Immigrant Density Research Articles

Neighbourhood immigrant density and COVID-19 infection and hospitalization among healthcare workers

Abstract Background Studies have shown inequalities in COVID-19 infection among healthcare workers (HCWs), with occupational exposure failing to fully explain the inequalities. Little is known about the role of other social determinants of health, such as neighborhood immigrant density. We examined if living in immigrant-dominated neighborhoods was associated with increased risk of COVID-19 infection and hospitalization among HCWs in Sweden, and if so, whether such exposure amplified the risk of COVID-19 among immigrant HCWs. Addressing this question would contribute to a better understanding of factors driving COVID-19 disparities among HCWs. Methods Data were from HCWs aged 20 to 62 years (N = 86187) resident in one of 14 Swedish municipalities (three of which are Sweden’s largest metropolitan cities) on 1 January 2020. Residential neighborhoods were categorised into Swedish-dominated, mixed, and immigrant-dominated. The study outcomes were the first occurrence of COVID-19 infection and hospitalization registered until 30 September 2022. Multilevel mixed-effects survival regression was used for the association analyses, with control for confounders (age, sex, income, comorbidities etc). Results After adjusting for confounders, living in immigrant-dominated neighborhoods was only associated with an increased risk of COVID-19 infection in the first pandemic wave (HR 1.17, 95%CI 1.07 - 1.29), but living in these areas was associated with an elevated risk of COVID-19 hospitalization throughout the entire period. Immigrant HCWs, regardless of where they lived, had around 2-fold higher risk of being hospitalised for COVID-19 than non-immigrant HCWs living in Swedish-dominated neighborhoods. Conclusions Neighborhood immigrant density was associated with COVID-19 hospitalization among HCWs in Sweden. However, immigrant HCWs had a high risk of the outcome regardless of where they lived. More research is needed to identify the root causes of the excess risk among immigrant HCWs. Key messages • HCWs living in immigrant-dominated neighborhoods had an elevated risk of COVID-19 hospitalization. • This study sheds additional light on the drivers of COVID-19 inequalities among Swedish HCWs.

Examining Treatment Attendance Dynamics: Role of Immigrant Status and Neighborhood Factors

In the United States, where one in every seven residents identifies as an immigrant, this study explores the impact of both individual and neighborhood-level factors on treatment attendance, with a particular emphasis on immigrant status. The aim is to identify the drivers and obstacles contributing to disparities in treatment attendance. Hierarchical Linear Modeling (HLM) was employed to integrate individual and neighborhood-level variables and to assess interactions between immigrant status and neighborhood characteristics. Neighborhood factors like Neighborhood Immigrant Density and Neighborhood Concentrated Disadvantage did not show a significant association with treatment attendance. However, immigrant status was significantly associated with higher attendance rates, a trend that persisted even after controlling for other individual and neighborhood factors. Age, identification as Black, and preference for the English language also emerged as significant influences on attendance. This study utilized secondary data merging publicly available census information with electronic medical records (EMRs) from an integrated care clinic. Data integration was achieved using ArcGIS software. The findings underscore the predictive role of immigrant status in treatment attendance, shedding light on the potential challenges immigrants face. This research improves our understanding of the relationship between treatment attendance and both individual and neighborhood factors, guiding healthcare providers in creating targeted interventions for equal treatment access. Although neighborhood attributes yielded no significant associations, the study underscores the need for further exploration. Ultimately, these findings equip healthcare providers with insights into diverse influences on attendance, contributing to efforts aimed at addressing health disparities.

The Impact of Neighborhood-Level Factors on Perceived Quality of Hospice Service Satisfaction: A Geographic Information System Study.

Racial/ethnic minorities are underrepresented in hospice care in the United States, despite this being the standard of care for terminally ill individuals. Research indicates that location of services (e.g., rural vs. urban) plays a role in the differences in quality and quantity of services observed. However, the influences of neighborhood structural characteristics on quality of hospice services have not been explored. The purpose of this study was to explore the relationship between hospice neighborhood characteristics and caregiver-rated satisfaction with services in Florida. Data were derived from the Consumer Assessment of Healthcare Providers and Systems Hospice Survey and American Community Survey; ArcGIS was used to generate heat maps to provide visual representations. Findings showed that higher neighborhood immigrant density predicted lower family satisfaction with timely care, communication, spiritual support, and likelihood to recommend the agency services. The U.S. population is projected to continue to grow in its diversity, and thus understanding neighborhood characteristics associated with racial/ethnic minorities' perception of care quality are important for shaping care improvements.

Family Support Differences Between Immigrant and Non-Immigrant Adolescents Across 30 Countries: Examining the Moderating Role of Cultural Distance, Culture of Origin, and Reception in Receiving Societies

Differing theoretical indications suggest that immigrant adolescents’ perceptions of family support will either be lower or higher than those of their non-immigrant peers. To unravel this inconsistency, current cross-national study examines family support differences between first- and second-generation immigrant and non-immigrant adolescents. It also investigates how these differences vary based on restrictive integration policies, anti-immigrant attitudes, and immigrant density in the receiving country, the obedience orientation of the origin country, and the cultural distance in obedience orientation between the origin- and receiving country. Cross-classified multilevel regression analyses were conducted on data from the 2017 to 2018 Health Behavior in School-aged Children survey with a national representative sample of adolescents from 178 origin countries in 30 receiving countries across Europe, Central Asia, and in Israel. Results revealed the variance in family support was small at the level of the origin country (0.73%) and the community (1.24%), while modest at the receiving country level (10.91%). Family support was slightly lower for adolescents of both immigrant generations compared with non-immigrant adolescents, with greater differences for first-than for second-generation immigrants (respectively d = .16 and d = .02). Differences in family support were unrelated to restrictive integration policies, anti-immigrant attitudes, immigrant density, or obedience orientation. However, family support for second-generation immigrant adolescents decreased more compared with non-immigrants when their cultural distance was greater. Concluding, immigrant adolescents’ lower family support, may reflect their exposure to more stressors than non-immigrants. Cultural distance can amplify these stressors, thereby affecting family support for some immigrants more than others.

Neighbourhood context and diagnosed mental health conditions among immigrant and non-immigrant youth: a population-based cohort study in British Columbia, Canada.

Evidence from systematic reviews suggests that adult immigrants living in areas of higher immigrant density (areas with ahigher proportion of foreign-born residents) tend to experience fewer mental health problems-likely through less discrimination, greater access to culturally/linguistically appropriate services, and greater social support. Less is known about how such contexts are associated with mental health during childhood-a key period in the onset and development of many mental health challenges. This study examined associations between neighbourhood immigrant density and youth mental health conditions in British Columbia (BC; Canada). Census-derived neighbourhood characteristics were linked to medical records for youth present in ten of BC's largest school districts from age 5 through 19 over the study period (1995-2016; n = 138,090). Occurrence of physician assessed diagnoses of mood and/or anxiety disorders, attention deficit hyperactivity disorder (ADHD), and conduct disorder was inferred through International Classification ofDiseases (ICD) diagnosticcodes in universal public health insurance records. Multi-level logistic regression was used to model associations between neighbourhood characteristics and odds of diagnoses for each condition; models were stratified by generation status (first-generation: foreign-born; second-generation: Canadian-born to a foreign-born parent; non-immigrant). Higher neighbourhood immigrant density was associated with lower odds of disorders among first-generation immigrant youth (e.g., adjusted odds of mood-anxiety disorders for those in neighbourhoods with the highest immigrant density were 0.67 times lower (95% CI: 0.49, 0.92) than those in neighbourhoods with the lowest immigrant density). Such protective associations generally extended to second-generation and non-immigrant youth, but were-for some disorders-stronger for first-generation than second-generation or non-immigrant youth. Findings suggest there may be protective mechanisms associated with higher neighbourhood immigrant density for mental health conditions in immigrant and non-immigrant youth. It is important that future work examines potential pathways by which contextual factors impact immigrant and non-immigrant youth mental health.

Immigration and rates of entrepreneurship in large US communities

ABSTRACT Using US county-level data from the Business Information Tracking System, we revisit the influence of immigrants on business start-ups. We find that a higher density of foreign-born immigrants has a positive impact on new business formation, but the relationship varies by the ethnic background of the immigrants and by industry type. Specifically, Caucasian immigrants, and to a lesser extent Asians, drive the positive relationship. Higher concentrations of Latinx immigrants, however, have either no or a predominantly negative influence on business start-up rates. The largely positive relationship between foreign-born and entrepreneurship varies significantly across different industries, particularly for Asians and Latinx. Care must be taken when making broad generalizations about the immigrant and entrepreneurship relationship. Specifically, there are significant variations across ethnic backgrounds and types of industries.

1218-P: Immigrant Density and Prevalence of Diabetes in American Neighborhoods

Background: The “healthy immigrant effect” suggests that despite immigrants generally demonstrating lower socioeconomic status than non-immigrants, they have lower age-related disease prevalence and mortality compared to non-immigrants. Recent evidence suggests immigrants may have higher levels of physical activity and may also influence their neighbors to decrease sedentary behavior. Drawing from the literature, we investigated the association between immigrant density with the prevalence of diabetes in neighborhoods and of both foreign-born and U.S.-born populations by ZIP code level. Methods: In this retrospective, cross-sectional ecological study, we used data from the American Community Survey (ACS) and the CDC Behavioral Risk Factor Surveillance System (BRFSS) for 2018. We performed multiple regression to test our predictive model that appointed obesity and physical activity as possible mediators between immigrant density and diabetes. Participants: ZIP codes with more than 16 foreign-born individuals (324out of 41692 total ZCTAs) Results: Higher immigrant density in a neighborhood is associated with lower prevalence of diabetes (beta estimate = −0.056657; r-squared = 0.02709) ; this remains true even after adjusting for prevalence of obesity (0.038646; 0.5356) , physical activity (-0.014093; 0.7097) , and both (−0.001015; 0.7168) , with all p-values < 0.001. We concluded that immigrant density is a potential protective factor of diabetes, and the relationship is mediated by the prevalence of obesity and physical activity. Discussion: The effects may differ depending on the racial/ethnic composition of the neighborhood. A previous study has shown that living in communities with a high Hispanic concentration (>=25%) was associated with an increase in body mass index (BMI) and higher odds for obesity in non-Hispanic Whites, respectively; meanwhile, the opposite effect is observed for communities with high Asian concentration. As a next step, we will disaggregate our results by race.

Geographic concentration of SARS-CoV-2 cases by social determinants of health in metropolitan areas in Canada: a cross-sectional study.

Background:Understanding inequalities in SARS-CoV-2 transmission associated with the social determinants of health could help the development of effective mitigation strategies that are responsive to local transmission dynamics. This study aims to quantify social determinants of geographic concentration of SARS-CoV-2 cases across 16 census metropolitan areas (hereafter, cities) in 4 Canadian provinces, British Columbia, Manitoba, Ontario and Quebec.Methods:We used surveillance data on confirmed SARS-CoV-2 cases and census data for social determinants at the level of the dissemination area (DA). We calculated Gini coefficients to determine the overall geographic heterogeneity of confirmed cases of SARS-CoV-2 in each city, and calculated Gini covariance coefficients to determine each city’s heterogeneity by each social determinant (income, education, housing density and proportions of visible minorities, recent immigrants and essential workers). We visualized heterogeneity using Lorenz (concentration) curves.Results:We observed geographic concentration of SARS-CoV-2 cases in cities, as half of the cumulative cases were concentrated in DAs containing 21%–35% of their population, with the greatest geographic heterogeneity in Ontario cities (Gini coefficients 0.32–0.47), followed by British Columbia (0.23–0.36), Manitoba (0.32) and Quebec (0.28–0.37). Cases were disproportionately concentrated in areas with lower income and educational attainment, and in areas with a higher proportion of visible minorities, recent immigrants, high-density housing and essential workers. Although a consistent feature across cities was concentration by the proportion of visible minorities, the magnitude of concentration by social determinant varied across cities.Interpretation:Geographic concentration of SARS-CoV-2 cases was observed in all of the included cities, but the pattern by social determinants varied. Geographically prioritized allocation of resources and services should be tailored to the local drivers of inequalities in transmission in response to the resurgence of SARS-CoV-2.

Neighborhood Context and the Nativity Advantage in Preterm Birth among Black Women in California, USA.

Non-Hispanic Black women remain at increased risk for adverse birth outcomes, yet Black immigrant women are at lower risk than their US-born counterparts. This study examines whether neighborhood context contributes to the nativity advantage in preterm birth (PTB, < 37weeks) among Black women in California. A sample of live singleton births to non-Hispanic US-born (n = 83,169), African-born (n = 7151), and Caribbean-born (n = 943) Black women was drawn from 2007 to 2010 California birth records and geocoded to urban census tracts. We used 2010 American Community Survey data to measure tract-level Black immigrant density, Black racial concentration, and a neighborhood deprivation index. Risk ratios (RR) and 95% confidence intervals (95%CI) were estimated using log-binomial regression to assess whether neighborhood context partially explained nativity differences in PTB risk. Compared to US-born Black women, African-born Black women had lower PTB risk (RR = 0.65, 95%CI: 0.60-0.71). The difference in PTB risk between US- and Caribbean-born women did not reach statistical significance (RR = 0.87, 95%CI: 0.71-1.05). The nativity advantage in PTB risk was robust to neighborhood social conditions and maternal factors for African-born women (RR = 0.59, 95%CI: 0.51-0.67). This study is one of few that considers area-level explanations of the nativity advantage among Black immigrants and makes a significant contribution by showing that the neighborhood context does not explain the nativity advantage in PTB among Black women in California. This could be due to many factors that should be examined in future research.

Classroom Immigrant Density Predicts Psychological Well-Being Among Adolescents With an Immigration Background: Findings From the 2017/18 Swedish Health Behaviour in School-Aged Children Study.

Objectives: Group-level characteristics in shared contexts such as schools may affect adolescent psychological health. This study examined if the immigrant density in the classroom was associated with the level of self-reported psychological complaints among students with an immigration background. Methods: Cross-sectional data were derived from 2,619 lower secondary school students (aged 13–15) in the 2017/18 wave of the Swedish Health Behaviour in School-aged Children (HBSC) survey. Using multilevel analysis estimating two-level random intercept linear regression models, classroom immigrant density was considered as a potential predictor of immigrant students’ psychological complaints. Results: Students with an immigration background reported significantly fewer psychological complaints, on average, than students without such a background, even when adjusting for other sociodemographic characteristics. A cross-level interaction indicated that both first- and second-generation immigrant students experienced fewer psychological complaints in immigrant-dense classes compared to when the proportion of immigrant students was lower. Conclusion: Students with an immigration background fare better psychologically in classes with a higher proportion of immigrant students. Such compositional effects could be alleviated by strengthening all schools’ capacities to provide a more inclusive classroom climate.

The Spatiotemporal Interaction Effect of COVID-19 Transmission in the United States

(1) Background: Human mobility between geographic units is an important way in which COVID-19 is spread across regions. Due to the pressure of epidemic control and economic recovery, states in the United States have adopted different policies for mobility limitations. Assessing the impact of these policies on the spatiotemporal interaction of COVID-19 transmission among counties in each state is critical to formulating epidemic policies. (2) Methods: We utilized Moran’s I index and K-means clustering to investigate the time-varying spatial autocorrelation effect of 49 states (excluding the District of Colombia) with daily new cases at the county level from 22 January 2020 to 20 August 2020. Based on the dynamic spatial lag model (SLM) and the SIR model with unreported infection rate (SIRu), the integrated SLM-SIRu model was constructed to estimate the inter-county spatiotemporal interaction coefficient of daily new cases in each state, which was further explored by Pearson correlation test and stepwise OLS regression with socioeconomic factors. (3) Results: The K-means clustering divided the time-varying spatial autocorrelation curves of the 49 states into four types: continuous increasing, fluctuating increasing, weak positive, and weak negative. The Pearson correlation analysis showed that the spatiotemporal interaction coefficients in each state estimated by SLM-SIRu were significantly positively correlated with the variables of median age, population density, and proportions of international immigrants and highly educated population, but negatively correlated with the birth rate. Further stepwise OLS regression retained only three positive correlated variables: poverty rate, population density, and highly educated population proportion. (4) Conclusions: This result suggests that various state policies in the U.S. have imposed different impacts on COVID-19 transmission among counties. All states should provide more protection and support for the low-income population; high-density populated states need to strengthen regional mobility restrictions; and the highly educated population should reduce unnecessary regional movement and strengthen self-protection.

Mültecilerin kabulünden sonra bir referans çocuk hastanesinde çocukluk çağı tüberkülozu

Aim: We aimed to evaluate epidemiologic, clinical, laboratory, microbiologic features, treatment and outcomes of pediatric tuberculosis (TB) patients also to draw attention to immigrant patients.&#x0D; Material- Methods: We retrospectively conducted the medical records of children below 18 years of age with TB between January 2015 and September 2016. &#x0D; Results: A total of 20 TB patients (35% were Syrian refugees, total 65% female) with a median age of 135.5±52.6 months were evaluated. Fourteen (70%) patients were adolescent. The history of contact with an active TB disease patient was found in seven (35%) patients. Four (20%) patients had no complaint at admission whereas the most common symptom was prolonged cough &gt; 2 weeks. Fifteen (75%) patients had a Bacillus Calmette–Guérin scar on the left shoulder. A total of 16 (80%) patients had a positive tuberculin skin test (TST) result. Microbiological confirmation was provided in four (20%) patients totally. The most common chest X-ray findings on admission were hilar lymphadenopathy. Ten (50%) patients had normal chest X-ray and were diagosed with abnormal thorax tomography findings. All of the patients were treated succesfully except one Syrian patients with miliary TB who died.&#x0D; Conclusion: Microbiological confirmation of childhood TB may be absent and the diagnosis can be confirmed in the light of contact history, positive TST reaction, compatible symtomps and radiological evidence. Particular attention might be paid to Syrian refugees, taking into epidemiological characteristics of TB disease and the density of immigrants in the place we live in.

Social inclusion of immigrant children at school: the impact of group, family and individual characteristics, and the role of proficiency in the national language

ABSTRACT The present study, based on data concerning 2328 immigrant children attending a representative sample of 561 schools, investigates the impact of various group, family and individual characteristics as well as proficiency in the national language on acceptance and friendship among classmates, while controlling for measurement errors by means of a structural equation modelling approach. As regards group characteristics, the results indicate that only immigrant density in the classroom has a positive impact on social inclusion, which seems to be limited to peer acceptance. As regards family and individual characteristics, low-SES and female immigrants appear to be doubly vulnerable in class, which specifically affects their friendships. One of our main findings is that proficiency in the national language predicts the social inclusion of immigrant children, while controlling for all the other variables considered. A moderation analysis reveals that this factor also applies to second-generation immigrants. In conclusion, we suggest that interventions aiming to facilitate the social inclusion of immigrant children should take into account the fact that proficiency in the national language appears to be much more important than group, family and individual characteristics, and that low-SES and female immigrants require particular attention, since they are doubly vulnerable.

School-Class Co-Ethnic and Immigrant Density and Current Smoking among Immigrant Adolescents.

Although the school-class is known to be an important setting for adolescent risk behavior, little is known about how the ethnic composition of a school-class impacts substance use among pupils with a migration background. Moreover, the few existing studies do not distinguish between co-ethnic density (i.e., the share of immigrants belonging to one’s own ethnic group) and immigrant density (the share of all immigrants). This is all the more surprising since a high co-ethnic density can be expected to protect against substance use by increasing levels of social support and decreasing acculturative stress, whereas a high immigrant density can be expected to do the opposite by facilitating inter-ethnic conflict and identity threat. This study analyses how co-ethnic density and immigrant density are correlated with smoking among pupils of Portuguese origin in Luxembourg. A multi-level analysis is used to analyze data from the Luxembourg Health Behavior in School-Aged Children study (N = 4268 pupils from 283 classes). High levels of co-ethnic density reduced current smoking. In contrast, high levels of immigrant density increased it. Thus, in research on the health of migrants, the distinction between co-ethnic density and immigrant density should be taken into account, as both may have opposite effects.

Immigrant Skill Distributions and Location Choices

In the wake of rising immigration and concerns about immigrant skill levels, this paper investigates the skill distributions of immigrants across different sizes of cities to determine where immigrants of certain skill levels locate and what the implications of those choices are. To that end, I utilize existing theory on skill complementarities as a framework for labor mobility of immigrants across cities, which suggests disproportionately higher concentrations of low- and high-skilled workers in large cities compared to small cities. I use 2018 American Community Survey data and stochastic dominance testing to determine if this theory applies to immigrant workers. I find evidence of a thicker lower tail in the skill distribution of large cities, suggesting a higher density of low-skilled immigrants in those locations. At the same time, I find proof of a thicker upper tail in small cities, which consists of approximately the top 2% of earners, indicating a higher number of high-skilled immigrants there. Furthermore, the results also suggest that there is a range of skills, over which immigrants are more concentrated in large cities, that begins with individuals who have at least earnings consistent with a Bachelor's degree, but which does not include the top 2% of earners. This could have important welfare implications for existing and future immigrants.

HEALTHY LIFE EXPECTANCY OF OLDER HISPANICS: THE INFLUENCE OF NEIGHBORHOOD CHARACTERISTICS

Research consistently shows a survival advantage among Hispanics, despite a worse health profile. The goal of this study was to calculate disability free life expectancy for older Hispanics in the United States, and to explore any difference by neighborhoods. We used data from the Wave 5 (2004-5) of the Hispanic Established Population for the Epidemiological Study of the Elderly (Hispanic EPESE), linked to vital status data through 2016. We used Sullivan’s method to create disability free life expectancy (DFLE) estimates, and to calculate the ratio of life expectancy without disability to life expectancy with disability. These estimates were compared across neighborhood characteristics using Census FIPS data. All neighborhood characteristics were cut into tertiles and significance testing compared high versus low. The average age of the sample was 82 (range 75-109), a majority female (62%), non-married (57.5%), and born in the US (56%). Results showed that neighborhood Hispanic density, poverty, and percent linguistically isolated were not statistically significant for disability free life expectancy estimates. However, disability free life expectancy was higher in neighborhoods with higher density of immigrants, compared to neighborhoods with lower density of immigrants. This was statistically significant for all age groups 75 until age 88. These results suggest that for very old Mexican Americans living in the southwest, neighborhood effects are not significant predictors of disability free life expectancy. The exception is for the neighborhood immigrant density. This suggests that the healthy immigrant effect may maintain even in older ages. Policy and practice implications will be discussed.

Universal or Targeted Antenatal Care for Immigrant Women? Mapping and Qualitative Analysis of Practices in Denmark.

Inequity in immigrants’ health during pregnancy and childbirth has been shown. We studied the Danish regional organization of public midwifery-based antenatal care (ANC) for immigrant women to assess the strengths and weaknesses of organizing ANC as either universal or immigrant-targeted. A telephone survey in 2012 to all the Danish maternity wards (n = 20) was conducted. Semi-structured interviews with midwives providing targeted care (n = 6) were undertaken and characteristics of care were qualitatively analyzed, having the immigrant density of the facilities, the Danish ANC policy, and theories of cultural competence as the frame of reference. Six maternity wards were providing immigrant-targeted ANC. Targeted care implied longer consultations and increased attention to the individual needs of immigrant women. At these facilities, navigation in the health care system, body awareness, and use of interpreter services were key topics. The selection of women for targeted care was based on criteria (including names) that risk stigmatizing immigrant women. The arguments for not providing targeted care included that immigrant-targeted care was considered stigmatizing. Current universal care may overlook the needs of immigrant women and contribute to inequities. A strategy could be to improve dynamic cultural competencies of midwives, interpreter services, and flexibility of the care provision of the universal ANC system.

Neighborhood immigrant density and population health among native-born Americans

The healthy immigrant effect—whereby immigrants are on average healthier than the native-born—have been well studied. However, little is known about the relationship between immigration and the health of the native-born. This study fills this important research gap by examining the association between neighborhood immigrant density and several population health measures among native-born Americans. We used data from the Los Angeles County Health Survey to analyze four individual-level health behaviors and outcomes, including regular fast food consumption, fruit and vegetable consumption, body mass index, and hypertension. We conducted multilevel logistic regressions to assess the association between neighborhood immigrant density and the four health behaviors and outcomes. The results showed that neighborhood immigrant density was negatively associated with regular fast food consumption (OR = 0.33; 95% CI, 0.18–0.59), BMI (β = −2.16, 95% CI, −3.13 to −1.19), and hypertension (OR = 0.58; 95% CI, 0.38–0.89), and positively associated with fruit/vegetable consumption (OR = 1.64; 95% CI, 1.01–2.66) among native-born Americans. In conclusion, native-born Americans who lived in a neighborhood with a high density of immigrants had healthier behaviors and better health outcomes compared to those who lived in a neighborhood with a low density of immigrants.

Across borders: thoughts and considerations about cultural preservation among immigrant clinicians.

Immigrant clinicians make up 20-28% of the health workforce in many high-income countries, including Australia, Britain, Canada and the USA. Yet, the preserved culture of immigrant clinicians remains largely invisible in the medical literature and discourse. Research on immigrant clinicians primarily attends to medical professional requirements for the adopted country (medical board examination eligibility, fellowship training and licensing). Cultural preservation among immigrant clinicians has not been adequately considered or studied. This paper highlights this notable gap in healthcare delivery and health services research relevant to immigrant clinicians. We propose it is worthwhile to explore possible relationships between immigrant clinicians' preserved culture and clinical practices and outcomes since immigrant clinicians cross borders with their academic training as well as their culture. The sparse literature regarding immigrant clinicians suggests culture influences health beliefs, attitudes about the meaning of illness and clinical practice decisions. Additionally, immigrant clinicians are more likely to serve rural, low-income populations; communities with high density of ethnic minorities and immigrants; and areas with primary care shortage. Therefore, cultural preservation among immigrant clinicians may have important implications for public health and health disparities. This area of inquiry is important, if not urgent, in health services research.

Immigration and the public–private school choice

This paper empirically analyzes the effects of immigration on the schooling decisions of natives. We employ household-level data for Spain for years 2000–2015, a period characterized by high economic growth and large immigration that was halted by a long and severe recession. Our estimates reveal that increases in immigrant density at the school level triggered an important native flight from tuition-free, public schools toward private ones. We also find strong evidence of cream-skimming as more educated native households are the most likely to switch to private schools in response to immigration. Furthermore, we find that immigration leads to higher student–teacher ratios in public schools. We conclude that our results are consistent with the predictions of a political-economy model of school choice.