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Background: Type 2 diabetes (T2D) contributes to significant morbidity and mortality for Chinese immigrants in the United States, exacerbated by social determinants of health (SDOH) barriers such as language barriers, limited access to healthy foods, and low health literacy., Objective: The goal of the Integrating Cultural Aspects into Diabetes Education (INCLUDE) study is to test a social media-based intervention adapting the Diabetes Prevention Program (DPP) for Chinese immigrants alongside a culturally adapted, community-supported agriculture program. Here, we report the protocol for the INCLUDE study., Methods: INCLUDE is a 3-year randomized controlled trial (n=150). Participants with prediabetes or at risk for T2D are enrolled and randomized into either the control or intervention group (n=75 each). Participants from the intervention group receive 2-3 culturally tailored, in-language DPP videos weekly for 12 weeks, as well as biweekly phone calls from bilingual study staff to review video content, support goal setting, and assess and address SDOH-related barriers such as food insecurity. Intervention participants will also be given produce for 10 weeks as part of the community-supported agriculture program. Weight (primary outcome), self-efficacy, diet, physical activity, and food insecurity (secondary outcomes) are measured at baseline, 3-month, and 6-month intervals. Splined linear mixed models will be used to examine group differences in longitudinal weight and other secondary outcomes. The INCLUDE study was approved by the Institutional Review Board at the NYU Grossman School of Medicine., Results: Recruitment started in May 2023, with the first cohort of 75 participants enrolled and randomized into 2 groups in July 2023. The 3-month and 6-month assessment of the first-year cohort has been completed. We have recruited 75 participants for the second cohort as of July 2024., Conclusions: The INCLUDE study will serve as an innovative model for culturally adapted, multilevel interventions for underserved communities previously unable to access evidence-based diabetes prevention initiatives. Aligning with several national calls for multilevel interventions, the INCLUDE intervention will provide critical data that will inform how researchers and public health professionals address SDOH barriers faced by underserved populations and prevent diabetes., Trial Registration: ClinicalTrials.gov NCT05492916; https://clinicaltrials.gov/study/NCT05492916., International Registered Report Identifier (irrid): DERR1-10.2196/65455., (©Lu Hu, Nelson F Lin, Yun Shi, Jiepin Cao, Mary Ann Sevick, Huilin Li, Jeannette M Beasley, Natalie Levy, Kosuke Tamura, Xinyi Xu, Yulin Jiang, Iris Ong, Ximin Yang, Yujie Bai, Liwen Su, Sze Wan Chan, Stella S Yi. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 19.11.2024.)

While both the classroom cultural diversity climate and curriculum-based interventions can promote cultural identity development, they have not been studied together. Drawing on theories of ethnic-racial identity development, the current study aimed to understand the dynamic interplay of a curriculum-based intervention (the Identity Project) with the classroom cultural diversity climate (heritage culture and intercultural learning, critical consciousness socialization and equal treatment) on cultural identity exploration and resolution. Our sample included 906 mid-adolescents in Italy (32.36% immigrant descent, M age (SD) = 15.12 (0.68) years, 51.73% female), and 504 early adolescents in Germany (53.86% immigrant descent, M age (SD) = 12.82 (0.89) years, 42.37% female). Bayesian multivariate linear models show that the Identity Project and a stronger critical consciousness climate in the classroom before the intervention promoted cultural identity exploration at post-test in both countries. However, effects of the intervention and facets of the diversity climate on subsequent resolution were only observed in Italy. There was some evidence that the intervention could alter the classroom cultural diversity climate in Germany, while the intervention could compensate for a less positive diversity climate in the slightly older sample in Italy. Thus, it seems promising to systematically build in opportunities to engage with students' diverse heritage cultures and identities when developing new curricula, as well as to train teachers to implement such curricula., (© 2024. The Author(s).)

Aims: To evaluate a self-administered digital education resource for patients after a heart attack (adapted simplified Chinese version of Cardiac College™) on secondary prevention knowledge and health behaviour change outcomes., Methods and Results: Chinese immigrants recovering from a heart attack were recruited from cardiac rehabilitation programmes at four metropolitan tertiary hospitals. Participants provided access to Cardiac College™ (adapted simplified Chinese version), a self-learning secondary prevention virtual education resource over 4 weeks. The web-based resources include 9 booklets and 10 pre-recorded video education sessions. Assessments included health literacy, secondary prevention knowledge, self-management behaviours, self-reported physical activity, and a heart-healthy diet. Satisfaction, acceptability, and engagement were also assessed.From 81 patients screened, 67 were recruited, and 64 (95.5%) completed the study. The participants' mean age was 67.2 ± 8.1 years old, 81.2% were males, and the majority had no English proficiency (65.6%). Following the intervention, significant improvements were observed for secondary prevention knowledge overall and in all subdomains, with the most improvement occurring in medical, exercise, and psychological domains (P < 0.001). Dietary and self-management behaviours also improved significantly (P < 0.05). According to participants, the educational materials were engaging (100%), and the content was adequate (68.8%); however, 26.6% found the information overwhelming. Overall, 46.9% were highly satisfied with the resources., Conclusion: A self-learning virtual patient-education package improved secondary prevention knowledge and self-care behaviour in Chinese immigrants after a heart attack. The culturally adapted version of Cardiac College™ offers an alternative education model where bilingual staff or translated resources are limited., Competing Interests: Conflict of interest: none declared., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Inadequate comprehension of healthcare information contributes to poor health outcomes. Ethnic minorities are one of the populations most affected by low health and oral health literacy (OHL). The hypothesis of the current study was that an oral health education program (OHEP) can improve the OHL, oral health awareness and behaviors of refugees. We also hypothesized that there will be a difference between OHL in English and native language in the Pre-intervention phase. Fifty-two adult refugees participated in an educational program that included a comprehensive and culturally sensitive PowerPoint presentation and hands-on learning activities on oral health topics. The study used a cross-sectional pre-post study design. Before the program (Pre-intervention group), participants completed 2 surveys: Sociodemographic Survey and Oral Health Perceptions of Refugees in a bilingual format, and the Estimate of Oral Health Literacy-Bilingual40 (EOHL-BL40) in English, and in the participants' native language. Immediately after an OHEP (Post-intervention group), participants completed the EOHL-BL40 survey in English only. Two weeks after OHEP (Follow-up intervention), participants completed again the Sociodemographic Survey and Oral Health Perceptions of Refugees and the Estimate of Oral Health Literacy-Bilingual40 (EOHL-BL40) in English only. The mean percentage of words understood on Pre-intervention EOHL-BL40 survey were significantly higher in native languages (47.3% ±3.7%) compared with survey in English (15.3% ±1.2%, P < 0.001). Post-intervention scores, immediately after educational program, were higher (28.6% ±2.4%), P < 0.001) for survey in English compared with the Pre-intervention (15.3% ±1.2%). The follow-up (2 weeks later) scores (25.5% ±2.4) were slightly lower than Post-intervention but still significantly higher (P < 0.001) than Pre-intervention. Results for both Sociodemographic Survey and Oral Health Perceptions of Refugees surveys were similar: the OHEP positively affected oral health awareness and oral health behaviors. Results of the study suggested that OHEP may improve oral health literacy, oral health awareness, and personal oral hygiene practices of refugees., (© 2024. The Author(s).)

Objective: Despite increases in the US foreign-born population, medical education opportunities in immigrant and refugee health (IRH) remain limited. We summarize findings for published IRH curricula and offer recommendations for integrating IRH into pediatric residency programs., Methods: We performed a literature review of articles describing the design, implementation, or assessment of IRH curricula for US-based undergraduate and graduate medical trainees., Results: The literature review identified 36 articles from 21 institutions describing 37 unique curricula. Three curricula included pediatric residency programs. Commonly taught topics included cultural humility, interpreter use, and immigration status as a social determinant of health. Immigrant-focused training experiences existed at continuity clinics, clinics for refugees or asylum seekers, and dedicated electives/rotations. Curricula were most frequently described as stand-alone electives/rotations., Conclusions: IRH curricula provide opportunities to develop skills in clinical care, advocacy, and community partnerships with immigrant populations. Pediatric residency programs should align the IRH curriculum with existing learning priorities, support and hire faculty with expertise in IRH, and partner with community organizations with expertise. Programs can also consider how to best support learners interested in careers focusing on immigrant populations. Further work is needed to establish competencies and validated tools measuring trainee satisfaction and clinical competency for IRH curricula., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. This article was published as part of a supplement sponsored by the Robert Wood Johnson Foundation., (Copyright © 2024 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Introduction and Objective: Due to educational migration to Poland, students from Ukraine and Belarus may experience security to varying degrees. The aim of the study was to check the extent to which people from Ukraine and Belarus studying in Lublin feel safe, taking into account their own life and health. An attempt was also made to establish the relationship between the sense of security and selected features of the surveyed students., Material and Methods: The research was conducted using a survey method among 403 students from Ukraine, Belarus and Poland. Eight independent variables were introduced into the analysis of relationships: gender, age, self-assessment of the financial situation, country of origin, place of origin, place of residence during studies, and year of study. The dependency analysis used Wilcoxon and Kruskal-Wallisau tests and CATREG optimal scaling analysis., Results: The study showed that both Polish and foreign students assessed the level of safety in Poland and during their studies in Lublin as high. They feel safer during the day than after dark. Polish students are more afraid of theft, rape and being hit by a car than students from Belarus and Ukraine, and students from Ukraine are more afraid of verbal abuse. The predictors influencing students' sense of insecurity are, among others, their financial situation and gender., Conclusions: The conducted research and analysis of the obtained results suggest that the situation of students from Ukraine and Belarus studying in Lublin, Poland, in terms of safety, is similar to that of Polish students, and even better in some aspects. This result suggests that Lublin is a friendly academic centre for students from across the eastern border of Poland.

Pregnant people who are recent immigrants often face barriers navigating the health care system and establishing a support network to sustain them through pregnancy and new parenthood. The Cultivando una Nueva Alianza (CUNA) program from the Children's Home Society of New Jersey was created to address these obstacles. For over 20 years, CUNA has collaborated with local midwives to develop a program for newly immigrated, Spanish-speaking Latinx pregnant people. The curriculum, facilitated by trained members of the community, provides education around pregnancy, birth, and early parenting and connects participants with prenatal care and community resources while cultivating a social support network. The program's success is seen in improved clinical outcomes, ongoing involvement by graduates, and strong continued support from community stakeholders. The CUNA program has been replicated in nearby communities and offers a blueprint for a low-tech intervention to improve the health and wellness of this population., (© 2023 The Authors. Journal of Midwifery & Women's Health published by Wiley Periodicals LLC on behalf of American College of Nurse Midwives (ACNM).)

The COVID-19 pandemic disrupted schooling for children worldwide. Most vulnerable are non-citizen children without access to public education. This study aims to explore challenges faced in achieving education access for children of refugee and asylum-seekers, migrant workers, stateless and undocumented persons in Malaysia during the pandemic. In-depth interviews of 33 stakeholders were conducted from June 2020 to March 2021. Data were thematically analysed. Our findings suggest that lockdowns disproportionately impacted non-citizen households as employment, food and housing insecurity were compounded by xenophobia, exacerbating pre-existing inequities. School closures disrupted school meals and deprived children of social interaction needed for mental wellbeing. Many non-citizen children were unable to participate in online learning due to the scarcity of digital devices, and poor internet connectivity, parental support, and home learning environments. Teachers were forced to adapt to online learning and adopt alternative arrangements to ensure continuity of learning and prevent school dropouts. The lack of government oversight over learning centres meant that measures taken were not uniform. The COVID-19 pandemic presents an opportunity for the design of more inclusive national educational policies, by recognising and supporting informal learning centres, to ensure that no child is left behind., Competing Interests: The authors have declared that no competing interests exist.

Certain members of society are disproportionately affected by the COVID-19 crisis and the added strain being placed on already overextended health care systems. In this article, we focus on refugee newcomers. We outline vulnerabilities refugee newcomers face in the context of COVID-19, including barriers to accessing health care services, disproportionate rates of mental health concerns, financial constraints, racism, and higher likelihoods of living in relatively higher density and multigenerational dwellings. In addition, we describe the response to COVID-19 by a community-based refugee primary health center in Ontario, Canada. This includes how the clinic has initially responded to the crisis as well as recommendations for providing services to refugee newcomers as the COVID-19 crisis evolves. Recommendations include the following actions: (1) consider social determinants of health in the new context of COVID-19; (2) provide services through a trauma-informed lens; (3) increase focus on continuity of health and mental health care; (4) mobilize International Medical Graduates for triaging patients based on COVID-19 symptoms; and (5) diversify communication efforts to educate refugees about COVID-19., Competing Interests: Conflict of interest: We have no conflicting or competing interests to declare., (© Copyright 2021 by the American Board of Family Medicine.)

Nonnative English speakers may hesitate or avoid accessing healthcare in the United States due to cultural and communication barriers. Role-play is effective as a method of reducing healthcare access due to inadequate communication skills. A role-play activity used with female Muslim immigrants to the United States enabled participants to develop communication skills and gain confidence for future interactions with a healthcare provider.

This study examined longitudinal relations between emotion knowledge (EK) in pre-kindergarten (pre-K; M age  = 4.8 years) and math and reading achievement 1 and 3 years later in a sample of 1,050 primarily Black children (over half from immigrant families) living in historically disinvested neighborhoods. Participants were part of a follow-up study of a cluster randomized controlled trial. Controlling for pre-academic skills, other social-emotional skills, sociodemographic characteristics, and school intervention status, higher EK at the end of pre-K predicted higher math and reading achievement test scores in kindergarten and second grade. Moderation analyses suggest that relations were attenuated among children from immigrant families. Findings suggest the importance of enriching pre-K programs for children of color with EK-promotive interventions and strategies., (© 2020 Society for Research in Child Development.)

Parents and friends can help facilitate the academic engagement of newcomer immigrant youth during the early post-migration years. Using an accelerated longitudinal design and the integrative risk and resilience framework, we examined how parent home involvement and friendships were directly and indirectly associated with the development of newcomer immigrant youths' academic engagement. We used data from three waves (Years 3-5) of the Longitudinal Immigrant Student Adaptation study where a culturally diverse group of immigrant youth (N = 354, ages 10-17, M timeinUS  = 3.98 years, SD = 1.39) in the United States reported on their perceptions of parent home involvement (educational values and communication) and friendship (educational values and academic support) in Year 3 and on their academic engagement (behavioural and emotional) across 3 years. Findings showed high-stable behavioural and emotional engagement and direct positive associations between perceptions of parent home involvement and initial levels of behavioural and emotional engagement and between perceptions of friend educational values and initial levels of emotional engagement. Additionally, perceptions of parents' educational values indirectly contributed to initial levels of emotional engagement through positive associations with perceptions of friends' educational values. These findings can inform family-school partnerships and school-interventions targeting newcomer immigrant youths' engagement., (© 2020 International Union of Psychological Science.)

Hispanic immigrant health disparities are among the highest in the nation, especially related to obesity and access to health services. Healthy Fit (En Forma Saludable) is a health promotion program that leverages public health department infrastructure to address these disparities through the use of three key innovations explored in this article: community health workers (CHWs), motivational interviewing (MI), and vouchers for free preventative health services. CHWs trained in MI conduct a health screening and then distribute preventive service vouchers and health resources as needed based on screening results. Vouchers cover breast, cervical, and colorectal cancer screening, and several vaccinations including flu and human papillomavirus. Resources to support exercise, to support a healthy diet, to quit smoking, and to reduce risky drinking are also distributed as needed. CHWs then use MI to address perceived barriers and strengthen intrinsic motivation to make use of the health resources. Integrating these strategies provides a low-cost approach to promote healthy behavior in an underserved immigrant population.

Scholars have proposed that immigrant optimism explains why some immigrant students outperform their United States-born peers academically. Yet, immigrant optimism has not been directly measured. This study aims to test the immigrant optimism hypothesis by operationalizing it using the Children's Hope Scale. Using structural equation modeling, the author examined the associations between hope, immigrant generation, citizenship status, and academic outcomes among a sample of 2,369 Latino 14- to 17-year-old students. Though no difference by immigrant generation was found, undocumented students were more hopeful than their documented peers. This finding suggests that the documentation status has an indirect relative effect on academic outcomes via hope. This article reexamines the immigrant optimism as a resource that could be fostered among Latino youth, regardless of immigrant status., (© 2019 Society for Research in Child Development.)

Latina immigrants living in farmworker communities are a population in need of HIV risk reduction interventions due to their high risk for HIV and their limited access to health care and prevention services. The present study is the first to evaluate the efficacy of SEPA intervention on a cohort of 234 pre-established Latina immigrants living in farmworker communities in South Florida. SEPA is a CDC evidenced-based and Latinx culturally tailored HIV risk reduction intervention. Data were collected through structured interviews at baseline and 6-months post intervention and were analyzed using generalized linear mixed modeling. Results showed that SEPA was effective on increasing condom use during vaginal and anal sex with male partners, self-efficacy for condom use, intentions to negotiate safe sex and HIV-related knowledge from baseline to 6-months post intervention. These findings contribute to the evidence supporting the efficacy of SEPA by confirming previous results and demonstrating the efficacy of this intervention for Latinas of diverse backgrounds.

Academics in non-tenure-track positions encounter a unique set of challenges on the road toward tenure. Institutionalized policies and lack of mentors are additional burdens for foreign scientists, resulting in representation differences. Becoming a scientist has been a personal and moving journey in which my multiple selves intersect and clash every now and again. My identity as a scientist is a life project and has intersected with my other identities: a young Latina immigrant in Western Europe. This crossroad has molded, and at times, challenged my participation in science., (Copyright © 2020 Hernandez-Sanabria.)

Intensive lifestyle interventions targeting diet and physical activity are recommended for reducing atherosclerotic cardiovascular disease (ASCVD) risk in adults. However, existing interventions often do not reach immigrant populations because of a mismatch between the social, cultural, and environmental context of immigrants and Western bio behavioral models which underpin evidence-based lifestyle interventions. The South Asian Healthy Lifestyle Intervention (SAHELI) study is a type 1 hybrid design randomized controlled trial aimed at reducing ASCVD risk in South Asian Americans, a group at higher ASCVD risk than whites and other Asian Americans. The objective is to evaluate the clinical effectiveness and implementation potential of a community-based, culturally-adapted lifestyle intervention for South Asian adults. Participants (n = 550) will be randomized to printed healthy lifestyle education materials or SAHELI, a group-based lifestyle change program that includes weekly classes for 16 weeks and 4 booster classes though month 11. SAHELI integrates evidence-based behavior change strategies with culturally-adapted strategies and group motivational interviewing to improve diet, physical activity, and stress management. Follow-up assessments will occur at 6 and 12 months. We hypothesize that the SAHELI intervention group will have greater improvements in clinical ASCVD risk factors (weight, blood pressure, glycated hemoglobin, and lipids), physical activity, and psychosocial outcomes than the print material group at 6- and 12- months. We will use mixed-methods to examine SAHELI's potential for reach, adoption, implementation, and maintenance from the perspective of multiple stakeholders. This study offers the potential to increase the reach and effectiveness of evidence-based lifestyle interventions for South Asian adults at increased risk for ASCVD., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objectives: The aim was to assess the effects of a parental sex education program on knowledge, attitudes, self-efficacy, and practices among immigrant parents., Methods: A cluster randomized trial was conducted at immigrant activity centers in northern Taiwan. Recruited participants were randomly assigned to an experimental (four centers, n = 86) or control (four centers, n = 67) group. A practical booklet and a booster session were delivered. In total, 132 participants' knowledge, attitudes, self-efficacy, and practice of parenting sexual education were examined at the baseline and 6 weeks after the intervention., Results: After controlling for possible confounders, the posttest scores of self-efficacy of the experimental group were higher than those of the control group. The Johnson-Neyman procedure indicated that the intervention was effective for participants who had pretest knowledge, attitude, and practice scores of <14.62, <110.27, and <41.5, respectively., Conclusions: An intervention with both practical booklet and booster session can improve knowledge, attitudes, self-efficacy and practices of parental sex education among immigrant parents., Practice Implications: In addition to practical booklets, health care professionals should provide booster sessions that meet the needs of immigrant parents to prevent sexual problems among children and adolescents at an early age., Competing Interests: Declaration of Competing Interest The authors report no conflict of interest pertaining to this manuscript., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Somali American women have low rates of breast and cervical screening. This research aimed to test the feasibility and impact of religiously tailored workshops involving Somali American Muslim women and male imams to improve intention to undergo breast or cervical cancer screening. Religiously tailored workshops addressing cancer screening (each approximately 3 h in length) were conducted with 30 Somali American women and 11 imams. Pre- and post-test surveys measured attitudes toward screening, screening intention, and workshop experience. The workshops were feasible, and both the women and the imams found the workshops enjoyable as well as informative. The discussions of religiously tailored messages had a positive impact on attitudes toward cancer screening, and, for the women, a positive impact on intention to screen. Religiously tailored messages can be an important community asset for engaging Somali American Muslim women around the value of breast and cervical cancer screening.

Background and Objectives: Latino children in immigrant families experience health care disparities. Text messaging interventions for this population may address disparities. The objective of this study was to evaluate the impact of a Spanish-language text messaging intervention on infant emergency department use and well care and vaccine adherence., Methods: The Salud al Día intervention, an educational video and interactive text messages throughout the child's first year of life, was evaluated via randomized controlled trial conducted in an urban, academic pediatric primary care practice from February 2016 to December 2017. Inclusion criteria were publicly insured singleton infant <2 months of age; parent age >18, with Spanish as the preferred health care language; and at least 1 household cellular phone. Primary outcomes were abstracted from the electronic medical record at age 15 months. Intention-to-treat analyses were used., Results: A total of 157 parent-child dyads were randomly assigned to Salud al Día ( n = 79) or control groups ( n = 78). Among all participants, mean parent age was 29.3 years (SD: 6.2 years), mean years in the United States was 7.3 (SD: 5.3 years), and 87% of parents had limited or marginal health literacy. The incidence rate ratio for emergency department use for the control versus intervention group was 1.48 (95% confidence interval: 1.04-2.12). A greater proportion of intervention infants received 2 flu vaccine doses compared with controls (81% vs 67%; P = .04)., Conclusions: This Spanish-language text messaging intervention reduced emergency department use and increased flu vaccine receipt among a population at high risk for health care disparities. Tailored text message interventions are a promising method for addressing disparities., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2020 by the American Academy of Pediatrics.)

The authors designed and evaluated an innovative, branded campaign called 'Adelante' to promote positive youth development (PYD) and reduce risk behaviors among Latino youth near Washington, DC. Repeated cross-sectional surveys were conducted in the intervention and a comparison community to evaluate campaign exposure and changes in PYD outcomes. The sample consisted of 1549 Latino and immigrant adolescents surveyed at three time points in intervention and comparison communities. A social marketing campaign was implemented using outdoor advertising, Web, video and social media channels to promote PYD and health outcomes over a 1-year period from 2015 to 2016. Measures included media use; self-reported exposure to campaign promotions; Adelante message receptivity; validated PYD scales; substance use, sexual risk taking, violence-related knowledge, attitudes, beliefs, intentions and risk behavior. Outcomes were regressed first on campaign exposure to examine dose-response effects of the Adelante campaign over time. Second, we compared outcomes between the Adelante and comparison communities. We observed a positive effect of self-reported exposure on multiple outcomes, including improvements in pro-violence and sexual risk outcomes and lower pro-violence attitudes and lower risky attitudes toward sex. Adelante was effective in improving youth risk outcomes and offers a promising model for future health promotion with Latino and immigrant populations., (� The Author(s) 2019. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Latino/a populations in the United States are negatively impacted by widespread mental health disparities. Although the dissemination of culturally relevant parent training (PT) programs constitutes an alternative to address this problem, there is a limited number of efficacious culturally adapted PT prevention interventions for low-income Latino/a immigrant families with adolescents. The current manuscript describes the level of acceptability of a version of the GenerationPMTO ® intervention adapted for Latino/a immigrant families, with an explicit focus on immigration-related challenges, discrimination, and promotion of biculturalism. Qualitative reports were provided by 39 immigrant parents who successfully completed the prevention parenting program. The majority of these parents self-identified as Mexican-origin. According to qualitative findings, participants reported overall high satisfaction with immigration and culture-specific components. Parents also expressed high satisfaction with the core GenerationPMTO parenting components and provided specific recommendations for improving the intervention. Current findings indicate the need to adhere to the core components that account for the effectiveness of PT interventions. Equally important is to thoroughly adapt PT interventions according to the cultural values and experiences that are relevant to target populations, as well as to overtly address experiences of discrimination that negatively impact underserved Mexican-origin immigrant families. Due to the exploratory nature of this study, the efficacy and effectiveness of the adapted prevention intervention remains to be established in empirical research., (© 2018 Family Process Institute.)

Health literacy is a priority issue in both medicine and public health, as it refers to the capacity to obtain and understand basic health information and services and to make appropriate health decisions. Health literacy has been associated with a variety of health care and health outcomes such as hospital admissions, use of preventive services, management of chronic conditions, and mortality. There is also evidence of the connection between low health literacy and health disparities. Despite federal and private efforts, improving health literacy has proven to be an enormous challenge. The negative health consequences of low health literacy are being experienced by most minority groups; however, health literacy is particularly relevant to Spanish speakers. Although disparities in health literacy among language minorities have been sufficiently identified and reported, there continue to exist fundamental research gaps. This article discusses health literacy research and practice gaps affecting Spanish speakers and recommends educational opportunities as an effective strategy for improving the health literacy level of Hispanic immigrants.

Background: Rubella is a common exanthematous viral disease all over the world. The disease can be prevented by administering a safe and effective vaccine, and in Italy it is subject to reporting obligations. A national plan for the elimination of measles and congenital rubella (in Italian "PNEMoRC") was approved in 2003 and updated in 2010. This plan originally aimed at reducing the susceptible target population (women in fertile age, 15-49 years old) to below 5% and at eliminating the congenital form of rubella by 2015, a goal which has not been achieved yet., Study Design: Our research work was focused on a convenience sample of pregnant women attending the antenatal classes at the two main hospitals in Messina, Sicily (Italy)., Methods: After we obtained an informed consent, we administered to 200 Italian and foreign pregnant women an anonymous questionnaire reporting socio-demographic characteristics, type of gynaecological assistance and information received about Rubella serological statu., Results: The mean age was 30.6 years ± 5.45. The majority of these women were married, at work and with a high educational level. Most of them (75.3%) reported to be assisted by a private gynaecologist, while only 24.7% used a public facility. A remarkable percentage (62.8%) of these women reported to be serologically negative at the anti-rubella antibodies test, but, only 7.5% of them reported to have passed the anti-rubella antibody test before the conception., Conclusion: Our results clearly show that we are still far from achieving the elimination of rubella risk in pregnancy. We are facing a cultural gap perhaps also due to a generalized loss of "historical memory" about the impact that infectious diseases have had in the past in terms of mortality and morbidity. In fact, alongside the considerable drop in vaccination coverage in the recent years, our research also reveals a reduced focus on pre-conceptional testing and limited awareness of associated risks. Furthermore, we correlated the serological status with the sociodemographic characteristics of these women and found a statistically significant correlation with their age and their educational level (P<0.05). A lot still needs to be done to improve the situation; in particular, better education at various levels could considerably increase the awareness among women about this relevant public health issue.

Objective: To develop a scientifically sound and standardized medical language examination for the State of Bavaria according to the requirements set forth by the 87 th Conference of State Health Ministers. This Sprachtest für Ausländische Mediziner (SAM, Language Test for Foreign Physicians) ought to become part of the licensing procedure for foreign physicians in Germany. Using testing stations that are situation-based, it will assess medical language competence and communication skills at the proficiency level of C1. Methods: Case scenarios for four mini-interviews of 10 minutes each were developed. For the written part of the exam, consisting of two separate testing stations with a combined duration of 40 minutes, one video of a physician taking a patient's history and one annotated set of laboratory results were developed. Based on the analysis of existing scientific literature as well as real-life examples, features and characteristics of professional medical language were identified. This served as the basis for the development of itemized rating scales for each of the testing stations. The exam was validated in three simulated trial runs. Each run was video-recorded and subsequently graded by a team of test-raters. Results: 19 participants took part in the three trial runs. A benchmark (gold standard) could be set for 18 of these. A ROC-analysis yielded an AUC-value of .83. This confirmed the predictive quality of the SAM-test. The reliability of the SAM-test could be calculated for only ten participants. The internal consistency, calculated with the use of Cronbach's Alpha, was .85. The pass/fail mark was calculated based on the Youden-Index and yielded a result of >60%. Conclusion: The SAM-test presents a statistically valid medical language examination with a high level of objectivity. As required, it tests language proficiency at the level of C1 and uses authentic communication scenarios within a standardized test setting. Additional studies with larger test samples will help to further validate this test and thus guarantee a higher degree of reliability., Competing Interests: The authors declare that they have no competing interests.

Background: International marriages between Vietnamese women and Korean men have increased rapidly in Korea. Successful adaptation of these women is challenging, and concerns on the issue have been raised. Most existing studies have surveyed Vietnamese immigrant women in urban Korea; less is known about women residing in rural areas of Korea. Uncovering the experiences and perspectives of these women can inform the design of community support resources. The purpose of this study was to identify a typology to effectively describe the subjective perspectives of Vietnamese women residing in rural Korea on adaptation to Korean culture and society., Methods and Results: A Q-methodological study was conducted with five steps: construction of the concourse, Q sample, selection of participants, Q-sorting, and data analysis. Twenty-six Vietnamese women married to Korean men who attended local public health centers were surveyed and asked to rank-order 39 Q-statements using a 9-point scale. Principal component factor analysis using a pc-QUANL program was performed to identify adaptation sub-types. Four types of adaptation were identified and labeled: positive adaptation (35.54%), passive adaptation with reservations (8.33%), adaptation with frustration (6.20%), and adaptation and involvement (5.33%). These four types explained 55.40% of the total variance in the women's experience of adaptation to Korean culture and society., Conclusions: This study provides data that may be helpful in understanding the challenges immigrant women in rural areas of Korea face, and in planning family-sensitive adaptation support programs for these women and their families., Competing Interests: The authors have declared that no competing interests exist.

International migration of individuals or families seeking to improve economic conditions or escape political oppression increases each year. With migrant movement, there is a need for appropriate health care to meet their health beliefs and cultural health traditions. Nurses comprise a large portion of the healthcare workforce and yet, the number of immigrant nurses educated in their adopted country remains low. The aim of this study was to understand the learning experiences of immigrant registered nurses who graduated from an entry-level baccalaureate nursing program in the United States. A hermeneutic phenomenological approach with a Gadamerian focus was utilized. Purposive sampling identified five immigrant graduates who were individually interviewed using several open-ended questions in a non-structured format. Analysis identified an overarching theme, "being on the outside." Five subthemes emerged: harsh realities, disruptions, nurturance, resilience, and propagation. Recommendations from the interviews include: recognition and appreciation of each student, the nurse educator coming to know oneself first, followed by dialoguing with each student to perpetuate deeper understanding. Rather than accommodating the ethnically diverse immigrant nursing student through targeted interventions, the nurse educator should maintain an all-inclusive learning environment., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Beginning immigrant teachers may experience cross-cultural conflicts because their home cultures may differ in important ways from U.S. school culture. In California, mentors are assigned to work with new teachers, many born in other countries, to solve a range of problems-often attributable to cross-cultural conflicts between the culture of the school and the cultures of these teachers. Mentors are veteran teachers, but even those who receive special training as mentors are not educated in theories explaining how culture influences child-rearing and schooling practices. In this study, 12 beginning immigrant high school math and science teachers born in Asia and Latin America participated in lengthy, semi-structured interviews conducted by an experienced mentor specialist (not known to the participants). Conflicts reported by participants were analysed from the perspective of differences between the collectivistic cultures of the teachers and individualistic culture of the schools in which they teach. The conflicts reported, primed in part by the nature of interview questions, were categorised as having to do with differences in perceptions of the roles of parents, teachers and students and relations among those roles-particularly in terms of role hierarchy and regard for authority., (© 2018 International Union of Psychological Science.)

Introduction: Chronic hepatitis B (HBV) is prevalent among Asian immigrants in Canada with high morbidity and mortality rates. While some studies have identified barriers to health care and information access, few have studied the impact of culturally relevant information and addressed challenges with recommendations for effective public education and outreach programs., Methods: Culturally tailored HBV education workshops were delivered over a 12-month period to Chinese, Filipino, Korean and Punjabi immigrants in Lower Mainland, British Columbia (BC). Data from pre- and post-workshop surveys and 2-week and 1-month follow-up interviews were collected and analyzed to evaluate knowledge gaps and challenges around HBV prevention and screening. Barriers, health care service gaps and facilitators identified in the interviews were coded and analyzed., Results: Data were collected from 827 workshop participants. Our results show that targeted immigrants in Lower Mainland, BC face many barriers to accessing HBV screening and vaccination. Limited knowledge and awareness of HBV vaccination/prevention/treatment, limited English proficiency and eLiteracy skills, system and provider level barriers to accessing HBV care, and immigration related barriers are among the reported challenges. More than half of participants who took part in the HBV education workshops engaged in actions related to HBV prevention or management., Conclusion: Study findings support the need for culturally tailored HBV public education and outreach programs to further advance HBV immunization and awareness in BC. Addressing barriers and developing targeted programmatic strategies identified in this study will promote more effective HBV education programming and improve uptake of HBV screening and vaccination in BC's immigrant populations.

In light of calls for improving people's skill in collaboration, this paper examines strengths in processes of collaboration of Mexican immigrant children. Sibling pairs (6-10 years old) in California were asked to collaborate in planning the shortest route through a model grocery store. On average, 14 sibling pairs with Mexican Indigenous-heritage backgrounds engaged together collaboratively as an ensemble, making decisions in common and fluidly building on each other's ideas, more often than 16 middle-class European American sibling pairs, who on average more often divided decision making into a solo activity (often ignoring the other or simply bossing the other). Siblings who spent more time collaborating fluidly as an ensemble in the shared planning task were also more likely to collaborate with initiative at home, according to their mothers, which suggests that family socialization practices may contribute to cultural differences in collaboration., Competing Interests: The authors declare no conflict of interest.

The successful integration of immigrants into a host country's society, economy, and polity has become a major issue for policymakers in recent decades. Scientific progress in the study of immigrant integration has been hampered by the lack of a common measure of integration, which would allow for the accumulation of knowledge through comparison across studies, countries, and time. To address this fundamental problem, we propose the Immigration Policy Lab (IPL) Integration Index as a pragmatic and multidimensional measure of immigrant integration. The measure, both in the 12-item short form (IPL-12) and the 24-item long form (IPL-24), captures six dimensions of integration: psychological, economic, political, social, linguistic, and navigational. The measure can be used across countries, over time, and across different immigrant groups and can be administered through short questionnaires available in different modes. We report on four surveys we conducted to evaluate the empirical performance of our measure. The tests reveal that the measure distinguishes among immigrant groups with different expected levels of integration and also correlates with well-established predictors of integration., Competing Interests: The authors declare no conflict of interest., (Copyright © 2018 the Author(s). Published by PNAS.)

Background: The prevalence of North Korean female defectors is increasing in South Korea. Women who leave North Korea are exposed to sexual harassments, abuse, and other threats to their survival, which can have a devastating effect on their health., Aims: In this study, a mobile video intervention program about selected aspects of women`s health was developed specifically for North Korean female defectors; its impact on behavioral change was evaluated., Methods: A one group pre/posttest design was used with 61 female defectors who participated in the mobile video intervention. The program consisted of eight sessions focusing on the prevention and management of vaginitis and cervical cancer., Results: The study results showed that knowledge and behavioral confidence on vaginitis and cervical cancer increased significantly among the participants following the intervention., Conclusions: This mobile video intervention program was effective in improving specific health knowledge and behavioral confidence of the participants. The program can be used to improve women`s health in this population., (© 2018 Wiley Periodicals, Inc.)

Children of mothers affected by gestational diabetes mellitus (GDM) are at higher risk of long-term cardio-metabolic diseases. We explore the diet and physical activity knowledge and practices of Australian-born and overseas-born mothers with GDM history, for their three- to four-year-old children following antenatal health promotion education at a tertiary hospital. We conducted face-to-face, semi-structured interviews with 8 Australian-born and 15 overseas-born mothers with a history of GDM. Findings indicated that mothers of both groups were unaware of the increased health risks of their GDM for their children and could not recall receiving specific dietary or physical activity advice aimed at future child health. Their understanding of the diet and physical activity recommendations was inconsistent. Mothers of both groups expressed concern about the lack of reiteration of child health promotion messages following childbirth, particularly at postnatal follow-up visits. Diet and physical activity of the children of overseas-born mothers were adversely affected by inadequate maternal understanding of the recommendations due to language barriers, and child weight, healthy eating, and physical activity patterns derived from their home countries. We recommend enhanced health education for women with GDM on the future child health risks and their reduction by healthy lifestyle choices. This needs to be culturally relevant and reiterated after pregnancy.

Aims and Objectives: To explore the experiences of immigrant nurses working in Shanghai, China., Background: With the development of China, population growth has been accelerating. Simultaneously, the number of immigrant nurses in Shanghai has been increasing dramatically. Meanwhile, their turnover rate is abnormally high, primarily because of job concerns stemming from cultural differences. An understanding of immigrant nurses' job concerns caused by cultural differences can be used to help them to work more efficiently and cohesively. We aimed to investigate immigrant nurses' lived experiences regarding job concerns caused by cultural differences in Shanghai, China., Methods: This is a phenomenological study. In-depth semi-structured interviews were conducted with fifteen immigrant nurses from January-July 2016. Data were collected using audio-taped face-to-face interviews; the narratives were then transcribed verbatim and analysed thematically., Results: The following three major themes emerged from the data: "communication difficulties," "work adjustment difficulties" and "life adjustment difficulties." The eight sub-themes within these were as follows: (i) language barrier, (ii) inability to integrate oneself with the local culture, (iii) feelings of unfairness, (iv) difficulty asking for leave, (v) feeling stressed, (vi) not being acclimatised, (vii) feeling helpless and (viii) feeling guilt at being unable to take care of their family., Conclusion: It is important to implement appropriate training programmes on language and cultural adaptation for immigrant nurses. To enhance integrate immigrant nurses into Shanghai's society, more support needs to be provided., Relevance to Clinical Practice: Administrators in hospitals should pay attention to immigrant nurses' job concerns that are caused by cultural differences and provide timely and effective assistance., (© 2017 John Wiley & Sons Ltd.)

Deferred Action for Childhood Arrivals (DACA) is the first large-scale immigration policy to affect undocumented immigrants in the United States in decades and offers eligible undocumented youth temporary relief from deportation as well as renewable work permits. Although DACA has improved the economic conditions and mental health of undocumented immigrants, we do not know how DACA improves the social mobility of undocumented immigrants through its effect on educational attainment. We use administrative data on students attending a large public university to estimate the effect of DACA on undocumented students' educational outcomes. The data are unique because they accurately identify students' legal status, account for individual heterogeneity, and allow separate analysis of students attending community colleges versus four-year colleges. Results from difference-in-difference estimates demonstrate that as a temporary work permit program, DACA incentivizes work over educational investments but that the effect of DACA on educational investments depends on how easily colleges accommodate working students. At four-year colleges, DACA induces undocumented students to make binary choices between attending school full-time and dropping out of school to work. At community colleges, undocumented students have the flexibility to reduce course work to accommodate increased work hours. Overall, the results suggest that the precarious and temporary nature of DACA creates barriers to educational investments.

Early intervention programmes are designed to address complex inequities for Canadian families living with low income, affecting social relationships, well-being and mental health. However, there is limited understanding of resiliency and change in families living with low income over time. We conducted a mixed methods study with recent immigrant, other Canadian-born, and Aboriginal families living with low income, who attended a two-generation preschool programme (CUPS One World) between 2002 and 2008. The aim of this study was to develop an understanding of the processes of change. We included 134 children and their caregivers living with low income, and experiencing mental health problems, addiction or social isolation. Children's receptive language, a proxy for school readiness, was measured at programme intake, exit, and age 10 years using the Peabody Picture Vocabulary Test 3rd Edition (PPVT-III). In Phase I (quantitative), we identified children with receptive language scores in the top and bottom 25th percentile, informing participant selection for Phase II. In Phase II (qualitative), we engaged in constructivist grounded theory to explore experiences of 14 biological mothers, after their children (n = 25) reached age 10 years. Interviews were conducted between June and September 2015. The core category, Stepping Stones to Resiliency, encompassed Perceptions of Family, Moving Forward, Achieving Goals, and Completely Different. Perceptions of Family influenced families' capabilities to move across the Stepping Stones to Resiliency. Stepping Stones to Resiliency provides a lens from which to view others in their daily challenges to break free of painful intergenerational cycles. It is a reminder of our struggle, our shared humanness, and that movement towards resiliency is more difficult for some than others. Our findings challenge traditional episodic, biomedical treatment paradigms for low-income families also experiencing intergenerational cycles of mental health problems, addictions, social isolation, and family violence., (© 2017 John Wiley & Sons Ltd.)

Refugees have complex physical, psychological and social needs that are challenging to manage comprehensively in primary care. In recent years, many refugees settling in Australia have been sponsored by family members. Although they may receive settlement support, these new arrivals may not be assessed or managed by specialised refugee health services. Their sponsors usually link them to bilingual general practitioners, but these doctors may not be aware of or have access to a comprehensive range of services. There is an urgent need for more integrated health service provision for people from refugee backgrounds, based on trust and communication. This requires change at the practice, local service and system level., Competing Interests: MH is a volunteer medical officer at the Asylum Seekers Centre and a board member of the Central and Eastern Sydney Primary Health Network.

Responsive primary health care systems and services must be at once complex and nimble. Policy makers may wish to believe that existing health systems effectively care for all populations equally, including refugees. However, we know that refugees may require a health equity approach: an approach where all levels of government, all types of health practitioners, and even the public sector, participate to ensure access to effective primary health care. This article outlines some of Canada's healthcare responses for refugee populations. We provide field examples and guidelines that demonstrate responses, as well as ongoing inconsistencies and limitations. Refugee-receiving countries such as Australia, the US and Canada all have stories of success in resettlement and health systems. This article will focus on Canada., Competing Interests: None declared

Professor Peter Shergold was appointed as the New South Wales (NSW) Coordinator General for Refugee Resettlement in 2015, providing him with an opportunity to reimagine how the not-for-profit, public and private sectors could collaborate to improve the wellbeing of refugees settling in NSW, Australia. Through collaboration, NSW agencies are shifting the service response from one that is reactive to refugees' immediate settlement needs towards an investment approach that creates employment pathways. By identifying and building on refugees' strengths, resilience and human capital, Professor Shergold believes NSW can deliver better outcomes for both refugees and the communities they live in. PHRP asked him about his role, its objectives and its achievements., Competing Interests: None declared

Here we examine a conceptualization of immigrant assimilation that is based on the more general notion that distributional differences erode across generations. We explore this idea by reinvestigating the efficiency-equality trade-off hypothesis, which posits that stratified education systems educate students more efficiently at the cost of increasing inequality in overall levels of competence. In the context of ethnic inequality in math achievement, this study explores the extent to which an education system's characteristics are associated with ethnic inequality in terms of both the group means and group variances in achievement. Based on data from the 2012 PISA and mixed-effect location scale models, our analyses revealed two effects: on average, minority students had lower math scores than majority students, and minority students' scores were more concentrated at the lower end of the distribution. However, the ethnic inequality in the distribution of scores declined across generations. We did not find compelling evidence that stratified education systems increase mean differences in competency between minority and majority students. However, our analyses revealed that in countries with early educational tracking, minority students' math scores tended to cluster at the lower end of the distribution, regardless of compositional and school differences between majority and minority students.

Introduction: The majority of children with a migration background suffer from language deficits in one or both languages. The aim of our study was to describe the patterns of language acquisition in children with Turkish background in Austria and to find factors which influence these Patterns., Method: Fifty-two children at the age of 5 to 6 years and their parents were assessed. Inclusion criteria for parents were Turkish migration background and use of Turkish at home. Inclusion criteria for children: no hearing impairment, no blindness, no chronic disease, average cognitive development, born in Austria, and attending a kindergarten. Language competence was measured with Havas 5. Parents were administered a questionnaire about socio-demographics and their child centered literacy orientation (CCLO)., Results: There was a significant difference between language patterns in Turkish and German. Moreover, language competence was higher in both Turkish and German, the more parents tended to read to their children in Turkish., Discussion: Children acquired a grammatically correct but simple Turkish, while their competence in German was reduced. Reading to the children seems to stimulate language development not only of their natural language, but also of German., Conclusion: Early literacy in migrant languages should be integrated in training programs.

Background: Health literacy is considered a social health determinant that influences improvement in health, patient empowerment and reduction in inequalities. There is a lack of health literacy interventions for vulnerable social groups (i.e. immigrants), and nurses have shown little familiarity with the concept., Aim: This study aimed to identify and analyse whether interventions directed at immigrant populations improve the functional (basic reading, writing and arithmetic skills), interactive (social and cognitive skills) and critical (advanced cognitive and social skills in critically analyzing information and making informed decisions) dimensions of health literacy, taking into account the role played by nursing in these interventions., Methods: A systematic review of four databases including PubMed, PsycINFO, the Cochrane Library and ERIC was conducted to identify relevant articles published between 2000 and 2015. Thirty-four articles met the inclusion criteria, and nine articles used a validated instrument., Results: Few specific health literacy interventions for immigrant populations were found. The main findings of the studies showed positive changes in functional health literacy. However, the interventions were less effective in improving interactive and critical health literacy., Limitations: Several of the findings of this review were based on studies that had their own limitations. The assessment of the articles was not blinded, and the review was restricted to articles written in Spanish and English., Conclusions: The interventions studied were reported as being effective in improving health literacy in immigrants, particularly the functional aspects. Regarding the role played by nursing, this review observed little involvement., Implications for Nursing and Health Policy: It is important for educational strategies to include health literacy dimensions. The concept of health literacy should be included as a Nursing Outcomes Classification and in its subsequent validation taxonomy. To promote community health, health literacy must be a prioritized objective of health management and policies., (© 2017 International Council of Nurses.)

Purpose: To evaluate a healthy eating and physical activity intervention for immigrant families, derived through community-based participatory research., Design: The Healthy Immigrant Families study was a randomized controlled trial with delayed intervention control group, with families as the randomization unit., Setting: US Midwest city., Participants: Participants were recruited by community partners from Hispanic, Somali, and Sudanese immigrant communities., Intervention: Family health promoters from participating communities delivered 6 healthy eating modules, 4 physical activity modules, and 2 modules synthesizing information in 12 home visits (60-90 minutes) within the first 6 months. Up to 12 follow-up phone calls to each participant occurred within the second 6 months., Measures: Primary measures were dietary quality measured with weekday 24-hour recall and reported as Healthy Eating Index score (0-100) and physical activity measured with accelerometers (14 wear days) at baseline, 6, 12, and 24 months., Results: In total, 151 persons (81 adolescents and 70 adults; 44 families) were randomly assigned. At 12 months, significant improvement occurred in Healthy Eating Index scores for adults in the intervention group compared with controls (change, +8.6 vs -4.4; P < .01) and persisted at 24 months (+7.4 from baseline; P < .01). No differences were observed for adolescents and no significant differences occurred between groups for physical activity., Conclusion: This intervention produced sustained dietary quality improvement among adults but not among adolescents. Program outcomes are relevant to communities working to decrease cardiovascular risk among immigrant populations.