sub-Saharan African Immigrants Research Articles

"The Children Are Not Controllable Because They Follow Western Values" - Narratives of the Parenting Experiences of African Immigrants in Alberta, Canada.

African immigrants are moving to high-income nations such as Canada in greater numbers in search of a better life. These immigrants frequently struggle with several issues, including limited social support, shifts in gender roles/status, cultural conflicts with their children, and language barriers. We used participatory action research (PAR) to gather data about Sub-Saharan African immigrants residing in Alberta, Canada, with a focus on their viewpoints, difficulties, and experiences of parenting children in Canada. We contextualized our study and its findings using both postcolonial feminism and transnationalism approaches. Study findings show African immigrant parents place a high priority on respect between generations. The absence of assistance, conflicts caused by culture, and language barriers are notable difficulties they encountered in parenting. An additional factor is a lack of acquaintance with and comprehension of the culture of their new home nation. Several implications stem from our findings, including the need for interventional research that explores effective, culturally relevant strategies for enhancing parenting among African immigrants. Our findings demonstrate the need for culturally sensitive policies and practices that support the transition and integration of African immigrant families into Canadian society. It is imperative for health care providers and policy makers to develop and revise culturally appropriate policies that take into consideration the importance of African immigrants in destination countries. Adopting culturally relevant policies and practices will improve the wellbeing of this growing but underprivileged minority of Canadians.

Depression and loneliness among Sub-Saharan immigrants living in the greater Paris area: results from the MAKASI empowerment stepped wedge cluster randomised controlled trial.

The MAKASI intervention aimed to empower Sub-Saharan African immigrants living in precarious situations in the Paris metropolitan area. Because there are factors specifically related to immigration that may increase the risk for common mental disorders, the present study aimed to examine participants' levels of depression and loneliness and analyze the effect of the intervention on depression and loneliness. The MAKASI study was designed as a stepped wedge cluster randomized trial. Study participants were recruited through an outreach program led by a nongovernmental organization and randomly assigned to two clusters, with an intervention delay of 3months between them. Participants were assessed for 6months after inclusion and the effect of the intervention on depression and loneliness was assessed using generalized linear mixed models. The study was conducted from 2018 to 2021 and took in consideration whether being interviewed during one of the Covid-19 confinement had an effect on the results. Between 2018 and 2021 a total of 821 subjects participated in the Makasi study. High levels of depression and loneliness were found in the study population. We found no effect of the intervention on depression [95% CI 0.77 to 2.40]. Similarly, no effect of the intervention was found on loneliness [95% CI 0.87 to 2.54]. The intervention tested did not appear to improve the level of depression and loneliness among participants. However, the high prevalence of mental and emotional problems in the study population suggests a public health crisis among immigrants in the greater Paris area. Trial registration Clinicaltrials.gov, NCT04468724 (July 13, 2020).

Abstract 1310: Social determinants of migrant health factors impacting prostate cancer care and survivorship among sub-Saharan African immigrant men diagnosed with prostate cancer

Abstract Background: Sub-Saharan African Immigrants (SSAI) represent one of the fastest-growing segments of the immigrant population in the United States (US). Between 2010 and 2018, the SSAI population in the US increased by 53%, significantly outpacing the 12% growth rate for the overall foreign-born population in the US during that time frame. Despite these growing numbers, little is published about the extent to which SSAIs adapt to health behaviors more common in the US or remain immersed in the values, beliefs and practices reflective of their country of origin. Importantly, no study has comprehensively examined the Social Determinants of Health (SDOH) among this population relative to their migration experiences and their influence on health-seeking behaviors and decision-making regarding prostate cancer care and treatment options. Methods: This qualitative study employed grounded theory and the social determinants of migrant heath framework to better understand the needs of SSAI prostate cancer survivors in the United States and how to effectively support these survivors. In-depth interviews were conducted with 8 survivors who live in the states of Florida and Minnesota. Findings: Some participants reported limited access to care and financial challenges paying for drugs. In terms of coping with diagnosis and treatment, most of the participants relied on their faith, a positive outlook about survivorship and support of family members. Some participants relied on the coaching and support of a loved one who experienced prostate cancer in the past. Erectile dysfunction severely impacted the sexual life of most participants as they experienced difficulty getting an erection. Conclusion: Participants expressed the benefit of belonging to support groups with other survivors for social and emotional support. As the number of immigrants from sub-Saharan continue to rise, so too will the demand for culturally tailored care to address and reduce disparities in survivorship among this sub-population. Citation Format: Ernest Kaninjing, Gladys Asiedu, Kaitlin Van Voorhis, Mary Ellen Young, Ebenezer Erefah, Emmanuel Agboola, Folakemi Odedina, Roxana Dronca, Kimlin Ashing, Solomon Rotimi, Che Ngufor, Arnola Merriweather, John McCall, Anthony Hill. Social determinants of migrant health factors impacting prostate cancer care and survivorship among sub-Saharan African immigrant men diagnosed with prostate cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1310.

From private dialect to public language: Transforming Moroccan Arabic through the voices of sub-Saharan African immigrants

Over the past few decades, Morocco has witnessed a surge of activity related to colloquial Moroccan Arabic, or Darija ( dārija), a vernacular variety of Arabic that is unstandardized and officially unrecognized. Darija has become increasingly present in domains that were previously reserved for standard Arabic ( fuṣḥā), and there has been a tangible shift in how Moroccans think about their “mother tongue.” Largely unremarked, though, is the fact that this linguistic shift has coincided with another major transition: the transformation of Morocco from a “sender” country to a “receiver” country, i.e., from a mere transit point for irregular Mediterranean migration to a sought-after destination for cosmopolitan African immigration. This article investigates the intersection of these two shifts by looking at the use of Darija by sub-Saharan African immigrants in Morocco. Based on fieldwork in two urban centers, Casablanca and Tetouan, it argues that Darija has become a key site for sub-Saharan African immigrants to negotiate their place in Moroccan society. It also argues that their growing audibility in the Moroccan soundscape is challenging commonplace assumptions about the limited and provincial nature of Darija. Ultimately, I contend that Darija is transitioning toward what Woolard (2016) has called a public language, and that this shift is due not only to Moroccan language activists but also to sub-Saharan African immigrants.

Access to healthcare services and confidence in healthcare professionals’ management of malaria: the views of Francophone sub-Saharan African Immigrants living in western Canada

BackgroundThere is a paucity of knowledge about the healthcare attitudes and practices of French-speaking immigrants originating from Sub-Saharan Africa (FISSA) living in minority settings. The purpose of this study was to characterize FISSA healthcare experiences and confidence in the malaria-related knowledge of health professionals in Edmonton.MethodsA structured survey was used to examine a cohort of 382 FISSA (48% female; 52% male) living in Edmonton. FISSA general healthcare attitudes, experiences and satisfaction with the Canadian healthcare system were studied. Healthcare Competency Perception (HCP) was characterized by using an index score. Statistical analyses were performed to evaluate the impact of healthcare experiences and other outcomes.ResultsIntriguingly, while only 42% of FISSA had a French-speaking family physician, 83% (197/238) of those who had received health care services in Alberta found that access to medical treatment was easy, and 77% (188/243) were satisfied with received care. Although 70% (171/243) of FISSA did not receive services in French, 82% (199/243) surprisingly reported having good levels of comprehension during their visits. Satisfaction with care was associated with having a family physician (p = 0.018) and having health insurance (p = 0.041). Nevertheless, confidence in the healthcare system’s ability to treat malaria effectively was significantly lower, with only 39% (148/382) receiving a positive score on the HCP index.ConclusionThis study provides an important insight into FISSA experience with and perception of the Alberta’s healthcare system.

Abstract A070: The influence of cultural factors on health-seeking behaviors regarding prostate cancer among African immigrant men in the United States

Abstract Background: The increasing number of African immigrants in the United States has contributed to the diversity of the country's Black population. However, there is limited research on the impact of immigration, particularly regarding chronic diseases like cancer, within the sub-Saharan African immigrant (SSAI) community. To address this gap, this study aimed to explore cultural factors among SSAIs to better understand the drivers of health disparities in prostate cancer outcomes. Methods: A qualitative approach using grounded theory was employed for this study. Participants were purposefully recruited to reflect the cultural diversity among SSAIs. Recruitment occurred at health fairs, community events and by snowball approach. In-depth interviews were conducted with 16 participants, including prostate cancer survivors. Nine participants have lived in the US for at least 10 years. The average age of participants was 51 years. Country of birth for study participants include, Nigeria, Ghana, Cameroon, Kenya, and Ethiopia. Interviews were transcribed, verified, and de-identified then imported into NVivo 12 software. Four research team members, three of them African immigrants, performed open and axial coding, with consensus on the emerging findings. Results: This study identified several key cultural factors influencing SSAI men’s health behaviors. These factors include the perception of cancer in their country of birth, the low priority given to preventative care in their country of origin, and reluctance to embrace a Westernized diet, the perception of cancer in their country of origin as a death sentence, viewing cancer as a spiritual/religious attack, and associating cancer with affluence. In addition, these cultural factors made participants hesitant to discuss cancer, relying on religion for healing instead of medical care, and seeking healthcare only for cure. Conclusion: This study illuminates key cultural factors among SSAI men that influence their health-seeking behaviors. These findings highlight the need for culturally tailored behavioral interventions to address these factors and improve health outcomes within this understudied population. Citation Format: Ernest Kaninjing, Motolani Ogunsanya, Kaitlin Van Voorhis, Gladys Asiedu, Assata Kokayi, Rae Walker Brennan, Mary Ellen Young, Folake Odedina. The influence of cultural factors on health-seeking behaviors regarding prostate cancer among African immigrant men in the United States [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A070.

Abstract A062: Intersecting acculturation and decision making about cancer screening among sub-Saharan African immigrant men: A qualitative study

Abstract Background: Sub-Saharan African immigrant (SSAI) men constitute one of the fastest-growing immigrant populations in the United States and a large heterogeneous group in cancer survivorship. Yet research has ignored decision making about health and behavioral risk factors among SSAI communities. Intersecting acculturation and culture-specific perceptions about cancer screening within decision-making frameworks may be an essential step towards developing meaningful interventions for immigrant men’s healthcare. Objectives: This study aimed to gain insight into cancer-related beliefs and health decision-making practices among sub-Saharan African immigrant men. Methods: A qualitative design intersecting grounded theory analysis was employed using 16 semi-structured, in-depth individual interviews with SSAI men residing in Georgia and Florida. Participants were recruited from health fairs, community events, and by snowball effect. The average age of participants was 51 years with country of birth including Cameroon, Ethiopia, Ghana, Kenya, and Nigeria. An interview guide was prepared with emphasis on SSAI’s perspectives on lifestyle factors for cancer and decision making about cancer screening. Data were audio-recorded, transcribed, and analyzed using open, inductive, and axial coding via NVivo 12 qualitative data analysis software. Results: Findings identified key cultural factors impacting barriers to and facilitators of SSAI men’s decision-making processes and health-seeking behaviors. Most participants making positive decisions reflected on intercultural health practices made in collaboration with clinicians, significant others and community partnerships. Most participants with negative decisions tended to consider socio-cultural barriers and shortcomings in US health-care system. Participants’ preventative care decisions about cancer screening differed. Conclusions: This qualitative study illuminated key cultural factors among SSAI men that influenced their decision making about cancer screening and health-seeking behaviors. Future research should investigate longitudinal and quantitative studies to test decision-making outcomes. Funding Source: This study is funded by the National Institute on Minority Health and Health Disparities (1R15MD017012-01A1). Keywords: Cancer health disparities, Decision-making, Immigrant men, Intersectionality, Qualitative study Citation Format: Assata Kokayi, Gladys Asiedu, Kaitlin Van Voorhis, Rae Walker, M.E. Young, Folakemi Odedina, Motolani Ogunsanya, Ernie Kaninjing. Intersecting acculturation and decision making about cancer screening among sub-Saharan African immigrant men: A qualitative study [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A062.

Abstract C106: Association between cancer risk perception and patient-centered communication and cervical cancer screening behavior among African Americans (AA) and Sub-Saharan African immigrant (SAI) women

Abstract Background- Black women in the US have disproportionately higher mortality and shortest survival than any ethnic or racial group for cervical cancer. Many factors contribute to the elevated cancer burden, including cancer risk perceptions and knowledge as well as patient centered communication behaviors that may influence cervical cancer screening uptake. Misperceptions of cancer risk and limited knowledge may decrease the use of preventive cancer screening. In addition, patients who encounter clinicians who practice communication not reflective of patient-centeredness may be less likely to participate in regular cancer screening. The aim of this study was to determine if cervical screening uptake among Black women was associated with cancer risk perceptions and knowledge and clinician communication behavior. Methods- We conducted a cross-sectional survey of Black women (African Americans (AA) and sub-Saharan African (SAI) recruited from Lexington, KY and surrounding towns. Data included sociodemographics, measures of cancer perceptions, and patient-centered communication. The chi-squared test of association and multiple linear regression were used to assess the unadjusted and adjusted associations among cancer risk perceptions and knowledge, patient-centered communication, and receipt of pap test. Data analysis was conducted using SAS, version 9.4 with an alpha of .05. Results- In the sample of 116 Black women who were age appropriate for pap screening (n = 48 SAI; n = 68 AA), nearly two-thirds had received a pap test (63%) in concordance with guidelines. Compared to those who had not had a pap, women who had received a pap test endorsed the statement ‘it seems like everything causes cancer (p=.006),’ while fewer agreed ‘when I think about cancer, I automatically think about death (p<.001)’. Both responses remained significant after adjusting for age, ethnicity, health insurance status and having a primary care provider. A higher proportion of women agreed with the six patient-centered communication items in the bivariate analysis, and remained significant in the adjusted modeling for the responses to the following three items: 1) During the past 12 months, how often did doctors, nurses, or other health professionals give you the chance to ask all the health-related questions you had?; 2) In the past 12 months, how often did you feel you could rely on doctors, nurses, or other health professionals to take care of your health care needs?; and 3) During the past 12 months, how often did doctors, nurses, or other health professionals make sure you understood the things you needed to do to take care of your health? Conclusion- Evaluation of cancer risk perceptions and patient-centered communication provide useful guidance for the development of interventions for Black women. Future research should target Black women that have misperceptions of cancer risk and limited knowledge for cervical cancer awareness. Clinicians should practice communication reflective of patient-centeredness to promote cervical cancer screening behavior. Citation Format: Adebola Adegboyega, Amanda Wiggins, Mark Dignan. Association between cancer risk perception and patient-centered communication and cervical cancer screening behavior among African Americans (AA) and Sub-Saharan African immigrant (SAI) women [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C106.

Abstract B018: An exploration of the prostate cancer survivorship experience of sub-Saharan African immigrants in the United States

Abstract Background: Prostate cancer (CaP) is a significant public health problem affecting men globally. In 2020, there were over 1.4 million new cases, making it the second most commonly occurring cancer in men worldwide. While CaP disproportionately affects men of African ancestry research studies often characterizes men of African descent as a homogenous group: Black. Subpopulations, such as sub-Saharan African immigrants (SSAI) in the US, are 1.5 times more likely to develop CaP compared to US born blacks. Health behaviors, cultural beliefs, and lived experiences of SSAI may be contributing factors to these disparities. With a 5-year relative survival rate of 97%, men are living longer after CaP diagnoses. This study aimed to explore the survivorship experiences of SSAI living in the US. Methods: 16 SSAI including CaP survivors aged 40 to 70 years participated in this qualitative study guided by Grounded Theory and the NIMHD Framework. A purposeful sampling was employed to ensure diversity in socioeconomic status, age, duration of stay in the US and country of origin. One-on-one interviews were conducted and transcribed, followed by a two-step verification process. Nvivo 12 was utilized for open, axial, and theoretical coding. Results: This study identified four major trends affecting survivors: (a) the impact of CaP on sexual health, (b) emotional health, (c) dietary changes, and (d) changes in physical activity. Participants reported CaP has reduced their ability to perform sexually, which in some cases, resulted in marital strife. Furthermore, major triggers of declining emotional health were mentioned by survivors including partner rejection and difficulties acculturating. Dietary changes were especially difficult due to the major change in available foods options in the US versus their home country. Multiple survivors expressed the hardship of limited access to fresh, healthy foods compared to unhealthy food options, making it challenging for them to have a healthy diet. Lastly, some survivors found it harder to be physically active in the US compared to their home country due to lifestyle, environment, and cultural differences. For instance, in the US, motorized vehicles are the most utilized form of transportation, but in most sub-Saharan African countries, walking is more common. Without walking, it is challenging for some survivors to achieve their physical activity goals in the US. Conclusion: This research illuminates how the CaP survivorship and acculturation experience are heavily intertwined, influencing one another. This interwoven relationship can be utilized in healthcare to facilitate improved CaP survivorship outcomes and to increase other positive health outcomes for SSAI.Key Words: African immigrants, survivorship, prostate cancer, sexual health, emotional health, diet, physical activity. Funding Source: This study is funded by the National Institute on Minority Health and Health Disparities (1R15MD017012-01A1). This study is also part of the Prostate Cancer Transatlantic Consortium (CaPTC) network. Citation Format: Walker B. Rae, Kaitlin Van Voorhis, Ernie Kaninjing. An exploration of the prostate cancer survivorship experience of sub-Saharan African immigrants in the United States [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B018.

Empowerment-based intervention and immigrant awareness of biomedical HIV prevention tools in France

Abstract Background Sub-Saharan African immigrants are particularly affected by HIV in France and social hardship is an indirect factor of HIV acquisition. While biomedical HIV prevention tools are available for HIV prevention, evidence suggests a lack of knowledge of these tools among immigrants from Sub-Saharan Africa. We analysed the impact of an empowerment-based intervention on the knowledge of treatment as prevention (TasP), Pre Exposure Prophylaxis (PrEP) and Post Exposure Prophylaxis (PEP) among a population of precarious sub-Saharan African immigrants. Methods Data were collected in the Makasi research project. Participants were recruited in public places based on their precarious situations, they were randomised into two groups (intervention and control) followed during six months between 2018 and 2021. We described the knowledge of biomedical HIV prevention tools at each follow-up time (0, 3, 6 months) and used random-effects logistic regression models to analyse the intervention effect on the level of knowledge of these tools. Results The majority of the participants were men (77.5%) and almost half of them arrived in France within 2 years prior to inclusion (49.3%). At the time of inclusion, 56% of participants knew about TasP, 6% knew about PEP and 4% knew about PrEP. Receiving the intervention increased the odds of knowing PEP (aOR=2.02 [1.09-3.75]; p < 0.026). Intervention effect were observed for TasP and PrEP only after 6 six months. We observed significant time effect for PEP (at 3 months aOR=4.26 [2.33-7.80]; p < 0.001; at 6 months aOR=18.28 [7.39-45.24]; p < 0.001) and PrEP (at 3 months aOR=4.02 [2.10-7.72]; p < 0.001; at 6 months aOR=28.33 [11.16-71.91]; p < 0.001). This time effect is linked to the associations outreach activities. Conclusions Our results suggest that exposure to the Makasi intervention combined with associations activities contributed to increase knowledge of biomedical HIV prevention tools among precarious sub-Saharan African immigrants. Key messages • The Makasi intervention improved the knowledge of biomedical HIV prevention tools. • One-shot empowerment-based intervention shows encouraging result for HIV prevention.

Barriers to Cervical Cancer Screening among Sub-Saharan African Immigrant Women in the United States: A Qualitative Report

Objective: Cervical cancer screening can prevent women across all age groups from developing cervical cancer (CC). However, Sub-Saharan African immigrant women (SAIW) sparsely engage in routine CC screening. Thus, developing prevention strategies to improve SAIW’s adherence to recommended CC screening guidelines is critical. To ensure that such strategies are successful, they must meet the needs of the target population. By conducting qualitative interviews with SAIW (N = 15), we aimed to get a deeper understanding of barriers to CC screening receipt. Methods: We asked SAIW about barriers to CC screening and possible ideas to facilitate their future screening behavior. Results: Our findings revealed that SAIW are especially affected by several major barriers: lack of awareness of CC guidelines, fear/fatalism, lack of resources (eg, a lack of time due to job and family commitment), other resource-related barriers (eg, unreliable mode of transport, and no health insurance), modesty, and overt bias. Participants indicated a preference for female healthcare providers for CC screening and suggested spousal involvement in CC intervention development to foster support. Conclusion: The identification of multi-level barriers indicates that multiple strategies are needed to improve the uptake of CC screening among SAIW.

Bridging the knowledge gap of biomedical HIV prevention tools among sub-saharan african immigrants in France. Results from an empowerment-based intervention

IntroductionBiomedical HIV prevention tools are available in France to prevent new infections. However, evidence suggests a lack of knowledge of these tools among sub-Saharan African immigrants, who are particularly affected by HIV due to social hardship, an indirect factor of HIV acquisition. We analysed the impact of an empowerment-based intervention on the knowledge of treatment as prevention (TasP), pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) in a population of precarious sub-Saharan African immigrants. MethodsData were collected throughout the MAKASI project. Following an outreach approach, participants were recruited in public places based on their precarious situations and followed for six months (0, 3, 6 months) between 2018 and 2021. Participants were randomized into two groups and received an empowerment intervention sequentially (stepped wedge design). We used random-effects logistic regression models to evaluate the intervention effect on the knowledge of biomedical HIV prevention tools. ClinicalTrials.gov Identifier: NCT04468724. ResultsThe majority of the participants were men (77.5%), and almost half of them had arrived in France within 2 years prior to inclusion (49.3%). At baseline, 56% of participants knew about TasP, 6% knew about PEP and 4% knew about PrEP. Receiving the intervention increased the odds of knowing about PEP (aOR = 2.02 [1.09–3.75]; p < 0.026). Intervention effects were observed for TasP and PrEP only after 6 months. We found significant time effects for PEP (at 3 months, aOR = 4.26 [2.33–7.80]; p < 0.001; at 6 months, aOR = 18.28 [7.39–45.24]; p < 0.001) and PrEP (at 3 months, aOR = 4.02 [2.10–7.72]; p < 0.001; at 6 months, aOR = 28.33 [11.16–71.91]; p < 0.001). ConclusionsWe showed that the intervention increased the knowledge of biomedical HIV prevention tools. The effect of the intervention was coupled with an important time effect. This suggested that exposure to the intervention together with other sources of information contributed to increased knowledge of biomedical HIV prevention tools among precarious sub-Saharan African immigrants.

Experiences and Challenges of African American and Sub-Saharan African Immigrant Black Women in Completing Pap Screening: a Mixed Methods Study.

Understanding Black women's Papanicolaou (Pap) screening experiences can inform efforts to reduce cancer disparities. This study examined experiences among both US-born US Black women and Sub-Saharan African immigrant women. Using a convergent parallel mixed methods design, Black women born in the USA and in Sub-Saharan Africa age 21-65 years were recruited to participate in focus groups and complete a 25-item survey about patient-centered communication and perceived racial discrimination. Qualitative and quantitative data were integrated to provide a fuller understanding of results. Of the 37 participants, 14 were US-born and 23 were Sub-Saharan African-born Black women. The mean age was 40.0 ± 11.0, and 83.8% had received at least one Pap test. Five themes regarding factors that impact screening uptake emerged from the focus groups: (1) positive and negative experiences with providers; (2) provider communication and interaction; (3) individual barriers to screening uptake, (4) implicit bias, discrimination, and stereotypical views among providers, and (5)language barrier. Survey and focus group findings diverged on several points. While focus group themes captured both positive and negative experiences with provider communication, survey results indicated that most of both US-born and Sub-Saharan African-born women experienced positive patient-centered communication with health care providers. Additionally, during focus group sessions many participants described experiences of discrimination in health care settings, but less than a third reported this in the survey. Black women's health care experiences affect Pap screening uptake. Poor communication and perceived discrimination during health care encounters highlight areas for needed service improvement to reduce cervical cancer disparities.

Exploring the educational needs and challenges faced by undocumented sub-Saharan students in Moroccan public schools

PurposeThe purpose of this study is to investigate the educational experiences of sub-Saharan African undocumented students in Moroccan public schools, as well as the perceptions of instructors regarding the challenges and needs of sub-Saharan students in the capital city of Morocco, Rabat.Design/methodology/approachA qualitative interpretative case study approach was implemented to investigate this topic. This study involved seven respondents who had experience working with sub-Saharan students in their classrooms.FindingsThe findings of this study indicate that Moroccan public schools provide sub-Saharan African students with free education and a welcoming and secure learning environment. However, inadequate educational conditions, such as deficiencies in the designed programs, possibly limited competence of teachers, lack of professional instructors capable of teaching migrants and insufficient resources, can all hinder the learning process and educational integration of sub-Saharan African students.Originality/valueThis study contributes to the limited body of research on intercultural education in the Northern African region. The educational challenges and needs of hundreds or thousands of sub-Saharan African immigrants settling in Morocco are often overlooked or not given adequate consideration in scholarly works.

Abstract B050: The iCCARE consortium for prostate cancer in Black men: Grounded theory study of the social determinant of health factors among African immigrant men diagnosed with prostate cancer

Abstract Background: Sub-Saharan African immigrants (SSAI) in the United States (US) constitute one of the fastest-growing segments of the immigrant population. Between 2010 and 2018, the SSAI population in the US increased by 53%, significantly outpacing the 12% growth rate for the overall foreign-born population in the US during that time frame. For the purposes of this study, we define SSAI as the 2 million individuals living in the US originally from the region of the African continent located south of the Saharan desert. Despite their growing numbers, little is published about the extent to which SSAI adapt to health behaviors more common in the US or remain immersed in the values, beliefs and practices reflective of their country of origin. Importantly, no study has comprehensively examined the social determinants of health factors among this population and its influence on health-seeking behaviors and decision-making regarding prostate cancer care and treatment options. This study employs the social determinant of migrant health framework to examine the impact of immigration on the health-seeking behaviors of SSAI including informed-decision making, psychosocial effects and coping mechanisms. This study will fill the void of research studies that link social determinant of health and immigration among SSAI. Methods: Grounded theory will guide the study design that include in-depth interviews to document the experiences of SSAI relative to health seeking behaviors, care, and treatment. We explore differences and similarities among participants based on country or region of origin in Africa. We employ the social determinants of migrant health framework to better understand the needs of SSAI prostate cancer survivors in the United States and how to effectively support these survivors. Results: We will present findings based on preliminary interviews conducted with SSAI prostate cancer survivors recruited from Florida or Minnesota. Additionally, we will report on the development of a SSAI social determinant of migration model that explains individual and structural factors that impact the health-seeking behaviors and coping mechanisms among this population. We will provide new understanding about specific social determinant of health factors that can be addressed in intervention studies among SSAI in the United States. Conclusion: This study examines the full range of racial, social, environmental, behavioral and structural factors that SSAI prostate cancer survivors experience. It will illuminate the decision-making process and overall quality of care among this understudied population. Citation Format: Ernie Kaninjing, Gladys Asiedu, Mary Ellen Young, Ebenezer Erefah, Folakemi Odedina, Roxana Dronca, Kimlin Ashing, Solomon Rotimi, Che Ngufor, Arnold Merriweather, Jennifer Crook, Manisha Salinas, Parisa Fathi, Sha’Reff Rashad, John McCall, Ayinde Yahaya. The iCCARE consortium for prostate cancer in Black men: Grounded theory study of the social determinant of health factors among African immigrant men diagnosed with prostate cancer [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B050.

Abstract A093: Cancer risk factors awareness and cancer perceptions among African Americans and Sub-Saharan African immigrants

Abstract Background: Cancer risk factors awareness and cancer perceptions may influence individuals’ engagement or lack of engagement in preventive health behaviors including cancer screening and lifestyle changes. Blacks in the US have disproportionately higher death rates and the shortest survival rates than any ethnic or racial group for most cancers. Many factors may contribute to the elevated cancer burden, including level of awareness of cancer lifestyle risk factors and negative cancer perceptions. However, further research is needed to know more about cancer risk awareness and perceptions among ethnic sub-groups of Blacks. Therefore, the objective of this study was to assess awareness of cancer risk factors and cancer perceptions among African Americans and sub-Saharan African immigrant adults. Methods: We conducted a cross-sectional self-administered survey of 109 African Americans and 88 sub-Saharan African Black adults recruited from a medium size city in the Southeastern US and surrounding towns. Data collected included sociodemographics, measures of cancer risk awareness, and cancer perceptions. Linear regression models evaluated associations among sociodemographics and cancer risk factor awareness and cancer perceptions variables. Results: Participants’ average age was 41.5 years (SD=12.9), the majority were female (59%), and (45%) self-identified as sub-Saharan African immigrants. Based on a list of 13 cancer risk factors, the average number identified correctly was 6.5 (SD = 3.3). For cancer risk perceptions, with higher scores reflecting more negative cancer perceptions, scores were moderate (M = 13.8, SD = 2.8; potential range 5-25). Age, insurance status, education, and financial comfort were significantly associated with cancer risk factor awareness. For cancer risk perceptions, insurance status, education, and financial comfort were significant in the unadjusted analysis. Education was the only significant predictor for each outcome. Every one-level increase in educational attainment was associated with a 0.5-point increase in cancer risk factor awareness (b = 0.499, SD = 0.229; p = .031) and a 0.5-point decrease in cancer risk perception scores (b = -0.500, SE = 0.201; p = .014). Age, gender, ethnicity, marital status, insurance status, and financial comfort were not associated with either outcome in the adjusted model. Conclusion: Additional research is needed to improve cancer awareness and perceptions among Black adults. Future research should target women at higher risk of low awareness of cancer risk factors and negative cancer perceptions due to lower educational attainment. Increased attention to health promotion using different avenues and ensuring literacy may improve awareness of cancer risk factors and cancer risk perceptions. Citation Format: Adebola Adegboyega, Adaeze Aroh, Amanda Wiggins, Mark Dignan. Cancer risk factors awareness and cancer perceptions among African Americans and Sub-Saharan African immigrants [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A093.

Beliefs associated with cancer screening behaviors among African Americans and Sub-Saharan African immigrant adults: a cross-sectional study

BackgroundBeliefs influence cancer screening. However, there are conflicting findings about how belief influence cancer screening among Black adults. The aim of this study was to evaluate the relationships between beliefs (religiosity, fatalism, temporal orientation, and acculturation) and cervical, breast, and colorectal cancer screening behaviors among African Americans and sub-Saharan African immigrants.MethodsWe conducted a cross-sectional survey of 73 African American and 59 English speaking Sub-Saharan immigrant adults recruited from Lexington and surrounding cities in Kentucky. Data collected included sociodemographic variables, cancer screening behaviors, and several instruments that characterize beliefs, including religiosity, fatalism, temporal orientation, and acculturation.ResultsParticipants’ mean age was 43.73 years (SD = 14.0), 83% were females, and 45% self-identified as sub-Saharan immigrants. Based on eligibility for each screening modality, 64% reported having ever had a Pap test, 82% reported ever having mammogram, and 71% reported ever having a colonoscopy. Higher education (OR = 2.62, 95% CI = 1.43—4.80) and being insured (OR = 4.09, 95% CI = 1.10 – 15.18) were associated with increased odds of cervical cancer screening (pap test), while cancer fatalism (OR = 0.24, 95% CI = 0.07 – 0.88) was associated with decreased odds. Increased age (OR = 1.57, 95% CI = 1.06 – 2.32) and reduced present orientation (OR = 0.42, 95% CI = 0.22 – 0.80) were associated with receipt of a mammogram. Nativity was the only factor associated with colonoscopy screening. Compared to African Americans, sub-Saharan African immigrants were 90% less likely to have had a colonoscopy (OR = 0.10, 95% CI = 0.02 – 0.66).ConclusionThis study contributes to the existing literature by confirming that beliefs are important in cancer screening behaviors among African American and sub-Saharan African immigrants. These findings should inform the development of cancer control and prevention programs for Black adults.Trial registrationUS National Library of Science identifier NCT04927494. Registered June 16, 2021, www.clinicaltrials.gov

Abstract 13589: Strong African Immigrant Social Network Influences Self-Care of African Immigrants With Chronic Illness

Background: Self-care is a fundamental component of chronic illness management. Although, there is increasing recognition that social networks can substantially impact the self-care of individuals with chronic illness, little is known about how social networks are associated with self-care among African immigrants living with hypertension, diabetes, or other chronic illness in the US. Methods: In this descriptive, cross-sectional study, we enrolled a convenience sample (n=128) of self-identified sub-Saharan African immigrants in the Northeastern U.S. age ≥ 35 years, with symptomatic chronic illness, who spoke and understood English. Self-care was measured with the Self Care of Chronic Illness Inventory measuring self-care maintenance, monitoring, and management (scores standardized 0-100, ≥70 adequate self-care). Social network was measured using four items that assess social network either with Americans or other African immigrants (e.g., “I spend my free time with African people”) using a 5-point response scale (1-Never to 5-Always); higher score=better social network. Multivariable linear regression was used to assess associations between social network and self-care adjusting for age, gender, marital status, education, employment status, and duration of US residency. Results: The sample on average was 56 years old (±11 years), male (68%), married (70%), college educated (82%), employed (66%), lived with family or others (89%), and had a long duration of residency (16±11 years). Most participants had hypertension (48%) and/or diabetes (20%). Self-care scores were adequate ( x 78.7, 79.3, 73.9 for self-care maintenance, monitoring and management). Social network as a composite score was positively associated with self-care maintenance (p=0.06). Social network with other African immigrants had a positive association with self-care maintenance (p=0.03) while social network with American people was not associated with self-care. Conclusions: In this sample of African immigrants, self-care was adequate. Having a strong social network with other African immigrants promoted self-care maintenance. Social networks of African immigrants can be used and harnessed in developing culturally concordant self-care interventions.

Knowledge of HIV prevention biomedical tools among African immigrants in France: the Makasi project

Abstract Background In France, post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP) have been available for several years. However, there is still no evidence on the level of knowledge of these HIV prevention tools among immigrants from sub-Saharan Africa living in precarious situations, a population particularly affected by HIV. The aim of this study is to describe the knowledge of these tools in this population and analyse the factors associated with this knowledge. Methods The data mobilized are from the Makasi interventional research that was conducted between 2018 and 2020 among immigrants from sub-Saharan Africa in precarious situations in the greater Paris area. Using data collected from 601 participants, we described levels of knowledge of HIV treatment effectiveness, treatment as prevention (TasP), post-exposure prophylaxis (PEP), and pre-exposure prophylaxis (PrEP), by sex with a chi2 test. We investigated factors associated with their knowledge with logistic regressions adjusted for sociodemographic characteristics, living conditions and sexual behaviors (p ≤ 0.2). Results The population surveyed was predominantly men (76%), from West Africa (61%) and in a precarious situation: 69% were unemployed, 74% were undocumented, 46% had no health coverage and 13% were homeless. In this population, knowledge of antiretroviral treatments for HIV prevention was heterogeneous: the effectiveness of HIV treatment was well known (84%), but only half of the respondents (46%) were aware of TasP and very few knew about PEP and PrEP: 6% and 5% respectively. Multivariable-adjusted models showed that these tools was better known by educated people, those who had a social network in France, those who have had access to the health system and those who were exposed to sexual risks. Conclusions While sub-Saharan African immigrants know the effectiveness of HIV treatment and use certain prevention tools such as HIV testing, they are not aware of PEP and PrEP. Key messages

African Immigrant's Women Experiences on Extended Family Relations.

African immigrants are increasingly migrating to high-income countries, including Canada, in search of a better life. These immigrants often face several challenges, such as keeping healthy ties with their extended families back home and in a new socio-cultural context. We present findings from a participatory action research (PAR) study of Sub-Saharan African immigrants and refugees (SSAIRs) living in Alberta, Canada. Using the theoretical framework of postcolonial feminism and transnationalism, in this study we investigated how cultural roots and transnational ties affect newcomer transition and integration to provide information on the female perspectives of SSAIRs. The results of the study indicate that maintaining relational ties with one’s extended family in the homeland has been highlighted as both a source of support—providing moral, social, religious, and cultural support during the integration processes—and strain, with participants noting its impact on their integration processes, such as delaying the ability to restructure life and to successfully plan their life financially. Our findings outline various implications of the existing gaps and recommendations for policymakers and community stakeholders for future improvement. Overall, our study findings affirm the importance of extended family relations for African immigrants living in Canada.