The Politics of Migrant Health Care: A Comparative Study of Mexican Immigrants and Indochinese Refugees

Efforts to address the health care problems of undocumented migrants and refugees have typically lacked reliable information about their health status over time, their use of health services, and the nature and range of barriers that limit their access to adequate health care. This is the first comparative study of two sizable populations: Mexican immigrants (including both undocumented and legal permanent residents) and Southeast Asian refugees (from Vietnam, Cambodia and Laos, including the Hmong from Laos and ethnic Chinese from Vietnam). These populations represent polar opposite types of migrations, with many cultural, psychosocial and historical differences in both their contexts of exit and of reception in the Unites States. Structurally, however, these populations share many problems that limit their present and future access to health care. Their economic and legal-political status significantly affect their search for and utilization of health services. Both groups must also confront a variety of problems that arise out of cultural differences between medical practitioners and patients. A comparative analysis of their predicament sheds light on the nature and politics of migrant health care, and on the attendant dilemmas for health care planning and policy. The study is based on comprehensive surveys of large samples of Mexican immigrants and Indochinese refugees; nearly 3,000 in-depth interviews conducted in over 1,500 households in San Diego County, California; and field research in area hospitals and clinics. It examines the migration histories and social backgrounds of these populations, their demographic profiles, the range of health problems found among them, and factors affecting their health status and access to health care services — including legal, economic, social and cultural barriers that define their experience with the health care system — which are detailed both quantitatively and via qualitative case histories. The paper concludes with a review of policy options for improving access to health care for these populations

The Politics of Migrant Health Care: A Comparative Study of Mexican Immigrants and Indochinese Refugees

Efforts to address the health care problems of undocumented migrants and refugees have typically lacked reliable information about their health status over time, their use of health services, and the nature and range of barriers that limit their access to adequate health care. This is the first comparative study of two sizable populations: Mexican immigrants (including both undocumented and legal permanent residents) and Southeast Asian refugees (from Vietnam, Cambodia and Laos, including the Hmong from Laos and ethnic Chinese from Vietnam). These populations represent polar opposite types of migrations, with many cultural, psychosocial and historical differences in both their contexts of exit and of reception in the Unites States. Structurally, however, these populations share many problems that limit their present and future access to health care. Their economic and legal-political status significantly affect their search for and utilization of health services. Both groups must also confront a variety of problems that arise out of cultural differences between medical practitioners and patients. A comparative analysis of their predicament sheds light on the nature and politics of migrant health care, and on the attendant dilemmas for health care planning and policy. The study is based on comprehensive surveys of large samples of Mexican immigrants and Indochinese refugees; nearly 3,000 in-depth interviews conducted in over 1,500 households in San Diego County, California; and field research in area hospitals and clinics. It examines the migration histories and social backgrounds of these populations, their demographic profiles, the range of health problems found among them, and factors affecting their health status and access to health care services — including legal, economic, social and cultural barriers that define their experience with the health care system — which are detailed both quantitatively and via qualitative case histories. The paper concludes with a review of policy options for improving access to health care for these populations

Betel Chewing and Arecoline Affects Eotaxin-1, Asthma and Lung Function

Background: Betel nut is commonly used in many countries. Despite evidence suggesting an association with asthma, few studies have investigated the connection between betel nut use and asthma; thus, the underlying mechanism for the association with asthma is also unclear. the aim of this study was to investigate the association between betel chewing and asthma as well as the associations of plasma arecoline (a biomarker for exposure) and eotaxin-1 (a potential mediator) with asthma and lung function.Methods: We recruited 600 hospital-based asthmatic patients and 1200 age- and gender-matched community controls in southern Taiwan. To clarify the mechanism of action for eotaxin-1 in the association between betel chewing and asthma, we also designed an in vitro experiment to study the functional associations between arecoline exposure and eotaxin-1 levels.Results: A significant association was found between asthma and current betel chewing (adjusted odds ratio 2.05, 95% CI = 1.12-3.76), which was independent of potential confounders but was attenuated following adjustment for eotaxin-1. Arecoline and eotaxin-1 levels were positively correlated (Spearman r = 0.303, p = 0.02), while arecoline and arecaidine were negatively correlated with lung function. Functionally, arecoline alone does not induce eotaxin-1 release in vitro from dermal and gingival fibroblasts. However, in the presence of IL-4 and TNF-alpha, arecoline at 100 mg/ml induced more eotaxin-1 release than arecoline at 0 mu g/ml (2700 +/- 98 pg/ml vs 1850 +/- 142 pg/ml, p = 0.01 in dermal fibroblast cells, and 1489 +/- 78 pg/ml vs 1044 +/- 95 pg/ml, p = 0.03 in gingival fibroblast cells, respectively).Conclusion: Betel chewing is associated with asthma in this population, with arecoline induction of eotaxin-1 supported as a plausible causal pathway.National Health Research InstitutesNational Science Council, TaiwanNational Institute for Health Research (NIHR) Biomedical Research Centre and Dementia Biomedical Research Unit at South London and Maudsley NHS Foundation TrustKing's College LondonKaohsiung Med Univ, Coll Hlth Sci, Dept Publ Hlth, Kaohsiung, TaiwanKaohsiung Med Univ, Ctr Excellence Environm Med, Kaohsiung, TaiwanKaohsiung Med Univ, Kaohsiung Med Univ Hosp, Coll Med, Dept Internal Med,Div Pulm & Crit Care Med & Geri, Kaohsiung, TaiwanChang Gung Univ, Chang Gung Mem Hospital, Coll Med, Med Ctr,Dept Med,Div Pulm & Critical Care Med, Kaohsiung, TaiwanKaohsiung Med Univ, Dept Med & Appl Chem, Kaohsiung, TaiwanKaohsiung Chang Gung Mem Hosp, Dept Dermatol, Kaohsiung, TaiwanChang Gung Univ, Coll Med, Kaohsiung, TaiwanKaohsiung Med Univ, Coll Dent Med, Sch Dent, Kaohsiung, TaiwanChina Med Univ Hosp, Environment Omics Dis Res Ctr, Taichung, TaiwanChina Med Univ, Grad Inst Clin Med Sci, Taichung, TaiwanKaohsiung Med Univ, Kaohsiung Med Univ Hosp, Coll Med, Fac Med,Dept Internal Med,Div Pulm & Crit Care Me, Kaohsiung, TaiwanChung Shan Med Univ, Chung Shan Med Univ Hosp, Sch Med, Inst Med,Dept Psychiat, Taichung, TaiwanUniversidade Federal de São Paulo, Dept Psychobiol, São Paulo, BrazilKings Coll London, Inst Psychiat, London, EnglandUniversidade Federal de São Paulo, Dept Psychobiol, São Paulo, BrazilNational Health Research Institutes: NHRI-CN-PD9611PNational Science Council, Taiwan: NSC96-2314-B-037-040-MY3National Science Council, Taiwan: NSC100-2314-B-037-025-MY3Web of Scienc