Alex Pirie

The impact of Immigration and Customs Enforcement on immigrant health: Perceptions of immigrants in Everett, Massachusetts, USA

U.S. immigrants have faced a changing landscape with regard to immigration enforcement over the last two decades. Following the passage of the Illegal Immigration Reform and Immigrant Responsibility Act of 1996, and the creation of the Immigration and Customs Enforcement (ICE) agency after the attacks of September 11, 2001, detention and deportation activity increased substantially. As a result, immigrants today are experiencing heightened fear of profiling and deportation. Little research exists on how these activities affect the health and well-being of U.S. immigrant communities. This study sought to address this gap by using community-based participatory research to investigate the impact of enhanced immigration enforcement on immigrant health in Everett, Massachusetts, USA, a city with a large and diverse immigrant population. Community partners and researchers conducted 6 focus groups with 52 immigrant participants (documented and undocumented) in five languages in May 2009. The major themes across the groups included: 1) Fear of deportation, 2) Fear of collaboration between local law enforcement and ICE and perception of arbitrariness on the part of the former and 3) Concerns about not being able to furnish documentation required to apply for insurance and for health care. Documented and undocumented immigrants reported high levels of stress due to deportation fear, which affected their emotional well-being and their access to health services. Recommendations from the focus groups included improving relationships between immigrants and local police, educating immigrants on their rights and responsibilities as residents, and holding sessions to improve civic engagement. Immigration enforcement activities and the resulting deportation fear are contextual factors that undermine trust in community institutions and social capital, with implications for health and effective integration processes. These factors should be considered by any community seeking to improve the integration process.

Feeding styles and child weight status among recent immigrant mother-child dyads

BackgroundResearch has shown that parental feeding styles may influence children’s food consumption, energy intake, and ultimately, weight status. We examine this relationship, among recent immigrants to the US. Given that immigrant parents and children are at greater risk for becoming overweight/obese with increased time in the US, identification of risk factors for weight gain is critical.MethodsBaseline data was collected on 383 mother-child dyads enrolled in Live Well, a community-based, participatory, randomized controlled lifestyle intervention to prevent weight gain in recent immigrant mothers. Socio-demographic information together with heights and weights were collected for both mother and child. Acculturation, behavioral data, and responses to the Caregiver’s Feeding Styles Questionnaire (CFSQ) were also obtained from the mother.ResultsThe children’s average age was 6.2 ± 2.7 years, 58% male. Mothers had been in the country for an average of 6.0 ± 3.3 years, and are Brazilian (36%), Haitian (34%) and Latino (30%). Seventy-two percent of the mothers were overweight/obese, while 43% of the children were overweight/obese. Fifteen percent of mothers reported their feeding style as being high demanding/high responsive; 32% as being high demanding/low responsive; 34% as being low demanding/high responsive and 18% as being low demanding/low responsive. In bivariate analyses, feeding styles significantly differed by child BMIz-score, ethnic group, and mother’s perceived stress. In multiple linear regression, a low demanding/high responsive feeding style was found to be positively associated (ß = 0.56) with a higher child weight as compared to high demanding/high responsive, controlling for known covariates (p = 0.01).ConclusionsMost mothers report having a low demanding/high responsive feeding style, which is associated with higher child weight status in this diverse immigrant population. This finding adds to the growing literature that suggests this type of feeding style may be a risk factor for childhood obesity. Further research is needed to help understand the larger socio-cultural context and its influence on feeding dynamics among immigrant families and families of lower incomes. How parents establish a certain feeding style in their home country compared to when they move to the US “obesogenic” environment, should also be explored.

Immigrating to the US: what Brazilian, Latin American and Haitian women have to say about changes to their lifestyle that may be associated with obesity.

Our goal was to explore the perceived determinants of obesity in Brazilian, Latin American and Haitian women. This is part of an ongoing community-based participatory intervention. Focus groups by immigrant group were conducted and themes extracted. Women expressed differences in beliefs, attitudes, and barriers regarding diet and physical activity in the US versus their home country. Participants thought food in the US is “less natural,” there is less time for preparation, and there is more variety. The weather is a barrier to physical activity in the US and work is more physically demanding. Job-related efforts were not considered physical activity. They reported higher levels of stress, less control of their time and less social support in the US. Providing immigrants with appropriate support and education early in the acculturation process has the potential to help prevent obesity.

Community-Engaged Pedagogy: A Strengths-Based Approach to Involving Diverse Stakeholders in Research Partnerships

Background: To help build community capacity to partner in translational research partnerships, new approaches to training that incorporate both adult learning models and community-based participatory research (CBPR) are needed. Objectives: This article describes the educational approach—“community-engaged pedagogy”—used in a capacity-building training program with community partners in Boston. Drawing from adult learning theory and CBPR community-engaged pedagogy embraces co-learning and is rooted in a deep respect for the prior knowledge and experiences that community partners bring to the conversation around CBPR. This approach developed iteratively over the course of the first year of the program. Participating community partners drove the development of this educational approach, as they requested the application of CBPR principles to the educational program. Methods: The dimensions of community-engaged pedagogy include (1) a relational approach to partnership building, (2) establishment of a learning community, (3) organic curriculum model, (4) collaborative teaching mechanism with diverse faculty, and (5) applied learning. Conclusions: Using a community-engaged pedagogical approach helps to model respect, reciprocity, and power sharing, core principles of CBPR. Although community partners appreciate this approach, traditionally trained academics may find this method unfamiliar and uncomfortable.

The Vida Verde Women's Co-Op: Brazilian Immigrants Organizing to Promote Environmental and Social Justice

We reviewed the key steps in the launch of the Vida Verde Womens Co-Op among Brazilian immigrant housecleaners in Somerville, MA. The co-op provides green housecleaning products, encourages healthy work practices, and promotes a sense of community among its members. We conducted in-depth interviews with 8 of the first co-op members, who reported a reduction in symptoms associated with the use of traditional cleaning agents and a new sense of mutual support. Critical to the co-ops success have been the supportive roles of its academic partners (Tufts University and the University of Massachusetts, Lowell), effective media outreach, and a focus on advancing social justice. Next steps include implementing a formal business plan and assessing the appropriateness of cooperatives in other industries.

Baseline Socio-demographic Characteristics and Self-Reported Diet and Physical Activity Shifts Among Recent Immigrants Participating in the Randomized Controlled Lifestyle Intervention: “Live Well”

The goal of this paper is to describe the baseline characteristics of Live Well (intervention to prevent weight gain in recent immigrant mother–child dyads from Brazil, Haiti, and Latin America) participants, and to explore self-reported changes in diet and physical activity post-immigration. Baseline data from 383 mothers were used for this study. Dyads attended a measurement day where they completed self-administered surveys collecting information about socio-demographics, diet, physical activity, other psychosocial variables, and height and weight. Haitian mothers’ socio-demographic profile differed significantly from that of Brazilians’ and Latinas’: they have been in the US for a shorter period of time, have higher rates of unemployment, are less likely to be married, more likely to have ≥3 children, more likely to be obese, and have immigrated for family or other reasons. In multivariate models, self-reported changes in diet and physical activity since migrating to the US were significantly associated with BMI with non-linear relationships identified. Future research is needed to understand how diet and physical activity change while acculturating to the US and explore the adoption of both healthy and unhealthy dietary changes.

Occupational Health and Safety Experiences among Self-Identified Immigrant Workers Living or Working in Somerville, MA by Ethnicity, Years in the US, and English Proficiency

In this community based research initiative, we employed a survey instrument predominately developed and administered by Teen Educators to assess occupational health risks for Haitian, Salvadoran, and Brazilian immigrants (n = 405) in Somerville, MA, USA. We demonstrate that a combined analysis of ethnicity, years in the US, and English proficiency better characterized the occupational experience of immigrant workers than considering these variables individually. While years in the US (negatively) and English proficiency (positively) explained the occurrence of health risks, the country of origin identified the most vulnerable populations in the community. Brazilians, Salvadorans, and other Hispanic, all of whom who have been in the US varying length of time, with varying proficiency in English language had twice the odds of reporting injuries due to work compared to other immigrants. Although this observation was not significant it indicates that years in the US and English proficiency alone do not predict health risks among this population. We recommend the initiation of larger studies employing c community based participatory research methods to confirm these differences and to further explore work and health issues of immigrant populations. This study is one of the small number of research efforts to utilize a contemporaneous assessment of occupational health problems in three distinct immigrant populations at the community level within a specific Environmental Justice context and social milieu.

Development of the Live Well Curriculum for Recent Immigrants: A Community-Based Participatory Approach

Background: There are few weight gain prevention interventions aimed at new immigrants. Live Well, a community-based participatory research (CBPR) study, was designed to address this gap.Objective: The goal of this paper is to describe the development of the Live Well nutrition and physical activity curriculum.Methods: The curriculum draws on behavioral theory and popular education and was co-created, implemented, and will be evaluated by community partners and academic researchers.Results: The time it took to develop the curriculum exceeded initial estimates. However, the extra time taken was spent engaging in needed dialogue to create a better product, fully co-created by academic and community partners. Additionally, working with an outside expert created the opportunity for all partners to train together, build capacity, and increase cohesion. Our approach developed relationships and trust, and resulted in a unique curriculum.Conclusions: The commitment to partnership resulted in a curriculum to empower immigrant women to improve health decisions and behaviors. This will inform future research and programming targeting other at-risk and new immigrant communities.

Crossing the chasm of mistrust: collaborating with immigrant populations through community organizations and academic partners.

As a community partner and an academic researcher, we experienced the direct and extended benefits of a relatively small-scale, community-engaged informed consent process that developed in an immigrant occupational health study, Assessing and Controlling Occupational Health Risks for Immigrant Populations in Somerville, Massachusetts. The practice of human participants research played a positive role in the community, and both community partners and researchers, as well as the larger academic community, reaped unexpected benefits during the five-year project (2005-2010), which continue into the present. Lessons learned from our experience may be helpful for wider application.

Creating a Culture of Empowerment in Research: Findings from a Capacity-Building Training Program

Abstract: Background: This paper uses a theory from educational research – “the culture of power” – to explore power differentials between academic researchers and community partners in community engaged research partnership programs. Objectives: This paper describes how a capacity-building program illuminated the tensions between academics and community partners related to power differentials and offers strategies for how to balance the power dynamic. Methods: This paper relies on semi-structured interviews from 30 community partners who participated in the “Building your capacity” program. Results: The framework of “culture of power” applied to research relationships helps us understand the following: (1) The power differentials between academic institutions and community agencies are deeply entrenched. That is there is a “culture of power.” (2) This culture of power is often reinforced through the cultural rules and dominant language of the academy. (3) Academic institutions, by and large, have created and perpetuated the rules that have led to these uneven power relationships. (4) Being told explicitly about the rules of academic culture make acquiring power easier for community partners. (5) Community partners are often more aware of the culture of power in research and more willing to acknowledge these differentials than academic researchers. Conclusions: Academic partners who want to work with community partners need to acknowledge these power imbalances and be intentional about shifting these power dynamics. Capacity-building programs can help to shift these power imbalances because they help community partners acquire the confidence, knowledge and skills to advocate for more equitable research relationships