Jennifer Cochran

Growth status and related medical conditions among refugee children in Massachusetts, 1995-1998

OBJECTIVES This study analyzed growth and identified related medical conditions among refugee children in Massachusetts. METHODS Between July 1995 and June 1998, 1825 refugee children were screened. Variables included positive tuberculin (purified protein derivative; PPD) test; dental abnormalities; pathogenic parasites; weight-for-age, height-for-age, and weight-for-height z scores; and body mass index greater than the 84th percentile. RESULTS Of all the children, 21% had parasites, 62% had caries, and 25% had a positive PPD reaction. Twelve percent overall and 28% younger than 2 years had anemia. Eight percent had height-for-age z scores less than -2, and 6% had weight-for-age z scores greater than +2. Of those aged 1 to 9 years, 7% had weight-for-height z scores greater than +2. Weight-for-height z scores less than -2 were concentrated among Africans and East Asians (both 8%). Height-for-age z scores less than -2 were seen among African (13%), Near Eastern (19%), and East Asian (30%) children. Weight-for-height z scores greater than +2 and body mass index greater than the 84th percentile were concentrated among children from the former Yugoslavia (8% and 15%) and the former Soviet Union (8% and 14%). CONCLUSIONS Recently arrived refugee children have significant growth abnormalities. European refugees were overweight; those from developing countries had growth retardation.

The Impact of Functional Health Literacy and Acculturation on the Oral Health Status of Somali Refugees Living in Massachusetts

OBJECTIVES We assessed the impact of health literacy and acculturation on oral health status of Somali refugees in Massachusetts. METHODS Between December 2009 and June 2011, we surveyed 439 adult Somalis who had lived in the United States 10 years or less. Assessments included oral examinations with decayed, missing, and filled teeth (DMFT) counts and measurement of spoken English and health literacy. We tested associations with generalized linear regression models. RESULTS Participants had means of 1.4 decayed, 2.8 missing, and 1.3 filled teeth. Among participants who had been in the United States 0 to 4 years, lower health literacy scores correlated with lower DMFT (rate ratio [RR] = 0.78; P = .016). Among participants who had been in the country 5 to 10 years, lower literacy scores correlated with higher DMFT (RR = 1.37; P = .012). Literacy was not significantly associated with decayed teeth. Lower literacy scores correlated marginally with lower risk of periodontal disease (odds ratio = 0.22; P = .047). CONCLUSIONS Worsening oral health of Somali refugees over time may be linked to less access to preventive care and less utilization of beneficial oral hygiene practices.

Tuberculosis screening among foreign-born persons applying for permanent US residence.

OBJECTIVES This study sought to determine adherence of physicians to tuberculosis (TB) screening guidelines among foreign-born persons living in the United States who were applying for permanent residency. METHODS Medical forms of applicants from 5 geographic areas were reviewed, along with information from a national physician database on attending physicians. Applicant and corresponding physician characteristics were compared among those who were and were not correctly screened. RESULTS Of 5739 applicants eligible for screening via tuberculin skin test, 75% were appropriately screened. Except in San Diego, where 11% of the applicants received no screening, most of the inappropriate screening resulted from the use of chest x-rays as the initial screening tool. CONCLUSIONS Focused physician education and periodic monitoring of adherence to screening guidelines are warranted.

Blood lead levels of refugee children resettled in Massachusetts, 2000 to 2007.

OBJECTIVES We described elevated blood lead level (BLL; ≥ 10 μg/dL) prevalence among newly arrived refugee children in Massachusetts. We also investigated the incidence of BLL increases and BLLs newly elevated to 20 μg/dL or higher in the year following initial testing, along with associated factors. METHODS We merged data from the Massachusetts Department of Public Healths Refugee and Immigrant Health Program and the Childhood Lead Poisoning Prevention Program on 1148 refugee children younger than 7 years who arrived in Massachusetts from 2000 to 2007. RESULTS Elevated BLL prevalence was 16% among newly arrived refugee children. The rate ratio for BLL elevation to 20 μg/dL or higher after arrival was 12.3 (95% confidence interval [CI] = 6.2, 24.5) compared with children in communities the state defines as high-risk for childhood lead exposure. Residence in a census tract with older housing (median year built before 1950) was associated with a higher rate of BLL increases after resettlement (hazard ratio = 1.7; 95% CI = 1.2, 2.3). CONCLUSIONS Refugee children are at high risk of lead exposure before and after resettlement in Massachusetts. A national surveillance system of refugee childrens BLLs following resettlement would allow more in-depth analysis.

A Private-Sector Preferred Provider Network Model for Public Health Screening of Newly Resettled Refugees

US law and regulations stipulate a process for the health screening of refugees. The responsibility of caring for refugees resettled in the United States rests, in part, with public health or welfare departments. Massachusetts has met its screening responsibilities through the innovative creation of a network of private preferred providers. We explore the Massachusetts model of public-private collaboration within the context of federal refugee health priorities and current state fiscal restraints affecting public health programs, and demonstrate the models accomplishments.

Understanding Bhutanese Refugee Suicide Through the Interpersonal-Psychological Theory of Suicidal Behavior

Attention has been drawn to high rates of suicide among refugees after resettlement and in particular among the Bhutanese refugees. This study sought to understand the apparent high rates of suicide among resettled Bhutanese refugees in the context of the Interpersonal-Psychological Theory of Suicidal Behavior (IPTS). Expanding on a larger investigation of suicide in a randomly selected sample of Bhutanese men and women resettled in Arizona, Georgia, New York, and Texas (Ao et al., 2012), the current study focused on 2 factors, thwarted belongingness and perceived burdensomeness, examined individual and postmigration variables associated with these factors, and explored how they differed by gender. Overall, factors such as poor health were associated with perceived burdensomeness and thwarted belongingness. For men, stressors related to employment and providing for their families were related to feeling burdensome and/or alienated from family and friends, whereas for women, stressors such as illiteracy, family conflict, and being separated from family members were more associated. IPTS holds promise in understanding suicide in the resettled Bhutanese community.

The Cultural Basis for Oral Health Practices among Somali Refugees Pre-and Post-Resettlement in Massachusetts

Background. Oral health disparities related to socioeconomic status have been well described in the U.S., but oral health among refugee groups has not been well characterized. This article examines oral health among Somali refugees in Massachusetts. Methods. Eighty-three (83) participants were purposively selected for an in-depth, open-ended interview related to oral health. Results. Older individuals associated use of the stick brush with the Islamic practice of cleansing before prayer. When unable to find stick brushes in the U.S., many adopted the Western toothbrush. Parents expressed concern that their children had adopted U.S. practices of brushing with a toothbrush only once or twice a day. Conclusions/implications. Somali oral health practices have changed following arrival to the U.S., but the underlying model for oral health care remains rooted in Islam. By acknowledging the value of traditional practices, dentists may communicate the value of Western preventive and restorative dentistry, and recommend approaches to integrating the two.

Acculturation and a Potential Relationship with Oral Health Outcomes Among Somali Refugees in Massachusetts

This paper explores the relationship between acculturation and oral health in a study of Somali refugees. This cross-sectional survey included structured surveys and dental examinations of a convenience sample of 439 Somali adults living in Massachusetts. Associations between an acculturation scale and: (1) lifetime history of caries and (2) access to oral health services were calculated. In bivariate analyses, many individual questions in the scale were associated with outcomes. In multivariate analysis, speaking English (OR 0.5, CI 0.28–0.84) was associated with better access to, and utilization of, dental health services while reading American books and newspapers in English was associated with increased lifetime history of dental disease (OR 2.6, CI 1.1–6.0). As specific elements of acculturation have different relationships with oral health among Somali refugees, a summary acculturation scale may have limited utility. Ongoing efforts to remove language barriers may improve oral health.

Vaccine delivery to newly arrived refugees and estimated costs in selected U.S. clinics, 2015

BACKGROUND Newly arrived refugees are offered vaccinations during domestic medical examinations. Vaccination practices and costs for refugees have not been described with recent implementation of the overseas Vaccination Program for U.S.-bound Refugees (VPR). We describe refugee vaccination during the domestic medical examination and the estimated vaccination costs from the US government perspective in selected U.S. clinics. METHODS Site-specific vaccination processes and costs were collected from 16 clinics by refugee health partners in three states and one private academic institution. Vaccination costs were estimated from the U.S. Vaccines for Children Program and Medicaid reimbursement rates during fiscal year 2015. RESULTS All clinics reviewed overseas vaccination records before vaccinating, but all records were not transferred into state immunization systems. Average vaccination costs per refugee varied from

Evaluation of Hepatitis B Virus Screening, Vaccination, and Linkage to Care Among Newly Arrived Refugees in Four States, 2009–2011

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