Non-immigrant Population Research Articles

Measurement invariance across immigrant and nonimmigrant populations on PISA non-cognitive scales

Measurement invariance across immigrant and nonimmigrant populations on PISA non-cognitive scales

Stress interventions for immigrant parents in the United States: a scoping review protocol.

This review will map stress interventions designed for and implemented among immigrant parents in the United States (US) according to intervention characteristics, participant characteristics, and reported outcomes and measurement tools. In addition to parenting stressors shared with their non-immigrant counterparts, immigrant parents also face immigration stressors. Although stress interventions can effectively manage, reduce, or prevent stress among non-immigrant populations, we know little about stress interventions designed for immigrant parents in the US. This study will be the first to explore stress interventions implemented among immigrant parents in the US. This scoping review will include published, peer-reviewed quantitative, qualitative, and mixed methods studies that evaluate stress interventions designed specifically for US immigrant parents with at least 1 child under the age of 18 years. Reported interventions must include stress as a primary or secondary outcome or be labeled as a stress intervention. Stress interventions are broadly defined, with no restrictions on the type of stress targeted (eg, job, general, parenting) or the intervention's nature (ie, prevention vs. management/reduction vs. treatment). A literature search will be conducted in ProQuest's APA PsycINFO and PsycARTICLES, CINAHL Plus (EBSCOhost), ERIC (ProQuest), Embase, MEDLINE (Ovid), International Bibliography of Social Sciences (ProQuest), and the Cochrane Library. Only English-language publications will be eligible, with no date restrictions. Retrieved titles and abstracts will be screened by at least 2 independent reviewers in duplicate. Data will be extracted using a self-developed data extraction tool. Findings will be presented in tabular or diagrammatic format, accompanied by a narrative summary. Open Science Framework osf.io/ec39j.

Facebook city: Place-named groups as urban communication infrastructure in Greater London

This paper investigates the geography of Facebook use at an urban-regional scale, focussing on place-named groups, meaning various interest groups with names relating to places such as towns, neighbourhoods, or points of interest. Conceptualising Facebook as a digital infrastructure – that is, the platform’s urban footprint, in the form of its place-named groups, rather than what individuals share and create using the service – we explore the location, theme, and scale of 3016 groups relating to places in Greater London. Firstly, we address the quantitative and qualitative methodological challenges that we faced to identify the groups and ground them geographically. Secondly, we analyse the scale of the toponyms in the group names, which are predominantly linked to London’s suburbs. Thirdly, we study the spatial distribution of groups, both overall and by specific types, in relation to the socio-demographic characteristics of residents at the borough level. Through correlation and robust regression analyses, the presence and activity of groups are linked to a relatively older, non-deprived, and non-immigrant population living in less dense areas, with high variability across different group types. These results portray place-named Facebook groups as communication infrastructure skewed towards more banal interactions and places in Greater London’s outlying boroughs. This research is among the first to explore and visualise the urban geographies of Facebook groups at a metropolitan scale, showing the extent, nature, and locational tendencies of large-scale social media use as increasingly ordinary aspects of how people come to know, experience, live, and work in cities.

Maternal stressors and maternal bonding among immigrant and Refugee Arab Americans resettled in the United States.

Maternal bonding with the infant and child is essential for the growth and development of the child, and for establishing the relationship between them. The effect of maternal acculturative stress, trauma, and depressive symptoms on maternal bonding has been established in nonimmigrant populations, but not in immigrant and refugee populations. In this study, we aimed to (1) examine the relationships among maternal psychosocial stress (acculturative stress, posttraumatic stress), depressive symptoms, and maternal bonding, and (2) examine whether maternal depression is a mediator of the relationship between maternal psychosocial stress and maternal bonding among a sample of Arab American immigrant and refugee mothers. Using a cross-sectional design, we recruited 78 immigrant and refugee Arab American mothers. Acculturative stress was correlated with posttraumatic stress (ρ = 0.56, p < 0.001), depressive symptoms (ρ = 0.48, p < 0.001), and bonding impairment (ρ = 0.39, p < 0.001). Posttraumatic stress and depressive symptoms were also correlated with maternal bonding impairment (ρ = 0.39, and 0.52, respectively, p < 0.001 for both). The effect of maternal psychosocial stress on maternal bonding was mediated by depressive symptoms. We concluded that higher levels of acculturative stress and posttraumatic stress were associated with higher levels of depressive symptoms and impairment of maternal bonding. Additionally, maternal depressive symptoms mediated the relationship between maternal stress and bonding. Assessing the stressors and depressive symptoms of immigrant and refugee mothers is key to avoiding negative effects on child outcomes.

Sex differences in COVID-19 deaths in the early months of the pandemic in Canada: An examination with an immigration lens.

At the onset of the COVID-19 pandemic, there was an overrepresentation of males in COVID-19 deaths worldwide, with Canada reporting more female COVID-19 deaths. This paper examines the overrepresentation of female COVID-19 deaths in Canada, with an immigration lens. Data were extracted from the COVID-19 Sex-Disaggregated Data Tracker to compare the sex distribution of COVID-19 deaths in Canada with that of other countries. A linkage of deaths to the Longitudinal Immigration Database (IMDB) allows for the comparison of sex-specific COVID-19 death rates by immigrant status for age and geography, as well as by major employment sector among immigrants, using the tax data from the IMDB. While there were proportionately more female than male COVID-19 deaths in Canada in the early months of the pandemic, this trend was mainly a phenomenon among non-immigrants aged 85 and older. In addition, COVID-19-specific death rates for males were higher than those for females across age groups by immigrant status, except for those aged 85 and older among the non-immigrant population. Among immigrants, the death rate among health care and social assistance workers was higher among males than among females (10.7 vs. 2.9 per 100,000 population). The initially observed overrepresentation of female COVID-19 deaths to male COVID-19 deaths in Canada evened out in the summer of 2021. The higher proportion of female COVID-19 deaths was likely related to the high concentration of COVID-19 deaths in long-term care facilities, where a lower institutionalization rate for immigrants had been observed. Since the implementation of vaccination targeting long-term care facility residents in Canada, the overrepresentation of female COVID-19 deaths ceased.

Intergroup relations, acculturation orientations, and adaptation of Turkish immigrant descent parents across Europe.

The current research examines whether Turkish immigrant descent parents' perceived discrimination, intergroup contact with the majority, nonimmigrant society, and acculturation orientations are related to their psychological and sociocultural adaptation (i.e., life satisfaction and parental self-efficacy). Additionally, it explores potential differences in these relations between three European countries. Participants were parents (Mage = 38.05, SD = 5.81, 85.3%-99.6% female) of Turkish origin from England (n = 293), Germany (n = 338), and the Netherlands (n = 247) who participated in a large-scale structured interview study. As predicted, perceived discrimination was negatively associated with Turkish immigrant descent parents' psychological adaptation, although not with sociocultural adaptation. Positive contact with the majority, nonimmigrant society positively predicted both psychological and sociocultural adaptation. Contrary to the expected, only desire for contact was positively associated with both psychological and sociocultural adaptation, whereas culture and language adoption was not related to adaptation. Together these findings highlight the importance of majority, nonimmigrant societies fostering conditions and policies that promote opportunities for harmonious interactions between immigrant/immigrant descendants and majority, and nonimmigrant populations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Cervical, liver and stomach cancer incidence and mortality in non-Western immigrant women: a retrospective cohort study from four Nordic countries

Background Cervical, liver and stomach cancers are the most common infection-associated malignancies and the leading cause of morbidity in non-Western regions. We compared the incidence and mortality of these cancers between non-Western immigrant and non-immigrant Nordic female populations. We also analysed the effect of age at immigration, duration of residence and education on cancer burden. Material and Methods Study population consisted of women residents in Denmark, Finland, Iceland and Norway in 1973–2020. Non-Western women contributed 3.1% of the total 260 million person-years at risk. All women were followed from their 20th birthday, or from the date of immigration if after, until the date of their first primary cancer diagnosis, death, emigration, or the end of the country-specific study period. All data were adjusted for 10-year age groups and calendar periods, and immigrant data was further broken down by region of birth, age at immigration and education level. Country-specific estimates were produced by multivariable Poisson regression and pooled in Finland with a random effects model. Results Altogether, there were 60 982 cases of cervical, liver and stomach cancer in the study population, causing 36 582 deaths. The immigrant women had significantly higher liver (rate ratio [RR] 1.78, 95% confidence interval (CI) 1.03–3.06) and stomach cancer incidence (RR 1.68, CI 1.29–2.18), and stomach cancer mortality (RR 1.49, CI 1.17–1.92) than non-immigrant women. In the immigrant population, high education was related to lower incidence and mortality of studied cancers. The rate ratio of cervical cancer decreased with duration of residence and increased with rising age at immigration. Conclusion Due to the increased incidence and mortality of infection-related cancers and changes in cancer patterns by age at immigration and duration of residence, attention should be paid to targeted health care services for immigrants. Special efforts should be given to women who have spent their youth in high-risk areas.

Quantitative Data Availability and Measurement of US Immigrant and Immigration Policies: IMR Methods Note

In this IMR Methods Note, we spotlight the rise in quantitative data availability, measurements, and scholarly investigations of US immigrant and immigration policies (IIPs). To begin, we offer a detailed account of the quantitative data sources, measures, and analytical strategies that have been developed by scholars studying IIPs over the last two decades. We then highlight this scholarship's important advances toward identifying IIPs’ intended, unintended, and spillover effects on immigrant and nonimmigrant populations in the United States. To conclude, we discuss ongoing challenges and future opportunities for deepening research on US IIPs and their psychosocial, behavioral, and health implications. Our review illuminates how data on federal immigration enforcement activities, and on federal, state, and municipal immigrant laws have engendered increasingly sophisticated quantitative studies of the US IIP climate. At the same time, it highlights several dimensions in which existing work stands to be strengthened, including the need for comparisons of newly developed IIP measures and their estimated effects; greater exploration of IIPs’ potentially heterogeneous effects across distinct subpopulations; and more attention to endogeneity, or in other words, the political and demographic processes that give rise to nonrandom variation in how IIPs take shape across space and time.

Postpartum contraception usage in immigrants compared with non-immigrants in Buffalo, NY

ObjectivesThe purpose of this study was to compare rates of postpartum contraception use in immigrant populations in Buffalo, NY compared with non-immigrant populations. The study also explores rates of specific birth control selection amongst those who did choose to employ postpartum contraception. Study designA retrospective chart review was conducted comparing the rate of postpartum contraceptive use in 132 immigrant individuals with that of 134 non-immigrant individuals, as measured by the documented intent or refusal to initiate any contraceptive method within the first three months postpartum. Patients were from clinics affiliated with the Women and Children’s Hospital of Buffalo (WCHOB) who delivered during the years 2015–2016. The immigrant patients were chosen from the top ten immigrant countries of origin who delivered at WCHOB at the time. ResultsAfter controlling for factors of maternal age, gestational age at time of delivery, and gravidity and parity, the immigrant group was more likely to decline postpartum contraception in the first three months postpartum compared with the non-immigrant group (25.8% vs 6.7%, p < 0.001). Immigrants were more likely to select a barrier method (p = 0.036) and decided to employ contraception more remotely from delivery when compared with non-immigrant individuals (p < 0.001). Amongst the immigrant cohort, there was no statistically significant difference in methods chosen based on broad geographic areas of origin. ConclusionsImmigrant obstetric populations in Buffalo are less likely to employ postpartum contraception compared with non-immigrant populations. The factors influencing this are multifactorial; however, this information can inform care for both immigrant and non-immigrant patients.

Virtual care use among older immigrant adults in Ontario, Canada during the COVID-19 pandemic: A repeated cross-sectional analysis.

The critical role of virtual care during the COVID-19 pandemic has raised concerns about the widening disparities to access by vulnerable populations including older immigrants. This paper aims to describe virtual care use in older immigrant populations residing in Ontario, Canada. In this population-based, repeated cross-sectional study, we used linked administrative data to describe virtual care and healthcare utilization among immigrants aged 65 years and older before and during the COVID-19 pandemic. Visits were identified weekly from January 2018 to March 2021 among various older adult immigrant populations. Among older immigrants, over 75% were high users of virtual care (had two or more virtual visits) during the pandemic. Rates of virtual care use was low (weekly average <2 visits per 1000) prior to the pandemic, but increased for both older adult immigrant and non-immigrant populations. At the start of the pandemic, virtual care use was lower among immigrants compared to non-immigrants (weekly average of 77 vs 86 visits per 1000). As the pandemic progressed, the rates between these groups became similar (80 vs 79 visits per 1000). Virtual care use was consistently lower among immigrants in the family class (75 visits per 1000) compared to the economic (82 visits per 1000) or refugee (89 visits per 1000) classes, and was lower among those who only spoke French (69 visits per 1000) or neither French nor English (73 visits per 1000) compared to those who were fluent in English (81 visits per 1000). This study found that use of virtual care was comparable between older immigrants and non-immigrants overall, though there may have been barriers to access for older immigrants early on in the pandemic. However, within older immigrant populations, immigration category and language ability were consistent differentiators in the rates of virtual care use throughout the pandemic.

Impact of COVID-19 on health disparities between migrant and non-migrant households: the case of Dearborn, Michigan

ABSTRACT Objectives: Studies on immigration have shown that cultural changes can positively or negatively affect psychological, behavioral, and physical outcomes when different cultures settle into a new host community or country. The majority of research done in the United States and North America has focused on these changes for larger immigrant and minority groups such as Hispanics/Latinos and Asians. However, in the United States, there is a sub-group of immigrants that is largely understudied, resulting in misunderstood data on mental and physical health: Arab Americans. This study assesses mental health disparities between immigrant and non-immigrant populations, before and after COVID-19 restrictions, in Dearborn, MI, a city that has one of the largest concentrations of Arab immigrants in the nation. Design: Using an online survey instrument, this study assessed mental health disparities before and since COVID-19 restrictions, and stressors induced since the pandemic for immigrants and non-immigrants in Dearborn, MI. Results: Through inferential statistics and logistic regressions, results indicate that immigrants are less likely to have healthcare coverage, have lower annual incomes, lower educational attainment, and experience continuously higher mental health issues before the pandemic than non-immigrants faced during the pandemic. Conclusion: This study reinforces that the Arab-American immigrant population is a disadvantaged sub-group and faces considerable stress and mental health concerns as an acculturating population. This stress gets exacerbated when a worldwide event such as the COVID-19 pandemic strikes. Oversight of this population’s health issues results in the inability to receive appropriate social services and healthcare that is vital to address this community’s concerns.

Jewish population trajectories between the Jordan River and the Mediterranean Sea

ABSTRACT This article re-examines Jewish population in what is now Israel using historical estimates from Ottoman, Mandatory British and United Nations sources and recent data from the Israeli census bureau. A logistic model generates backward extrapolations and forward projections. The model quantifies three waves of Jewish immigration totalling about 3.5 million. Subtracting immigrant data from total population numbers gives the main empirical trajectory for non-immigrant native-born population. A multi-logistic model combining migrant and native populations projects a Jewish population of about 10 million in 2050, a level low in the range of estimates made by others.

Telehealth Perceptions Among US Immigrant Patients: Cross-sectional Study Within an Academic Internal Medicine Practice

Background The use of telemedicine has increased dramatically through the COVID-19 pandemic. While data are available about patient satisfaction with health care through telemedicine, little is known about the immigrant patient experience. Objective We investigated whether immigrant patients would prefer in-person visits and have higher ratings for interpersonal communication during in-person rather than telemedicine visits. We hoped to identify the reasons behind immigrant visit preferences and consider these reasons to guide suggestions for more equitable use of and access to visit options. Methods Overall, 270 patients including 122 immigrants and 148 nonimmigrants were seen by 4 internal medicine providers in either an in-person (n=132) or telemedicine (n=138) university practice setting. Immigrants were defined as having been born outside of the United States. Patients were queried between February and April 2021 using an adaptation of a previously validated patient satisfaction survey containing standard questions developed by the Consumer Assessment of Healthcare Providers and Systems Program. Patients seen via in-person visits completed a paper copy of the survey. The same survey was administered by a follow-up phone call for telemedicine visits. Patients surveyed spoke English, Spanish, or Arabic and were surveyed in their preferred language. For televisits, the same survey was read to the patient by a certified translator. The survey comprised 9 questions on a 5-point Likert scale assessing satisfaction under the categories of access to care, interpersonal interaction, quality of care, and next visit preference. An additional write-in question assessed reasons for subsequent visit type preferences. Survey question responses were compared with paired t tests. Results Across both immigrant and nonimmigrant patient populations, satisfaction with perceived quality of care was universally high regardless of visit type (televisits: P=.80 and P=.60; in-person: P=.76 and P=.37). During televisits, immigrants were more likely than nonimmigrants to feel that providers spent sufficient time with them (P&lt;.001). Different perceptions were noted among nonimmigrant patients. Nonimmigrants tended to perceive more provider time during in-person visits (P=.006). When asked to comment on reasons behind subsequent visit preference, nonimmigrant patients prioritized convenience, whereas immigrants noted the telemedicine advantage of not having to navigate other office logistics. Conclusions While satisfaction was quite high for both telemedicine and in-person visits across immigrant and nonimmigrant populations, significant differences in patient priorities were identified. Immigrants found televisits desirable because they felt they spent more time with their providers and were able to avoid additional office logistics that are often challenging barriers for non-English speakers. This suggests opportunities to use information technology to provide cultural and language-appropriate information throughout the in-person and telemedicine visit experience of immigrants, such as assistance with call-in scheduling, appointment reminders, and portal access. A focus on diminishing these barriers will help reduce health care inequities among immigrant patients. Conflicts of Interest None declared.

Assessing Quality of Life in First- and Second-Generation Immigrant Children and Adolescents; Highlights from the DIATROFI Food Aid and Healthy Nutrition Promotion Program.

To compare first- and second-immigrant pediatric populations with a non-immigrant pediatric population in terms of quality-of-life metrics, a cross-sectional analysis using data from the DIATROFI Program was implemented. In total, n = 2277 students (mean age: 9(4) years) from public schools in Greece participating in the 2020-2021 school year were analyzed. The students' immigration status (first-generation/second-generation) was defined as per the standard definition. The students' health related-quality of life (HRQoL) was assessed using a parental-perceived quality of life questionnaire. The sample included 4.8% first-generation and 21.2% second-generation immigrant students. Compared with non-immigrants, the first-generation immigrant students were more likely to have poor HRQoL (odds ratio (OR) = 2.82; 95% confidence interval (95%CI) = 11.75, 4.53), physical (OR = 1.91; 95%CI = 1.18, 3.10), social (OR = 1.94; 95%CI = 1.16, 3.22) and school function (OR = 2.52; 95%CI = 1.54, 4.13). Similar results were observed for second-generation immigrant students regarding HRQoL (OR = 1.68; 95%CI = 1.28, 2.21), physical (OR = 1.60; 95%CI = 1.23, 2.10) and school function (OR = 2.09; 95%CI = 1.58, 2.77). Children with one parent having a country of origin different that the country of residence had elevated odds of having poor emotional health (OR = 1.19; 95%CI = 0.87, 1.64). The family's affluency level was interrelated with the connection of poor HRQoL and immigration status. The immigrant students have a poorer quality of life depending on their immigration generation and irrespective of their socioeconomic background.

COVID-19 vaccine coverage among immigrants and refugees in Alberta: A population-based cross-sectional study.

Studies have shown that immigrants have lower vaccination rates than the Canadian-born population. We sought to assess COVID-19 vaccine coverage and factors associated with uptake among foreign-born immigrants relative to the non-immigrant population in Alberta, Canada. In this cross-sectional study, we analysed population-based linked administrative health data from Alberta to examine vaccine coverage for 3 931 698 Albertans, of which 731 217 were immigrants. We calculated COVID-19 vaccination coverage as the proportion of eligible Albertans with a record of receiving at least one dose of a COVID-19 vaccine as of November 29, 2021. We used multivariable logistic regression to examine the association of vaccine coverage with migration status (immigrants: four categories based on time since migration and non-immigrants) adjusting for socio-demographic variables. Overall, COVID-19 vaccination coverage was 78.2% (95% confidence interval (CI) = 78.1%-78.3%) among immigrants and 76.0% (95% CI = 75.9%-76.0%) among non-immigrants. Coverage among immigrants differed by continent of origin, with North America, Oceania, and Europe having the lowest coverage. Although vaccine coverage was relatively uniform across neighbourhood income quintiles for immigrants, immigrants living in rural areas had lower vaccine coverage compared to non-immigrants living in rural areas. Multivariable logistic regression analysis showed a significant interaction between age category and migration status. While immigrants below 50 years of age generally had significantly higher vaccine coverage compared to non-immigrants, there was some variation based on time since migration. Immigrants above 50 years of age showed significantly lower coverage compared to non-immigrants of the same age. Public health interventions should focus on older immigrants, immigrants living in rural areas, and immigrants from specific continental backgrounds in order to improve COVID-19 vaccination coverage.

Neighbourhood crime and major depression in Sweden: A national cohort study.

The association between neighbourhood crime and major depression (MD) has been described before but previous studies may be limited by biases in self-reported data and the use of homogenous study populations. Our study aimed to examine the association between neighbourhood crime and clinically diagnosed MD among the immigrant and non-immigrant populations in Sweden. A retrospective cohort study was performed, which included non-immigrants and first- and second-generation immigrants residing in Sweden, who were born between 1960 and 1996. We used linked Swedish national registers, geospatial analysis and multilevel logistic regression models to examine the potential effect of neighbourhood crime on the odds of major depression between January 1, 2012, and December 31, 2015. Overall, individuals living in neighbourhoods with high levels of neighbourhood crime had higher odds of MD than those who did not. There was a significant interaction by immigrant status; the odds of MD among those with non-immigrant backgrounds were more strongly associated with increases in neighbourhood crime, after adjusting for potential confounders. Male and female immigrants born outside Sweden did not seem to be affected by increases in neighbourhood crime. The apparent effect of increases in neighbourhood crime on the odds of MD seemed to differ between those of different immigrant statuses. Future research should aim to explore the possible mechanisms behind the differences in the rates of MD among the non-immigrant and immigrant populations in neighbourhoods with high crime.

Home Away from Home: Comparing Factors Impacting Migrants' and Italians Sense of Psychological Home.

Psychological home is an understudied concept within community psychology, especially focused on migrants. Previous literature on psychological home found a positive relationship with well-being and resilience in general populations and migrants. Studying psychological home in migrants may provide important tools to buffer various stresses associated with migration. The present study explored the relationship between psychological home and demographic factors, including dwelling type and situation between migrants (n = 132) and Italian citizens’ population (n = 76). Results offer theoretical reasons explaining the differences in the meaning of home between migrant and non-immigrant populations.

Diurnal cortisol variation during pregnancy in Turkish origin and non-migrant women in a German birth cohort study

BackgroundImmigrants from Turkey experience health disadvantages relative to non-immigrant populations in Germany that are manifest from the earliest stages of the lifespan onwards and are perpetuated across generations. Chronic stress and perturbations of stress-responsive physiological systems, including the hypothalamus-pituitary-adrenal (HPA)-axis, are believed to in part mediate this relationship. Cortisol plays an important role in the association between maternal stress during pregnancy and many pregnancy-, birth- and offspring-related outcomes. We therefore examined whether maternal migrant background is associated with diurnal cortisol variation during pregnancy. Methods109 pregnant women (incl. n = 32 Turkish origin women) that participated in a multi-site prospective cohort study in Germany collected saliva samples across the day on two consecutive days around 24 and 32 weeks gestation. Hierarchical linear models were applied to quantify associations between migrant background and diurnal cortisol variation across pregnancy. ResultsWomen of Turkish origin exhibited a significantly lower cortisol awakening response (CAR) and a flatter diurnal cortisol slope (DCS) compared to non-migrant women after adjusting for household income. These relationships between migrant status and diurnal cortisol variation were mainly driven by 2nd generation migrants. DiscussionA potential HPA axis dysregulation of Turkish-origin pregnant women may contribute to the intergenerational transmission of health disadvantages in this group.

Differential Impact of Stroke on Cognitive Impairment in Mexican Americans and Non-Hispanic White Americans.

The association between stroke and dementia is well established. Less is known about this association in underrepresented ethnic groups. In a large ethnically diverse cohort, we examined whether history of stroke was associated with cognitive impairment, and whether this relationship differed by ethnicity (Mexican American [MA] versus non-Hispanic White). This was a population-based cohort study conducted in Nueces County, TX, a biethnic community with a large and primarily nonimmigrant MA population. Residents aged ≥65 were recruited door-to-door or by telephone between May 2018 and December 2021. The primary exposure was history of stroke, obtained by self-report. Demographic, medical, and educational histories were also obtained. The primary outcome was the Montreal Cognitive Assessment (MoCA), a scale that evaluates multiple domains of cognitive performance. Scores were divided into 3 ordinal categories, roughly corresponding to normal cognition (MoCA 26-30), mild cognitive impairment (MoCA 20-25), or probable dementia (MoCA 0-19). One thousand eight hundred one participants completed MoCA screening (55% female; 50% MA, 44% Non-Hispanic White, 6% other), of whom 12.4% reported history of stroke. Stroke prevalence was similar across ethnicities (X2 2.1; P=0.34). In a multivariable cumulative logit regression model for the ordinal cognition outcome, a stroke by ethnicity interaction was observed (P=0.01). Models stratified by ethnicity revealed that stroke was associated with cognitive impairment across ethnicities, but had greater impact on cognition in non-Hispanic Whites (cumulative odds ratio=3.81 [95% CI, 2.37-6.12]) than in MAs (cumulative odds ratio=1.58 [95% CI, 1.04-2.41]). Increased age and lower educational attainment were also associated with cognitive impairment, regardless of ethnicity. History of stroke was associated with increased odds of cognitive impairment after controlling for other factors in both MA and Non-Hispanic White participants. The magnitude of the impact of stroke on cognition was less in MA than in Non-Hispanic White participants.

Telehealth Perceptions Among US Immigrant Patients at an Academic Internal Medicine Practice: Cross-sectional Study.

BackgroundThe use of telemedicine has increased dramatically through the COVID-19 pandemic. Although data are available about patient satisfaction with telemedicine, little is known about immigrant patients’ experience.ObjectiveWe sought to investigate patients’ experiences with telehealth compared to in- person visits between immigrants and nonimmigrants. We wanted to identify and describe next visit preferences within the Farmington University of Connecticut Internal Medicine practice to ultimately guide suggestions for more equitable use and accessibility of visit options.MethodsA total of 270 patients including 122 immigrants and 148 nonimmigrants were seen by 4 Internal Medicine providers in an in-person (n=132) or telemedicine (n=138) university practice setting. Patients were queried between February and April 2021, using an adaptation of a previously validated patient satisfaction survey that contained standard questions developed by the Consumer Assessment of Healthcare Providers and Systems Program. Patients seen via in-person visits completed a paper copy of the survey. The same survey was administered by a follow-up phone call for telemedicine visits. Patients surveyed spoke English, Spanish, or Arabic and were surveyed in their preferred language. For televisits, the same survey was read to the patient by a certified translator. The survey consisted of 10 questions on a Likert scale of 1-5. Of them, 9 questions assessed patient satisfaction under the categories of access to care, interpersonal interaction, and quality of care. An additional question asked patients to describe and explain the reasons behind next visit preferences. Survey question responses were compared by paired t tests.ResultsAcross both immigrant and nonimmigrant patient populations, satisfaction with perceived quality of care was high, regardless of visit type (P=.80, P=.60 for televisits and P=.76, P=.37 for in-person visits). During televisits, immigrants were more likely to feel providers spent sufficient time with them (P<.001). Different perceptions were noted among nonimmigrant patients. Nonimmigrants tended to perceive more provider time during in-person visits (P=.006). When asked to comment on reasons behind next televisit preference, nonimmigrant patients prioritized convenience, whereas immigrants noted not having to navigate office logistics. For those who chose in-person visits, both groups prioritized the need for a physical exam.ConclusionsAlthough satisfaction was high for both telemedicine and in-person visits across immigrant and nonimmigrant populations, significant differences in patient priorities were identified. Immigrants found televisits desirable because they felt they spent more time with providers and were able to avoid additional office logistics that are often challenging barriers for non-English speakers. This suggests opportunities to use information technology to provide cultural and language-appropriate information throughout immigrants’ in-person and telemedicine visit experience. A focus on diminishing these barriers will help reduce health care inequities among immigrant patients.