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The Journey to Wellness: Stages of Refugee Health Promotion and Disease Prevention

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Abstract

Refugees experience a threefold challenge to their health and well-being: 1) psychiatric disorders precipitated by the refugee experience, 2) infectious and parasitic diseases endemic to countries of origin, and 3) chronic diseases endemic to host countries. This paper documents the “journey to wellness” in which these challenges are faced in stages by the refugees themselves and by the array of health and social service agencies committed to providing refugee assistance. Using the experience of a consortium of agencies in San Diego as an example, we examine the interaction between these challenges and the mobilization of organizations to develop a program of health promotion and disease prevention for Somali and other East African refugees. This mobilization involves a series of steps designed to facilitate refugee confidence, comprehension, and compliance with prevention efforts through community-provider partnerships and negotiation between refugee and organizational explanatory models of disease causation and prevention.

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REFERENCES

  1. Toole MJ, Waldman RJ: Refugees and displaced persons: War, hunger, and public health. JAMA 1993; 270:600-605

    Google Scholar 

  2. Lipson JG, Omidan PA: Health issues of Afghan refugees in California. West J Med 1992; 157:271-275

    Google Scholar 

  3. Kinzie JD, Boehnlein JK, Leung PK, Moore LJ, Riley C, Smith D: The prevalence of posttraumatic stress disorder and its clinical significance in southeast Asian refugees. Am J Psychiatry 1990; 147:913-917

    Google Scholar 

  4. Kinzie JD, Frederickson RH, Ben R, Fleck J, and Karls W: Posttraumatic stress disorder among survivors of Cambodian concentration camps. Am J Psychiatry 1984; 141:645-650

    Google Scholar 

  5. Mollica RF, Wyshak G, Lavelle J: The psychosocial impact of war trauma and torture on southeast Asian refugees. Am J Psychiatry 1987; 144:1567-1572

    Google Scholar 

  6. Mollica RF, McInnes K, Sarajliac N, Lavelle J, Sarajliac I, Massagli MP: Disability associated with psychiatric comorbidity and health status in Bosnian refugees living in Croatia. JAMA 1999; 282:433-439

    Google Scholar 

  7. Williams CL, Berry JW: Primary prevention of acculturative stress among refugees: Application of psychological theory and practice. Am Psychol. 1991; 46:632-641

    Google Scholar 

  8. Palinkas LA: Health under stress: Asian and Central American refugees and those left behind: Introduction. Soc Sci Med 1995; 12:1591-1596

    Google Scholar 

  9. Zuber PL, Knowles LS, Binkin NJ, Tipple MA, Davidson PT: Tuberculosis among foreign-born persons in Los Angeles County, 1992—1994. Tuber Lung Dis 1996; 77:524-530

    Google Scholar 

  10. DeRiemer K, Chin DP, Schecter GF, Reingold AL: Tuberculosis among immigrants and refugees. Arch Intern Med 1998; 158:753-760

    Google Scholar 

  11. Slutsker L, Tipple M, Keane V, McCance C, Campbell CC: Malaria in east African refugees resettling to the United States: Development of strategies to reduce risk of imported malaria. J Infect Dis 1995; 171:489-493

    Google Scholar 

  12. Hayes EB, Talbot SB, Matheson ES, Pressler HM, Hanna AB, McCarthy CA: Health status of pediatric refugees in Portland ME. Arch Pediatr Adolesc Med 1998; 152:564-568

    Google Scholar 

  13. Walker PF, Jaranson J: Refugee and immigrant health care. Med Clin North Am 1999; 83:1103-1120

    Google Scholar 

  14. Jenkins CN, McPhee SJ, Bird JA, Bonilla NT: Cancer risks and prevention practices among Vietnamese refugees. West J Med 1990; 153:34-39

    Google Scholar 

  15. Hazuda H, Haffner S, Stern M, and Eifler CW: Effects of acculturation and socioeconomic status on obesity and diabetes in Mexican Americans: The San Antonio Heart Study. Am J Epidemiol 1988; 128:1289-1301

    Google Scholar 

  16. Dodson DJ, Hooton TM, Buchwald D: Prevalence of hypercholesterolaemia and coronary heart disease risk factors among southeast Asian refugees in a primary care clinic. J Clin Pharm Ther 1995; 20:83-89

    Google Scholar 

  17. Westermeyer J, Neider J, and Callies A: Psychosocial adjustment of Hmong refugees during their first decade in the United States: A longitudinal study. J Nerv Ment Dis 1989; 177:132-139

    Google Scholar 

  18. Berry JW, Kim U. Acculturation and mental health: In: Dasen P, Berry JW, Sartorius N, eds. Health and Cross-cultural Psychology: Towards Application. Beverly Hills, CA: Sage; 1988:207-236

    Google Scholar 

  19. Popkin BM, Udry JR: Adolescent obesity increases significantly in second and third generation U.S. immigrants: The National Longitudinal Study of Adolescent Health. J Nutrition 1998; 128:701-706

    Google Scholar 

  20. Westermeyer J: Substance use disorders among young minority refugees: Common themes in a clinical sample. NIDA Res Monogr 1993; 130:308-320

    Google Scholar 

  21. Palinkas LA, Pickwell SM: Acculturation as a risk factor for chronic disease among Cambodian refugees in the United States. Soc Sci Med 1995; 40:1643-1653

    Google Scholar 

  22. Bermingham M, Brock K, Tran D, Yau J, Tran-Dinh H: Smoking and lipid cardiovascular risk factors in Vietnamese refugees in Australia. Prev Med 1999; 28:378-385

    Google Scholar 

  23. Uba L: Cultural barriers to health care for Southeast Asian refugees. Public Health Rep 1992; 107:544-548

    Google Scholar 

  24. Baughan DM, White-Baughan J, Pickwell S, Bartlome J, Wong S. Primary care needs of Cambodian refugees. J Fam Pract 1990; 30:565-568

    Google Scholar 

  25. Curtin L, Brown RA, Sales D: Determinants of attrition from cessation treatment in smokers with a history of major depressive disorder. Psychol Addict Behav 2000; 14:134-142

    Google Scholar 

  26. Hall DG, Duhamel M, McClanahan R, Miles G, Nason C, Rosen S, Schiller P, Tao-Yonenaga L, Hall SM: Level of functioning, severity of illness, and smoking status among chronic psychiatric patients. J Nerv Ment Dis 1995; 183:468-471

    Google Scholar 

  27. Buckley TC, Blanchard EB, Neill WT: Information processing and PTSD: A review of the empirical literature. Clin Psychol Rev 2000; 20:1041-1065

    Google Scholar 

  28. Murphy, FC, Sahakian BJ, O'Carroll RE: Cognitive impairment in depression: Psychological models and clinical issues. Adv Biol Psychiatry 1998; 19:1-33

    Google Scholar 

  29. Wells CD, Zuber PL, Nolan CM, Binkin NJ, Goldberg SV: Tuberculosis prevention among foreign-born persons in Seattle—King County, Washington. Am J Respir Crit Care Med 1997; 156:573-577

    Google Scholar 

  30. MacIntyre CR, Plant AJ: Tuberculosis in South-East Asian refugees after resettlement—Can prevention be improved by better policy and practice? Prev Med 1998; 27:815-820

    Google Scholar 

  31. Kleinman A, Eisenberg L, Good B: Culture, illness, and care. Clinical lessons from anthropologic and cross-cultural research. Ann Intern Med 1978; 88:251-258

    Google Scholar 

  32. Carey JW, Oxtoby MJ, Nguyen LP, Huynh V, Morgan M, Jeffrey M: Tuberculosis beliefs among recent Vietnamese refugees in New York State. Public Health Rep 1997; 112:66-72

    Google Scholar 

  33. Ito KL: Health culture and the clinical encounter: Vietnamese refugees' responses to preventive drug treatment of inactive tuberculosis. Med Anthropol Q 1999; 13:338-364

    Google Scholar 

  34. Kelly AW, Fores Chacori M, Wollan PC, Trapp MA, Weaver AL, Barrier PA, Franz WB, Kottke TE: A program to increase breast and cervical cancer screening for Cambodian women in a midwestern community. Mayo Clin Proc 1996; 71:437-444

    Google Scholar 

  35. Mahloch J, Jackson JC, Chitnarong K, Sam R, Ngo LS, Taylor VM: Bridging cultures through the development of a cervical cancer screening video for Cambodian women in the United States. J Cancer Educ 1999; 14:109-114

    Google Scholar 

  36. Palinkas LA, Pickwell SM, Warnock F: Community-based health promotion for Cambodian refugees: A case study. J Immigrant Health 1999; 1:53-55

    Google Scholar 

  37. Carillo JE, Green AR, Betancourt JR: Cross-cultural primary care: A patient-based approach. Ann Intern Med 1999; 130:829-834

    Google Scholar 

  38. Pachter LM: Culture and clinical care: folk illness beliefs and behaviors and their implications for health care delivery. JAMA 1994; 271:690-694

    Google Scholar 

  39. Community Health Improvement Partners. Charting the Course II: A San Diego County Health Needs Assessment. San Diego: Community Health Improvement Partners,2001

    Google Scholar 

  40. Beine K, Fullerton JF, Palinkas LA, and Anders B: Conceptions of prenatal care among Somali women in San Diego. J Nurse Midwifery 1995; 40:376-381

    Google Scholar 

  41. Palinkas LA, Arciniega JI: Immigration reform and the health of Latino immigrants in California. J Immigrant Health 1999; 1(1):19-30

    Google Scholar 

  42. Frye BA: Use of cultural themes in promoting health among Southeast Asian refugees. Am J Health Promot 1995; 9:269-280

    Google Scholar 

  43. Chen MS, Anderson J, Moeschberger M, Guthrie R, Kuun P, Zaharlick A: Evaluation of heart health education for Southeast Asians. Am J Prev Med 1994; 10:205-208.

    Google Scholar 

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Authors and Affiliations

  1. Immigrant and Refugee Health Studies Program, Department of Family and Preventive Medicine, University of California, San Diego, California

    Lawrence A. Palinkas

  2. Division of Graduate Nursing Studies, University of California, San Diego, California

    Sheila M. Pickwell

  3. The California Program of Project Concern International San Diego, California

    Kendra Brandstein & Abdikadir Osman

  4. Refugee and Immigrant Services, Catholic Charities, Diocese of San Diego, San Diego, California

    Terry J. Clark & Robert J. Moser

  5. Linda Vista Health Care Center, San Diego, California

    Linda L. Hill

Authors
  1. Lawrence A. Palinkas
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  2. Sheila M. Pickwell
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  3. Kendra Brandstein
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  4. Terry J. Clark
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  5. Linda L. Hill
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  6. Robert J. Moser
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  7. Abdikadir Osman
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Correspondence to Lawrence A. Palinkas.

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Palinkas, L.A., Pickwell, S.M., Brandstein, K. et al. The Journey to Wellness: Stages of Refugee Health Promotion and Disease Prevention. Journal of Immigrant Health 5, 19–28 (2003). https://doi.org/10.1023/A:1021048112073

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