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STATEMENT OF THE PROBLEM
Immigrants to the United States represent a substantial and rapidly growing group that totaled more than forty-three million people or 13.5 percent of the U.S population in 2015 (Migration Policy institute (MPI), 2015). Since 1970, this percentage has almost tripled rising from 4.7% of the population to the current 13.5% in 2015 and shows no signs of decreasing (MPI Immigration over time 1850-2015). The inflow of immigrants even into smaller states is having a profound effect on a growing number of local communities as immigrants settle in non-traditional destinations like Minnesota and North Dakota. States that had relatively low percentages of immigrants are seeing these populations grow by big margins up to 90 percent in some cases (Derose, K. et al, 2007). The make-up of this immigrant population is diverse, for instance, India was the leading country of origin for recent immigrants, with 179,800 arriving in 2015, followed by 143,200 from China, 139,400 from Mexico, 47,500 from the Philippines, and 46,800 from Canada. In 2013, India and China overtook Mexico as the top origin countries for recent arrivals.
While Minnesota still has proportionally fewer immigrants than the U.S. as a whole with 8.3% of its population being immigrants compared to 13.5% nationally, the state’s foreign-born population is actually increasing faster than the national average. (Immigration Overview – Minnesota Compass)In Minnesota, the number of immigrants has tripled since 1990, but nationally it only doubled. Immigrants are among the fastest growing populations in Minnesota, growing by 76 percent since 2000, compared with a 12 percent growth rate for the state’s population overall. This translates to around 457,000 Minnesota residents who are foreign-born by the end of 2015, including many refugees who fled their home countries. Over 80% of these immigrant groups are concentrated in the 7-county twin cities metro area. (Immigration Overview – Minnesota Compass)
Immigrants are often identified as a vulnerable population, that is, a group at increased risk for poor physical, psychological, and social health outcomes and inadequate health care. The vulnerability is shaped by many factors, including political and social marginalization and a lack of socioeconomic and societal resources. Addressing the health care needs of immigrant populations is challenging both because of the heterogeneity of this group and because recent federal and state policies have restricted some immigrants’ access to health care. These policies have exacerbated existing differences in access, for example, legal residents versus undocumented and long-term residents versus recent arrivals. The stigma associated with some forms of immigration status; for example, undocumented versus refugee, can also contribute to vulnerability. (http://astrologytalks.com/issues-facing-latino-immigrants-in-todays-political-climate-essay).
Given immigrant’s concentration in the 7-county twin cities metro area, a major public health concern is their access to health services. At present in the United States, health insurance is the best way to ensure access to health care. A key provision of the Affordable Care Act (ACA) is the requirement that private insurance plans cover recommended preventive services without any patient cost-sharing. This provision is important because it increases access to preventive healthcare by lowering costs and eliminating some costs. According to the Kaiser Commission on Medicaid and the Uninsured, uninsured individuals are less likely to receive preventive care or care for routine medical conditions and injuries. Lack of preventive health care and lack of treatment for medical conditions can lead to more serious illnesses and health problems. This, in turn, can result in hospitalizations and deaths that could have been prevented. (Health – Key Measures – Minnesota Compass).
As these Immigrant groups assimilate and acclimatize into the system, the issue of Immigrant access to health care falls off as they begin to work and can gain access to health insurance through their employers. Existing literature suggests that there is a disparity in the utilization of healthcare in general and even preventive health care.
Statement of the problem
Preventive care includes health services like screenings, check-ups, and patient counseling that are used to prevent illnesses, disease, and other health problems, or to detect illness at an early stage when treatment is likely to work best. Getting recommended preventive services and making healthy lifestyle choices are key steps to good health and well-being. The existing literature on preventive care tends to focus on access to these procedures and even those few that are focused on utilization are mainly leaning towards individuals already diagnosed with specific disease states such as diabetes. However, since preventive care utilization recommendations are intended for all eligible individuals, it would seem more appropriate to apply a broader view on the use of preventive care services among healthy, disease-free individuals. (Prevention | Office of the Associate Director for Policy | CDC)
The significance of the problem
The purpose of this study is to analyze trends in the utilization of preventive care services among eligible immigrant groups in the twin cities area and comparing it to that of the non-immigrant population. Findings from this study will assist in identifying subpopulations that are not utilizing preventive care services adequately, thereby increasing their risk for developing chronic conditions. Taking a broad approach through predicting the use of preventive care services for all eligible individuals will draw the attention of policymakers towards individuals less likely to use health promotion and prevention services, and thus enable appropriate health care intervention recommendations.
This study will seek to answer the following research questions:
What are the rates of utilization of preventive health care among these different immigrant subgroups in the twin cities? What is the rate of utilization of preventive health care among the non-immigrant population in the twin cities? What are the differences or similarities in preventive healthcare utilization rates among the different subgroups and the non-immigrant population?
The study assumes that all participants will answer truthfully to all the questions, to this end, all participants are informed of their anonymity and confidentiality that will be preserved. The participants are informed about their right to withdraw from the study at any time and with no ramifications.
This study depends on self-reports of participants, it is possible for participants to provide answers that they deem to be socially acceptable even if not true. The interviewer will prod for more accurate answers by trying to reformulate the question where they believe this to be the case.
Access to these subgroups is dependent on social contacts information and although helpful, it may not be representative of the subgroups. A profile of each subgroup can help eliminate potential variations created by this limitation. This study also designates a geographical region, the 7-county twin cities metro area. The study assumes that the sample in the metro is representative of those in the greater Minnesota. Given the cultural heterogeneity of the participants, the researcher may not be culturally competent in the different cultures and may have to depend on a guidance from social contacts. The time needed to conduct this study is limited and therefore requires a limited sample size.
Focus on Immigrant groups in the twin cities metro area provide convenience in location of residence and the concentration of immigrants as opposed to those living in the greater Minnesota. Some immigrant groups originate from areas where healthy practices are automatically built into their lifestyles. For instance, if you cannot afford to buy a vehicle, then you will have to walk to and from the nearest means of public transportation. Likewise, some immigrant groups do not go to visit a doctor or a hospital unless they are unwell. These differences inspired the focus on gauging utilization of preventive health care services. The sample size will be determined by the subgroups population proportion to the population of Minnesota. This research will focus on adults with health insurance; this is so as to eliminate access to preventive health procedures as a variable in the study.
Definition of terms
Preventive healthcare: Health procedures including screenings, immunizations, and counseling. The study will select six overall procedures two from each category. Utilization: The measure of the population’s use of the health care services available to them. The term immigrants also are known as the foreign born refers to people residing in the United States who were not U.S. citizens at birth. This population includes naturalized citizens, lawful permanent residents, certain legal nonimmigrants like persons on student or work visas, those admitted under refugee or asylee status.( U.S. Immigrant Population and Share over Time, 1850 …)
Derose KP, Escarce J, Lurie N. Immigrants and health care: sources of vulnerability. Health Aff. 2007;26(5):1258–1268.
Migration Policy Institute (MPI) tabulation of data from U.S. Census Bureau, 2010-2015 American Community Surveys (ACS), and 1970, 1990, and 2000 Decennial Census. All other data are from Campbell J. Gibson and Emily Lennon, “Historical Census Statistics on the Foreign-Born Population of the United States: 1850 to 1990” (Working Paper no. 29., U.S. Census Bureau, Washington, DC, 1999).
U.S Census Bureau, Selected Characteristics of the Native and Foreign-Born Populations: 2016 American Community Survey 1-Year Estimates http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_16_1YR_S0501&prodType=table.
L.J. Larsen, “The Foreign-Born Population in the United States: 2003,” Current Population Reports no. P20-551, August 2004,
Fuseya, Y., Yamamoto, Y., Takahashi, T., Naito, D., Shima, K., Takahashi, K., & Sakai, N. (2016). A62 CLINICAL ASPECTS OF CAP, HCAP, HAP, AND VAP: Social Factors On Hospitalization Period Of Elderly Patients With Pneumonia In Japan. American Journal of Respiratory and Critical Care Medicine, 193, 1.