Sawsan Abdulrahim

Differences in self-rated health by immigrant status and language preference among Arab Americans in the Detroit Metropolitan Area

Arab Americans are a growing minority in the U.S., yet only a few studies have examined their health utilizing representative samples. Using data from the 2003 Detroit Arab American Study, which is based on a probability sample, we examined the self-rated health (SRH) of Arab Americans by two measures of acculturation--immigrant status and language preference. We specified logistic regression models to test whether immigrants report better or poorer health status compared to U.S.-born Arab Americans and whether language preference among the immigrant generation accounts for the association between immigrant status and SRH. Our findings reveal that the health status of Arab Americans improves with acculturation. Arab immigrants are more likely to report poorer SRH compared to U.S.-born Arab Americans. When language preference is taken into account, Arabic-speaking immigrants are more likely to report poorer SRH compared to both U.S.-born Arab Americans and to English-speaking immigrants. We discuss these findings in light of similar ones obtained in the literature on SRH among other immigrant groups in the U.S. We conclude by arguing that language is an important measure to include in SRH studies among Arab Americans as well as other non-English speaking ethnic groups.

Survey Methods and Aging Research in an Arab Sociocultural Context—A Case Study from Beirut, Lebanon

OBJECTIVES In Arab countries, the proportion of older adults is rapidly increasing, highlighting the need to conduct research on factors that influence aging. We describe the context-specific challenges faced and the solutions negotiated during the conduct of a survey study on family relations and aging in Greater Beirut, Lebanon. METHOD Drawing on the experience of a recently completed survey study, we reflect on the context-specific challenges faced and the solutions negotiated during the phases of questionnaire construction, interviewer training, sampling, and participant recruitment as a means to contribute to the growing area of cross-cultural survey research. RESULTS The social context of family relations influenced the nature of questions that can be included to obtain valid information. The unavailability of demographic data and the presence of cultural norms that promote deference to older adults also presented methodological challenges to the sampling and recruitment of older adults. DISCUSSION We provided illustrative examples on the importance of learning about a countrys social and cultural contexts, and the necessity of exercising flexibility in decision making to ensure the collection of valid data and the successful completion of the study. Lessons learned inform elements of the research process in an Arab country, as well as bring to light unusual, yet generalizable, circumstances that will inform experiences in other cultural settings.

Is self-rated health a valid measure to use in social inequities and health research? Evidence from the PAPFAM women's data in six Arab countries.

IntroductionSome evidence from high-income countries suggests that self-rated health (SRH) is not a consistent predictor of objective health across social groups, and that its use may lead to inaccurate estimates of the effects of inequities on health. Given increased interest in studying and monitoring social inequities in health worldwide, the aim of the present study was to evaluate the validity of SRH as a consistent measure of health across socioeconomic categories in six Arab countries.MethodsWe employed the PAPFAM population-based survey data on women from Morocco, Algeria, Tunisia, Lebanon, Syria, and the Occupied Palestinian Territories (OPT). Multivariate logistic regression analyses were performed to assess the strength of the association between fair/poor SRH and objective health (reporting at least one chronic condition), adjusting for available socio-demographic and health-related variables. Analyses were then stratified by two socioeconomic indicators: education and household economic status.ResultsThe association between SRH and objective health is strong in Algeria, Tunisia, Lebanon, Syria, and OPT, but weak in Morocco. The strength of the association between reporting fair/poor health and objective health was not moderated by education or household economic status in any of the six countries.ConclusionAs the SRH-objective health association does not vary across social categories, the use of the measure in social inequities in health research is justified. These results should not preclude the need to carry out other validation studies using longitudinal data on men and women, or the need to advocate for improving the quality of morbidity and mortality data in the Arab region.

Social and Cultural Meanings of Self-Rated Health: Arab Immigrants in the United States

Self-rated health (SRH) is used as an outcome measure in a vast number of epidemiologic studies, yet conceptual research into what the variable captures among diverse ethnic and immigrant groups remains limited. Utilizing data from 46 in-depth interviews among adult Arab immigrants in the United States, we examined the general criteria used to explain an SRH selection and the culturally embedded rationales individuals employ to construct meanings of health. Our findings showed that SRH is determined by two main criteria: presence/absence of health conditions and psychological well-being. In-depth analyses further revealed that Arab immigrants employ culturally embedded rationales to move away from extremes and project a view of good health as a state of balance and poor health as a state of imbalance. Our study adds to the limited conceptual knowledge on the meanings of subjective health evaluations among immigrants, and the findings suggest that exploring rationales provides richer information than focusing on criteria alone.

Social Networks and Health Among Older Adults in Lebanon: The Mediating Role of Support and Trust

OBJECTIVES Despite a growing body of literature documenting the influence of social networks on health, less is known in other parts of the world. The current study investigates this link by clustering characteristics of network members nominated by older adults in Lebanon. We then identify the degree to which various types of people exist within the networks. This study further examines how network composition as measured by the proportion of each type (i.e., type proportions) is related to health; and the mediating role of positive support and trust in this process. METHOD Data are from the Family Ties and Aging Study (2009). Respondents aged ≥60 were selected (N = 195) for analysis. RESULTS Three types of people within the networks were identified: Geographically Distant Male Youth, Geographically Close/Emotionally Distant Family, and Close Family. Having more Geographically Distant Male Youth in ones network was associated with health limitations, whereas more Close Family was associated with no health limitations. Positive support mediated the link between type proportions and health limitations, whereas trust mediated the link between type proportions and depressive symptoms. DISCUSSION Results document links between the social networks and health of older adults in Lebanon within the context of ongoing demographic transitions.

Development and Validation of the Arab Youth Mental Health Scale

A variety of measures of mental health have been used with youth. The reason for choosing one scale over another in any given situation is rarely stated, and cross-cultural validation is scarce. Psychometric testing is crucial before utilizing any measure of mental health with a certain population, due to possible cultural variations in interpreting meaning. The research reported herein describes the development and psychometric testing of the Arab Youth Mental Health Scale. The process included 5 phases: (1) reviewing existing scales leading to the identification of 14 non-clinical and relatively short mental health scales used previously with youth; (2) rating the scales by the researchers and community members leading to the identification of 3 scales with apt structure, and that were judged to be suitable, applicable, and appropriate; (3) soliciting youth input to assess comprehension of each item in the selected 3 scales and to discover context specific mental health related feelings, thoughts, and expressions; (4) seeking expert opinion to classify items remaining after phase 3 that measured common mental disorders, and to limit repetitiveness; and (5) testing for psychometric properties of the 28 items that remained after the previous 4 phases. The contribution of each phase to the process is described separately. Results of the exploratory principal component analysis resulted in one factor which explained 28% of the variance and for which 21 items loaded above an eigenvalue of 0.5. No other factor added significantly to the explanation of variance, nor had items that added theoretical or conceptual constructs. The process of soliciting feedback from youth groups, the community and professionals; and of field testing was challenging; but resulted in a contextually sensitive, culturally appropriate and reliable scale to measure mental health of youth. We recommend that researchers measuring mental health of youth critically analyze the relevance of existing scales to their context; consider using the AYMH scale if appropriate to their target population; and when needed, use a similar methodology to construct a relevant, culturally and contextually sensitive measure.

Validation of the Arab Youth Mental Health scale as a screening tool for depression/anxiety in Lebanese children

BackgroundEarly detection of common mental disorders, such as depression and anxiety, among children and adolescents requires the use of validated, culturally sensitive, and developmentally appropriate screening instruments. The Arab region has a high proportion of youth, yet Arabic-language screening instruments for mental disorders among this age group are virtually absent.MethodsWe carried out construct and clinical validation on the recently-developed Arab Youth Mental Health (AYMH) scale as a screening tool for depression/anxiety. The scale was administered with 10-14 year old children attending a social service center in Beirut, Lebanon (N = 153). The clinical assessment was conducted by a child and adolescent clinical psychiatrist employing the DSM IV criteria. We tested the scales sensitivity, specificity, and internal consistency.ResultsScale scores were generally significantly associated with how participants responded to standard questions on health, mental health, and happiness, indicating good construct validity. The results revealed that the scale exhibited good internal consistency (Cronbachs alpha = 0.86) and specificity (79%). However, it exhibited moderate sensitivity for girls (71%) and poor sensitivity for boys (50%).ConclusionsThe AYMH scale is useful as a screening tool for general mental health states and a valid screening instrument for common mental disorders among girls. It is not a valid instrument for detecting depression and anxiety among boys in an Arab culture.

Aging in Lebanon: Challenges and Opportunities

This spotlight offers a unique window into factors affecting aging in Lebanon. As a bridge between east and west, both geographically and culturally, Lebanon has the fastest growing older adult population in the Arab region, but few societal resources to address its needs. In a country with a history of political instability and war, but also a culture with strong family values, aging adults in Lebanon are vulnerable in some ways and advantaged in others. Outmigration of youth is an important determinant of the wellbeing of the elderly. While often advantaged by remittances sent by their children, older Lebanese adults have less access to instrumental social and personal support previously provided by young adults in the family. How Lebanon manages these challenges is likely to foreshadow the future aging experience for much of the Arab region.

The Cost of Being Palestinian in Lebanon

For over 60 years, long-term Palestinian refugees have been largely excluded from participating in the Lebanese labour force, yet no study has examined the socio-economic consequences of such exclusion. Utilising data from a survey conducted in three low-income urban neighbourhoods in Beirut in 2002, this paper provides a descriptive analysis of the cost of being Palestinian in Lebanon. Our findings reveal that, while exclusionary policies have not been successful at completely barring Palestinians from participating in the Lebanese labour force, this participation takes place at a cost. Palestinian men are segregated into less-desirable segments of the mainstream economy and earn lower wages than Lebanese men in virtually all educational and occupational categories. While Palestinian women are also segregated, they are more represented in professional occupations and in the health and social service sector. Nonetheless, this group pays the highest cost in wages due to the accumulated disadvantage of being Palestinian and female in the Lebanese context.

The Potentials and Challenges of an Academic–Community Partnership in a Low-Trust Urban Context

Academic–community collaborative partnerships have gained increasing acceptance as a model to assess and intervene on complex health problems in disadvantaged communities. True partnerships are instrumental to community-based participatory research (CBPR) methods, which strive to engage community members in all phases of research or intervention projects.1,2 The early wave of CBPR partnership studies were carried out in urban contexts in the USA. They produced promising evaluation findings,3,4 and the CBPR model has since been employed in research among minority groups in the USA and in other countries.5,6 Continuing evaluation of partnerships in international settings is crucial to shaping and expanding their potential in empowering communities and addressing health inequities worldwide.