Growth status and related medical conditions among refugee children in Massachusetts, 1995-1998.

OBJECTIVES: This study analyzed growth and identified related medical conditions among refugee children in Massachusetts. METHODS: Between July 1995 and June 1998, 1825 refugee children were screened. Variables included positive tuberculin (purified protein derivative; PPD) test; dental abnormalities; pathogenic parasites; weight-for-age, height-for-age, and weight-for-height z scores; and body mass index greater than the 84th percentile. RESULTS: Of all the children, 21% had parasites, 62% had caries, and 25% had a positive PPD reaction. Twelve percent overall and 28% younger than 2 years had anemia. Eight percent had height-for-age z scores less than -2, and 6% had weight-for-age z scores greater than +2. Of those aged 1 to 9 years, 7% had weight-for-height z scores greater than +2. Weight-for-height z scores less than -2 were concentrated among Africans and East Asians (both 8%). Height-for-age z scores less than -2 were seen among African (13%), Near Eastern (19%), and East Asian (30%) children. Weight-for-height z scores greater than +2 and body mass index greater than the 84th percentile were concentrated among children from the former Yugoslavia (8% and 15%) and the former Soviet Union (8% and 14%). CONCLUSIONS: Recently arrived refugee children have significant growth abnormalities. European refugees were overweight; those from developing countries had growth retardation.

Daily multivitamins with iron to prevent anemia in infancy: a randomized clinical trial.

This study assessed the effectiveness of multivitamins (MV) with iron as prophylaxis against iron deficiency (ID) and anemia in infancy. The study was a double-blind, randomized trial at 2 urban primary care clinics. Subjects included healthy, full-term infants enrolled at their 6-month well-child visit. Parents administered MV, either with iron or without iron, by mouth daily for 3 months. At 9 months of age, 28.3% of 310 had either anemia or ID without anemia. Among infants with any adherence, anemia was found in 11.1% of the iron group and 21.7% in the noniron group (RR=0.5, 95% CI=0.3-1.0). Iron deficiency without anemia was found in 18.5% of the iron group; 14.4% of the noniron group (p=0.46). When administered daily starting at age 6 months, standard-dose multivitamins with iron appear to reduce anemia prevalence at 9 months of age.

Lead poisoning among refugee children resettled in Massachusetts, 1995 to 1999.

OBJECTIVE: Lead poisoning has been reported among immigrant and refugee populations in the United States; however, prevalences of elevated blood lead (BPb) and risk factors have not been described fully among newly arrived refugee children. This study was conducted to address this lack of data. METHODS: We performed analysis of BPb levels among a cohort of refugee children, aged <7 years, who arrived in Massachusetts between July 1, 1995, and December 31, 1999. Gender, age, birthplace, time of year of lead testing, intestinal parasitoses, anemia, and growth retardation were examined as predictors of elevated BPb. RESULTS: BPb levels >/=10 microgram/dL were found in 11.3% of 693 children shortly after their arrival in the United States. Children from developing countries had the highest prevalences, including 27% of Somalis and Vietnamese. Country of birth was the strongest predictor of elevated BPb. No association between elevated lead and age was found. Among 213 children with BPb tests >/=6 months after the initial test, 7% had newly elevated levels of >/=10 microgram/dL. CONCLUSIONS: The prevalence of elevated BPb levels in recently arrived refugee children is more than twice that of US-born children. Children who are at particular risk are those from developing countries where environmental exposures are more ubiquitous. In addition, a significant percentage of refugees acquired elevated levels after arrival, thus suggesting the importance of follow-up testing of refugee children. Refugee status should be considered a risk factor for lead poisoning.

War trauma experience and behavioral screening of Bosnian refugee children resettled in Massachusetts.

The authors assessed war violence exposure and behavioral symptoms in Bosnian refugee children in Massachusetts and the utility of behavioral screening of refugees during the Refugee Health Assessment (RHA), required of newly arrived refugees. The study was a survey of 31 Bosnian refugee children in 1996 at the International Clinic of Boston Medical Center, the state's largest contracted provider of the RHA. Subjects were also offered referrals to appropriate mental health services. Sixty-eight percent experienced long-term separation from a parent. Eighty-one percent were directly exposed to armed combat. Seventy-one percent experienced the death of a close friend or relative. Fifty-two percent experienced economic deprivation. Families reported behavioral symptoms for 77% of children. Only one family expressed interest in psychosocial services of any kind. Large numbers of Bosnian refugees are likely to have experienced traumatic war violence and are at risk of behavioral symptoms. The RHA affords opportunities to screen for behavioral problems but not to intervene. Primary care providers and other clinicians should be aware of likely recurrences of symptoms in high-risk children such as these.

Immigration legal status and use of public programs and prenatal care.

This study assessed impacts of immigrants' legal status on utilization of prenatal care and public programs by non-citizen women. Interviews and chart reviews of 171 women were conducted less than 48 hours after delivery at an urban hospital. Among non-citizens, 67% were legally documented. No differences in prenatal care adequacy by legal status were detected among non-citizens, who as a group had less health insurance, worse socioeconomics, and less program use compared to U.S. citizens. Non-citizens also were less aware of newborn's citizenship and eligibility for public programs and benefits. Non-citizens utilized fewer programs while reporting greater economic hardship than citizens; however, non-citizens selectively used programs important for pregnancy. Given changes in eligibility for federal programs and high rates of reported food insecurity and socioeconomic hardship among non-citizens, monitoring for adverse effects on utilization of prenatal care and birth outcomes is needed.

Immigration reporting laws: ethical dilemmas in pediatric practice.

Objectives. This study assessed the potential impact of immigration reporting requirements on pediatricians' referrals to child protective services.Methods.A random sample of 200 Massachusetts pediatricians were surveyed. Chi-square and logistic regression analyses were performed.Results.Asked whether potential deportation of the family would cause them to question or alter a decision to refer, 50% of the respondents said yes.Conclusions.Pediatricians, as mandated reporters of child abuse, will face ethical dilemmas if laws requiring reporting of immigration status are enacted. (Am J Public Health. 1998;88:967-968)