The Immigrant Health Initiative Solange Muller, MPH. Hank Schmidt, MD, PhD & Audrey Waltner, MPH NYS PHA 2014

Transcription

1 The Immigrant Health Initiative Solange Muller, MPH Hank Schmidt, MD, PhD & Audrey Waltner, MPH NYS PHA 2014

2 The foreign-born population in Dutchess County has experienced a 43% increase in the last 10 years (8.4% in 2000 to 12% in 2010). In spite of increasing population, immigrants are underrepresented in patients presenting for care. New York Medical College study counties in Lower Hudson Valley Barriers to access to health care Recommended further study

3 Principal Investigators Dutchess County Department of Health Funders: Collaborators:

4 Collect data on the health status of the recent immigrant population from both rural and urban settings. Examine potential barriers impacting preventive, primary, and specialty care access. Develop new interventions to address existing barriers and to improve the overall health status of the recent immigrant population.

5 Target areas with high concentrations of immigrants Rural Eastern Dutchess Sample size Urban City of Poughkeepsie Sample size Target population individuals > 18 years old who entered the U.S. in the last 10 years 100 question survey in Spanish and English Personal health Healthcare seeking behaviors Barriers to access Field tested as a pilot and optimized Administered by Principal Investigator and 2 trained assistants Targeted Recruitment: ESL classes, farms, restaurants, convenience stores, gathering places for immigrants, health center waiting rooms, immigrant homes.

6 290 immigrants entering US within 10 yrs 141 (48.6%) Rural Eastern Dutchess 149 (51.4%) Urban City of Poughkeepsie 81% undocumented Mean age 33, Median age 31 Female 54.5%, Male 45.5% Race/Ethnicity Hispanic/Latino 92.4% White 1.7% Black 2.8% Other 1.0% 61% came alone 83% knew someone here

7 Characteristics Total Eastern Dutchess Poughkeepsie N = 290 N = 141 (48.6%) N = 149 (51.4%) p Value Region of Origin Mexico 59.7% 41.8% 76.5% Central America 26.9% 47.5% 7.4% Guatemala 23.8% 46.1% 2.7% South America 9.0% 9.9% 8.1% Caribbean 3.1% 0.0% 6.0% Africa 0.7% 0.0% 1.3% Asia 0.7% 0.7% 0.7%

8 No one has ever taken this much interest in my life and in my experiences. Thank you Sara

9 Seeking Healthcare Services - Regional Comparison 60% 50% Eastern Dutchess Poughkeepsie 40% 30% 20% 10% 0% No visits Only when sick For sick & well care

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11 70% 60% 50% Gender Differences in Seeking Health Care Male Female 40% 30% 20% 10% 0% Never go to doctor Go only when sick Go for sick & well care Every 1-2 years Sometimes Never Seek Health Care (p=0.001) Routine Physical Exam (p=0.015)

12 Females were much more likely to engage in preventive health or routine health care visits than males (34.2% vs 19.7%). The rate of never going to the doctor was much higher among males than females (28.8% vs 3.8%). Residence in the US > 5 years Living with children under 18 years old 90.8% preventive health visits 84.8% became aware of services via word of mouth

13 Question Total Eastern Dutchess Poughkeepsie p value N = 246 N = 141 N = 149 Difficulty getting to the doctor 25.0% 33.0% 18.3% Reasons for difficulty N = 58 N = 35 N = 22 Transportation 70.2% 97.1% 17.1% Getting time off from work 15.8% 8.6% 17.1% Other 29.8% 8.6% 39.0%

14 In multivariate analysis, speaking English was not a significant factor in seeking health care. However, English speaking immigrants were twice as likely to engage in preventive care Language was more important in rural setting Immigrants selected health center based on Spanish language speaking providers Often traveled farther to see these providers

15 Total Population (N = 290) Country of Origin U.S. Hypertension 7.6% 11.0% p Value Diabetes 2.8% 6.2% Heart disease 2.1% 2.4% Cancer 0.0% 0.7% Sexually transmitted diseases (STD) 0.7% 2.8% HIV 0.0% 0.0% Depression 9.7% 18.3% p = 0.004

16 Almost two thirds of immigrants acknowledged use of herbal remedies (63.4%) in country of origin and 36.6% acknowledged use in the U.S. Over half of those who used these remedies in the U.S. indicated they did not admit use of herbal remedies to their doctor. Nearly half (47.1%) said their doctor did not ask about use of herbal remedies because the doctor was not interested in knowing about herbal remedies (21.6%), or the doctor would want them to take Western medicines instead (21.6%).

17 Reasons for Sadness & Depression Regional Comparison Miss family Alone/isolated Unwelcome/unwanted Housing/work Poughkeepsie Problems with partner Eastern Dutchess 0% 20% 40% 60% 80% 100%

18 Kinship Circles of Support Solange Muller Principal Investigator

19 Take advantage of a significant female gender bias in initial health care engagement Develop services targeting immigrants dealing with loss and stress of separation from family, community and culture. Program Goals: To improve the health of immigrant families, in particular women, and to enhance access to resources. To connect individuals and families to their local communities to ease the stress and loss resulting from loss of family, community and culture.

20 Importance of accessing health care for the entire family Nutrition and healthy eating Chronic disease prevention Prevention of Type 2 Diabetes Stress reduction techniques Lifestyle changes

21 Knowledge increased on diabetes, hypertension, cholesterol, depression. All participants and their spouses had a preventive physical exam indicating healthcare involvement for the whole family. Changes in their food and beverages choices and improvement in Body Mass Index (BMI) Sharing among the participants led to connections, support, minimizing feelings of loss and isolation. Involvement empowers immigrant women to be leaders and help fellow immigrants in the community.

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23 Goals 30 trained CHWs Increase healthcare access for diverse populations by linking community and health center Increase preventive care particularly regarding Type 2 diabetes Increase general health understanding

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25 Goals: To help prevent Diabetes Type 2 To help reduce rates of obesity by addressing healthy eating and stress related eating

26 Goals: To help promote lifestyle changes To help alleviate the feelings of isolation and sadness by listening to the patient

27 Goals: To engage the entire family into preventive health care To improve the health of new New Yorkers by considering cultural, economic and social factors.

28 The Health of Recent Immigrants to the Lower Hudson Valley and the Challenges Faced by Those Who Serve Them, School of Public Health, New York Medical College, August 31, A study of the Health Care of Recent Immigrants in Dutchess County, New York. Hank Schmidt, MD PhD, Audrey M. Waltner MPH, Solange T. Muller, MPH. February Permission granted by the Community Foundation of Dutchess County to use the photograph of the two immigrants. Permission granted by Catholic Charities to use the photograph of the immigrant women in the Kinship Circles of Support group. Permission granted by Hudson River HealthCare to use the photographs of the Community Health Workers, Peekskill. Permission granted by the immigrants to use their photographs.

29 Solange Muller, MPH Immigrant Health Initiative (845)

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