Afghan refugee issues in the U.S. social environment.

Since Afghan refugees began coming to the United States in the early 1980s, the Afghan community of the San Francisco Bay Area has become the largest in the United States. This population copes with a number of stressors that negatively affect their health and psychological well-being. Based on an ethnographic study, we focus on the social context in which Afghan refugees find themselves, describing Afghans' perceptions of their interactions with mainstream American citizens and health and social service providers. The theme running through all such interactions is information--its scarcity, character, and cultural differences in type, purposes, and means of transmission. Quotes from interviews illustrate four types of problems: economic and occupational problems, health-care access, family and children's issues, and immigration issues/ethnic bias. Policy and program recommendations are applicable to other recent refugee populations that experience similar information problems with regard to the dominant society.

Health issues among Afghan women in California.

Afghan refugee women are part of the largest refugee population in the world. In the United States, they deal with loss of family members, property, and status and cultural, familial, religious, role, and generational conflict in making the transition from a traditional patriarchal society to a more egalitarian postindustrial society. Findings from a San Francisco Bay Area Afghan community health assessment conducted from 1992 to 1993 are presented. The assessment included 38 telephone interviews, seven community meetings, and a survey of 196 Afghan families. Six years of ethnographic study with more than 200 Afghans and their health providers provide contextual data. We describe cultural characteristics that influence women's access to health care, women's approach toward preventive care, control of information regarding sexuality, and spouse abuse.

Afghan Health Education Project: a community survey.

This study assessed the health concerns and needs for health education in the Afghan refugee and immigrant community of the San Francisco Bay Area. The study used a telephone survey, seven community meetings and a survey administered to 196 Afghan families through face-to-face interviews. Data were analyzed qualitatively and statistically. Health problems of most concern are mental health problems and stress related to past refugee trauma and loss, current occupational and economic problems, and culture conflict. Physical health problems include heart disease, diabetes and dental problems. Needed health education topics include dealing with stress, heart health, nutrition, raising children in the United States (particularly adolescents), aging in the United States, and diabetes. Using coalition building and involving Afghans in their community assessment, we found that the Afghan community is eager for culture- and language-appropriate health education programs through videos, television, lectures, and written materials. Brief health education talks in community meetings and a health fair revealed enthusiasm and willingness to consider health promotion and disease-prevention practices.

Health issues of Afghan refugees in California.

Since the 1979 Soviet invasion of Afghanistan, more than 6 million Afghan refugees have become the world's largest refugee population. Although refugees in Pakistan and Iran are now beginning to repatriate, continuing political turmoil in Afghanistan and children's acculturation and educational opportunities will keep many Afghans in the United States permanently. Although there are no accurate statistics, local resettlement agencies and Afghan community leaders estimate that there are 10,000 to 35,000 Afghans in northern California. They suffer from a variety of problems common to refugees: language, economic and occupational problems, and substantial challenges in psychological, family, social, and cultural adjustment to the United States. Although many Afghans are doing well, many others have depression, psychosomatic symptoms, and posttraumatic stress disorder.

Assessing Arab-American health care needs.

A health needs assessment was conducted with Arab-American immigrants in northern California. Data were obtained from community forums, key informants, the U.S. Census, and from a survey of 47 Arab immigrants. In the community forums, parenting difficulties, marital conflicts, and health risks were identified. Key informants (clergy, community leaders, health professionals) identified mental health problems related to child rearing, referrals for appropriate services, education to assist Arab women interface with the health and education systems, and translation and cultural interpretation for Arab patients and health care providers. Arab patients requesting health care identified referrals for appropriate care, advocacy, education about the medical regimen, and technical assistance obtaining care. Social indicators indicated potential needs for health services for those of lower income. A survey of 47 Arab-Americans indicated that predominant illnesses experienced in the past year were upper respiratory infections, cardiovascular and hypertension, diabetes, and family and social stress. Health-related problems reported most frequently were family stress, adjusting to the U.S., managing acute illness, coping with adolescents, and marital stress. For the most part, this group was satisfied with medical care received and stated that their most important health services were health education, availability of Arab speaking health providers, and referrals for appropriate treatment.