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Background: Despite achievements in the reduction of malaria globally, imported malaria cases to the United States by returning international travelers continue to increase. Immigrants to the United States from sub-Saharan Africa (SSA) who then travel back to their homelands to visit friends and relatives (VFRs) experience a disproportionate burden of malaria illness. Various studies have explored barriers to malaria prevention among VFRs and non-VFRs–travelers to the same destinations with other purpose for travel–but few employed robust epidemiologic study designs or performed comparative analyses of these two groups. To better quantify the key barriers that VFRs face to implement effective malaria prevention measures, we conducted a comprehensive community-based, cross-sectional, survey to identify differences in malaria prevention knowledge, attitudes, and practices (KAP) among VFRs and others traveling to Africa and describe the differences between VFRs and other types of international travelers. Methods and findings: Three distinct populations of travelers with past or planned travel to malaria-endemic countries of SSA were surveyed: VFRs diagnosed with malaria as reported through a state health department; members of the general VFR population (community); and VFR and non-VFR travelers presenting to a travel health clinic, both before their pretravel consultation and again, after return from travel. A Community Advisory Board of African immigrants and prior qualitative research informed survey development and dissemination. Across the three groups, 489 travelers completed surveys: 351 VFRs and 138 non-VFRs. VFRs who reported taking antimalarials on their last trip rated their concern about malaria higher than those who did not. Having taken five or more trips to SSA was reported more commonly among VFRs diagnosed with malaria than community VFRs (44.0% versus 20.4%; p = 0.008). Among travel health clinic patients surveyed before and after travel, VFR travelers were less successful than non-VFRs in adhering to their planned use of antimalarials (82.2% versus 98.7%; p = 0.001) and employing mosquito bite avoidance techniques (e.g., using bed nets: 56.8% versus 81.8%; p = 0.009). VFRs who visited the travel health clinic were more likely than VFR respondents from the community to report taking an antimalarial (83.0% versus 61.9%; p = 0.009), or to report bite avoidance behaviors (e.g., staying indoors when mosquitoes were out: 80.9% versus 59.5%; p = 0.009). Conclusions: We observed heterogeneity in malaria prevention behaviors among VFRs and between VFR and non-VFR traveler populations. Although VFRs attending the travel health clinic appear to demonstrate better adherence to malaria prevention measures than VFR counterparts surveyed in the community, specialized pretravel care is not sufficient to ensure chemoprophylaxis use and bite avoidance behaviors among VFRs. Even when seeking specialized pretravel care, VFRs experience greater barriers to the use of malaria prevention than non-VFRs. Addressing access to health care and upstream barrier reduction strategies that make intended prevention more achievable, affordable, easier, and resonant among VFRs may improve malaria prevention intervention effectiveness. [ABSTRACT FROM AUTHOR]

Introduction: When Hmong refugees arrived in the U.S. from 1975 to 1997, no epidemiological studies measured the prevalence of or development of cardiovascular diseases (CVD) (such as hypertension and diabetes) or CVD risk factors (such as obesity, high blood pressure, and high cholesterol). Some recent studies on convenience samples estimated prevalence rates as: overweight 49%, obesity 31%, hypertension 18-24%, and diabetes 13-40%. This study measured the prevalence of CVD and CVD risk factors in Hmong refugees recently arrived from an unofficial refugee camp at War Tham Krabok (WTK), Thailand. Methods: Cross-sectional descriptive epidemiological study of 1462 Hmong refugees from WTK who received refugee screening exams at seven primary care clinics in St. Paul MN, from June 2004 to December 2005. Results: Significant percents of adults and children/adolescents had CVD risk factors. Of 448 people >20 years old, 48.2% were overweight or obese (BMI >=25). Using Asian BMI, 71.7% were overweight or obese (BMI >=23). Also, 16.5% had hypertension (BP-systolic > 140 or BP-diastolic >90) and 36.2% had pre-hypertension (BP-systolic 120-139 or BP-diastolic 80-89). For a subset, 2.8% had diabetes mellitus (glucose >200), 31.7% had hyperglycemia (glucose 100-199), 25.8% had hyperlipidemia (total cholesterol >200), 7.4% had renal failure (GFR7.5 female, >8.2 male). For 988 people 0-20 years old, 13.7% were overweight and 9.6% had hypertension. For a subset, 20.7% had hyperglycemia, and 13.% had hyperlipidemia. Conclusion: Hmong refugees had significant CVD risk factors on arrival, and are at risk for developing significant CVD over time. Community health programs need to be implemented to decrease the development of CVD for the Hmong community, whether people arrived in 1975-1997 or 2004-2005. And an epidemiological study measuring CVD incidence needs to be conducted. [ABSTRACT FROM AUTHOR]