care were prevalent, including mental health services which typically were not well developed for trauma and post-traumatic stress disorder (PTSD), particularly for men. Newcomers expressed frustration with lengthy wait times and not being able to access specialists directly. Youth frequently played a key role in translation and disseminating information about services to their families.ConclusionChronic disease management was a low priority for newcomers who were focussed on resettlement issues such as learning English or finding work. Provision of practical supports such as bus tickets, translation, and information about the healthcare system were identified as means of improving access to care.

Adjusting the Canadian Healthcare System to Meet Newcomer Needs.

Newcomers’ ability to access healthcare can be impacted by cultural, religious, linguistic, and health status differences. A variety of options are available to support the development of healthcare systems to equitably accommodate newcomers, including the use of basic English and other languages in public health information, engagement with immigrant communities to advise on program development, offering culturally competent health services, interpretation services, and through creating space to collaborate with traditional practitioners. This study employed in-depth interviews with newcomer families from the Healthy Immigrant Children Study that had been living in Regina or Saskatoon, Saskatchewan, Canada, for less than 5 years, as well as with healthcare providers and immigrant service providers to understand how to improve healthcare services. Analysis of participant quotes related to accessible healthcare services revealed five main themes: (1) responsive, accessible services, (2) increasing cultural competence, (3) targeted newcomer health services, (4) increasing awareness of health services, and (5) newcomer engagement in planning and partnerships. An accessible healthcare system should include primary healthcare sites developed in partnership with newcomer service organizations that offer comprehensive care in a conveniently accessible and culturally responsive manner, with embedded interpretation services. The Saskatchewan healthcare system needs to reflect on its capacity to meet newcomer healthcare needs and strategically respond to the healthcare needs of an increasingly diverse population.

Drug-dispensing limits within Medicaid during the COVID-19 pandemic.

SUMMARY The 1-month drug-dispensing limit is a common drug utilization tool used by state Medicaid agencies to control spending. Since the beginning of the COVID-19 pandemic, many states relaxed the 1-month dispensing limit restriction in order to align with social distancing recommendations. Yet, some states have not relaxed this limit and have differed substantially regarding the policies that have been implemented. Among states that relaxed the 1-month supply limit, determining which chronic disease drugs qualified for this extension can be challenging for patients and clinicians. As more commercial and Medicare insurance beneficiaries are offered 90-day drug supplies, the 30-day drug supply limit with Medicaid has become a health equity issue, since many individuals insured by Medicaid have already experienced a disproportionate impact from and remain at high risk for severe COVID-19 disease. Thus, we propose policy solutions to ensure that Medicaid beneficiaries have safe and uninterrupted access to chronic disease medications during and beyond the COVID-19 pandemic. DISCLOSURES: No funding was received for this work. Alpern has received funding from Arnold Ventures for research related to the use and spending of off-patent drugs, unrelated to this work, and is a member of the Pharmacy and Therapeutics Committee at Regions Hospital, St. Paul, MN. DeSilva has received CDC support for work on Vaccine Safety Datalink, VISION network, and Center of Excellence for Newcomer Health, unrelated to this work. Chomilo is Medicaid Medical Director for the State of Minnesota's Department of Human Services.

Health and service use of newcomers and other adults with intellectual and developmental disabilities: A population-based study.

This study examines newcomers with intellectual and developmental disabilities compared to other adults with intellectual and developmental disabilities in Ontario, Canada. This population-based retrospective cohort study used linked health and social services administrative data to identify adults with intellectual and developmental disabilities as newcomers, or non-newcomers, and compared their health status and health service outcomes. Among those with intellectual and developmental disabilities, compared to non-newcomers, newcomers generally had lower or similar rates of health issues, except for higher rates of psychosis. Newcomers also had slightly greater use of community-based health services, but less hospital use. Trends among those with the intellectual and developmental disabilities were consistent with general population trends; newcomers had lower rates of many health issues and lower hospital use. It also underscores the value of understanding drivers of heterogeneity within newcomers, such as the circumstances of admission and settlement in their new country.

Community Health and Wellness Fair: A strategy for Assessment of Social Determinants of Health, Inclusion and Engagement of Newcomers.

Community health fair has been used informally as a way of offering health promotion, education, and screening services onsite to underserved and hard to reach populations such as the newcomers. To utilize an annual health fair for the assessment of the overall perception of health status of newcomers in relation to the determinants of health; and to evaluate its effectiveness as an intervention to engage attendees in their community. The 3rd Annual refugees and immigrant's health and wellness resources fair in Allegheny County. A cross sectional study was designed using questionnaires focused on the health and social determinants of health, with few open-ended questions related to engagement and networking. A total of 107 individuals participated in the study. The age ranged between 18-75years, 46.9% males and 53% females. The largest representations from Bhutan, Arab Middle Eastern countries, and Ghana. Perception of health was examined in relation to other determinants such as language, regular checkups, employment, income, education, access to health, and psychosocial needs. Results revealed that health perception varied by ethnicity, was influenced by English proficiency, access to health, employment, and regular checkups, while education, and income did not show an impact. A qualitative analysis to the narrative responses revealed that the health fair was very effective in breaking the structural barriers with providers as well as for community engagement. The annual health fair was a successful strategy in the assessment of the health determinants and for community engagement of the newcomers.

The history of refugee and newcomer health care in Canada

Canada represents a global leader in refugee resettlement, having embraced an identity of multiculturalism that promotes the acceptance of newcomers. A crucial factor in facilitating post-arrival integration of newcomers into Canadian society is the maintenance of good health through the provision of adequate health care services. Throughout the past century, there has been an increase in the number of refugees in Canada, beginning largely in the post-World War period and extending into the second half of the twentieth century. This influx has required the development of health care systems and coverage specific to unique post-arrival medical needs of refugees. The history of refugee health care has been shaped by both policy and advocacy on behalf of refugees, resulting in a larger breadth of coverage today than ever before. This article summarizes the evolution of health care services provided to refugees, challenges that particular populations of refugees have faced in accessing care, and suggestions for continued improvements in refugee access to health care services.

A resident-led clinic that promotes the health of refugee women through advocacy and partnership

Implication StatementLongitudinal global health experiences promote cultural competency and a commitment to caring for underserved populations beyond residency. This paper describes a longitudinal, co-curricular local global health experience. Obstetrics and gynaecology residents have partnered with the Family Medicine-led Halifax Newcomer Health Clinic to provide education and clinical well woman care to refugee women. This resident-led initiative meets the care needs of an underserved population while promoting resident engagement in health advocacy.

The Newcomer Health Clinic in Nova Scotia: A Beacon Clinic to Support the Health Needs of the Refugee Population.

Refugees tend to have greater vulnerability compared to the general population reporting greater need for physical, emotional, or dental problems compared to the general population. Despite the importance of creating strong primary care supports for these patients, it has been demonstrated that there is a significant gap in accessing primary care providers who are willing to accept the refugee population. These have resulted in bottlenecks in the transition or bridge clinics and have left patients orphaned without a primary care provider. This in turn results in higher use of emergency service and other unnecessary costs to the healthcare system. Currently there are few studies that have explored these challenges from primary care provider perspectives and very few to none from patient perspectives. A novel collaborative implementation initiative in primary healthcare (PHC) is seeking to improve primary medical care for the refugee population by creating a globally recommended transition or beacon clinic to support care needs of new arrivals and transitions to primary care providers. We discuss the innovative elements of the clinic model in this paper.

Germless Borders: A Review of “The Health of Newcomers: Immigration, Health Policy, and the Case for Global Solidarity”

Germless Borders: A Review of “The Health of Newcomers: Immigration, Health Policy, and the Case for Global Solidarity”

Culture, Identity, and Walkability: Determining Patterns of Walking Behavior in a High-risk Population ( breakout presentation )

Background Walkability, viewed from a population health intervention perspective, holds enormous promise with research showing that the more walkable a neighbourhood, the healthier its residents. How to harness this across diverse populations and identified harder-to-reach groups is a difficult question from both a social justice and equity perspective. Newcomers to Canada face a special set of barriers to leading physically active lifestyles: despite the known benefits of physical activity, studies show that the physical health of many newcomers declines significantly following their transition into the host country. While there is speculation in the research as to why this is the case – acculturation or loss of protective cultural barriers – there is a dearth of research exploring the everyday links between culture, motivation and utilitarian physical activity? Rundle, in Calgary’s north-east is a community with a significant newcomer presence and a low–mid walkability score, and the site for our research. Aim Our project explores the motivation and barriers to ‘walking for health’ and ‘transportation walking’ among first- and second-generation South Asian Canadians living in Rundle, Calgary. It highlights the interrelationships and interactions that play out between culture, identity, and walkability in determining patterns of walking behavior in a high-risk population. Method Up to 15 participants are involved in this qualitative study. Using “engagement ethnography” this project focuses on day-to-day cultural practices and habits and their impact on the experience of walkability in the SA population in Rundle. ‘Cultural probes’ (cameras, maps, diaries etc.), participant observation, and semi-structured interviews elicit insights from participants on the factors that encourage or discourage the active incorporation of walking in their daily lives. Results/Conclusions This project offers a new kind of access to an often 'hard-to-reach' community. Findings offer insights concerning actual/potential disconnects between big picture data and experiences of certain end-users.

Metal Concentrations in Newcomer Women and Environmental Exposures: A Scoping Review.

Newcomer women from developing countries are recognized to be at risk for elevated exposures to environmental contaminants and associated negative health effects. As such, data on exposure sources and contaminant body burden concentrations is critical in the development of effective public health policies and interventions in support of newcomer health. We conducted a scoping review to gather evidence on important toxic metals of health concern, lead (Pb), mercury (Hg) and cadmium (Cd), and their concentrations and potential exposure sources among newcomer women. An initial 420 articles were identified through the databases MEDLINE, EMBASE and Scopus, many reporting by ethnicity rather than newcomer/immigrant status. Several articles reported metal concentrations for other biomarkers but did not include blood, nor stratify results. From the remainder, we selected a total of 10 articles for full textual review, which reported blood Pb, Hg or Cd levels for newcomer women and/or stratified blood metal results according to foreign birth or country of origin. Three of the articles reported higher Pb, Hg and Cd concentrations in newcomer women compared to their native-borne counterparts. Exposures identified as contributing to elevated Pb, Hg and Cd blood concentrations included: pica behaviour, the use of lead-glazed cookware or eye cosmetics, and fish/shellfish consumption. The review revealed a limited availability of data on metal body burden concentrations, exposure sources and routes among newcomer women specifically. More research is needed to better understand the extent to which newcomer women are disproportionately at risk of elevated metal exposures due to either country of origin or current exposures and to inform relevant, multi-national risk management strategies.

115: Don & Elizabeth Hillman International Child Health Grant Awardees: Where are they Now?

In 2003, the Don & Elizabeth Hillman International Child Health Grant was created by the Canadian Pediatric Society (CPS) Global Child & Youth Health Section to promote international health opportunities for residents and fellows. Forty awards were administered ($750 – $1000) from 2003 to 2013, for use towards costs of paediatrics elective in low-middle income countries (LMIC). It is one of the few funding opportunities of its kind available to Canadian paediatric trainees. It is timely to evaluate the impact of providing supportive funds for such experiences and their effects on recipient career paths. This evaluation aimed to describe interest, enablers, and perceived barriers of career activities in global health amongst those who completed a funded international elective during residency, and to examine how these experiences may influence the time dedicated to global health activities including local patient populations. Past Hillman Grant recipients were contacted by email to complete an online survey, which was designed from review of relevant literature, to assess interest, perceived enablers and barriers in global health experiences and career paths. Data were collected and managed using REDCap electronic data capture tools hosted at University of British Columbia. Nineteen out of 40 grant awardees completed the online survey; five are still in residency or fellowship. While for 8/19, receiving the grant influenced their decision to go, the remainder would have done an international residency elective (IRE) regardless but qualitative review indicates that it assisted in lifting ‘burden of cost’ and was appreciated, but not sole influential factor in participating. Nearly half (47%) have pursued further training related to global health (GH), while another 36% are planning to do so in the future. The majority (79%) endorsed that participation in an IRE encouraged future global health involvement, while all respondents felt the experience influenced their attitudes towards health care. Ten (of 14 total) pediatrician respondents indicated that they currently spend time in GH activities (both locally and abroad); respondents are involved with caring for families receiving social assistance (14/19), newcomer health (11/19), First Nations/Inuit/Metis health (10/19), GH education within Canada (14/19), and health education outside Canada (10/19). Enablers to participation in GH activities include: family support (11/19), departmental support (10/19), international electives (9/19) and mentorship (8/19). Most significant barriers to participation in GH activities were: scheduling (16/19) with 68% of these indicating need to use vacation time, financial (15/19), and family obligations (10/19). Recipients of the Hillman grants generally are involved with the care of vulnerable children within and outside Canada, and for many, their international elective experience influenced those career directions.

Bringing global health home

Dr Bhayana is a family physician in London who also works with the London InterCommunity Health Center (LIHC) and the Newcomer Health Project, a Schulich initiative. She graduated from the Schulich School of Medicine and Dentistry in 1985, after which she worked in Toronto for 5 years. She is fluent in English, Hindi and Punjabi, and utilizes all 3 in her community work with recent immigrants and refugees. We met with Dr Bhayana over the phone to hear her thoughts on global health, to understand her involvement with multicultural initiatives and to gather advice for medical students interested in global health.

Navigating Uncharted Waters

Although the stress and socialization literatures have flourished over the past several decades, they have done so largely independently, and our understanding of the cost of stress to organizations in the form of newcomer turnover, lowered adjustment, and the health and well-being of newcomers is largely unknown. This review takes an explicitly newcomer-centric perspective toward the socialization process by examining newcomer experiences through the lens of popular models of work stress, including the job demands-resources model, the transactional theory of stress, and the challenge-hindrance stressor framework. In doing so, we identify individual and work-related factors that contribute to the experience of stress for newcomers and point to ways in which organizational and employee-driven inputs can assist in building and acquiring important resources needed to cope with the demands faced in a new work role. In addition, we offer a framework that incorporates individual experiences and behaviors as they relate to newcomer stress in the context of socialization. This framework delineates the newcomer stress appraisal process and describes the impact these appraisals have on the experience of stress or engagement for new employees as well as the behaviors that can be expected in reaction to those states. Through this process, our review highlights natural points for integration between stress and socialization research and identifies potential areas for future investigation that leverage understanding of work stress to expand socialization theory and practice.

The Dark Side of Socialization: A Longitudinal Investigation of Newcomer Alcohol Use

Organizational veterans and external stakeholders such as clients often play an important and informal role in newcomer socialization, influencing newcomer cognition and behavior and providing learning opportunities and social support that facilitate employee adjustment and performance enhancement. However, from a sensemaking perspective, newcomers may also draw insight from stakeholder behavior in order to better understand how to best meet job-related objectives and expectations. These understandings may manifest as performance-related motives, leading to the adoption of risky behaviors that can be detrimental to newcomer health and organizational effectiveness. Using multisource, multilevel, and longitudinal data, we demonstrate that the alcohol use norms of both organizational veterans and clients are significantly associated with the performance drinking motives of newcomers in sales and client service teams, suggesting that veteran and client norms signal to newcomers that drinking alcohol is an effective and legitimate means to improve job performance. In addition, we demonstrate that performance drinking motives mediate the positive relationship between veteran and client alcohol use norms and newcomers' frequency of work-based heavy drinking. Finally, we find that the frequency of work-based heavy drinking is positively related to newcomer alcohol misuse and mediates the positive relationship between performance drinking motives and newcomer alcohol misuse.

The Dark Side of Socialization: A Longitudinal Investigation of Newcomer Alcohol Use

The informal socialization process plays an important role in shaping newcomer cognition and behavior, providing learning opportunities and social support which facilitate employee adjustment and performance enhancement. However, such social influences may also lead to the adoption of risky behaviors that can be detrimental to newcomer health and organizational effectiveness. Using a sample of sales and client-service employees, we demonstrate that the alcohol use norms of both organizational veterans and clients are significantly associated with the frequency of work-based heavy drinking among newcomers of sales and client service teams. We also demonstrate that these positive relationships are mediated by newcomers’ performance-enhancing drinking motives, suggesting that veteran and client behavior signals to newcomers that drinking is an important means by which to improve job performance. Finally, we find that the frequency of work-based heavy drinking is positively related to newcomer alcohol misuse....