title: Behavioral risk factor and preventive health care practice survey of immigrants in the emergency department.
abstract: OBJECTIVE
  To compare the demographic profiles, behavioral risk factors, and preventive health care practices of adult immigrant and non-immigrant patients while considering the effects of various socioeconomic variables.
  
  
  METHODS
  This was a prospective survey administered at a large urban emergency department in New York City. Study subjects were adult immigrant patients presenting in an eight-week period in 1998. One non-immigrant control patient was recruited concurrently with every two immigrant patients. Differences between immigrants and non-immigrants were evaluated using the chi-square test. Multivariate logistic regression models were used to adjust for confounding variables.
  
  
  RESULTS
  Eight hundred sixty-nine immigrant patients from 80 countries and 354 non-immigrant patients completed surveys. Immigrants were more likely not to have reached high school (28.9% vs 8.5%; p < 0.001), to have annual family incomes less than $20,000 (73.8% vs 64.5%; p < 0.01), and to have no health coverage (51.7% vs 30.8%; p < 0.001). Immigrant women were more likely never to have had a Papanicolaou test (16.1% vs 1.4%; OR 11.24, 95% CI = 2.70 to 46.8) and never to have performed a self-breast examination (20.8% vs 7.5%; OR 2.03, 95% CI = 1.29 to 3.20). Immigrants were more likely not to use condoms (63.4% vs 42.8%; OR 1.61, 95% CI = 1.20 to 2.15) and never to have visited a dentist (21.2% vs 7.8; OR 2.54, 95% CI = 1.60 to 4.04). Immigrants were more likely never to have received a purified protein derivative (PPD) skin test (30.3% vs 9.1%; OR 3.85, 95% CI = 2.56 to 5.80) and never to have received a tetanus immunization (48.1% vs 13.5%; OR 3.09, 95% CI = 2.17 to 4.42). These differences were independent of age, gender, marital status, employment, education, income, and health insurance status. When analyzing the immigrant group alone, region of origin, length of time in the United States, and English ability were significant independent predictors of higher-risk behavioral profiles and poor preventive health care practices.
  
  
  CONCLUSIONS
  Differences exist between the socioeconomic profiles, behavioral risk profiles, and preventive health care practices of immigrant and non-immigrant patients presenting to a large inner-city municipal emergency department. Different populations within a heterogeneous group of immigrants have distinct health risks and public health needs.
authors.affiliation: Department of Emergency Medicine, Bellevue Hospital Center/New York University Medical Center, New York, NY 10016, USA. djacobs911@yahoo.com
authors.forename: David H
authors.initials: DH
authors.lastname: Jacobs
authors.forename: Juan M
authors.initials: JM
authors.lastname: Tovar
authors.forename: Oliver L
authors.initials: OL
authors.lastname: Hung
authors.forename: Mimi
authors.initials: M
authors.lastname: Kim
authors.forename: Philip
authors.initials: P
authors.lastname: Ye
authors.forename: William K
authors.initials: WK
authors.lastname: Chiang
authors.forename: Lewis R
authors.initials: LR
authors.lastname: Goldfrank
mesh_terms: D000328:Adult; D017677:Age Distribution; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004641:Emigration and Immigration / Q000706:statistics & numerical data*; D005191:Family Characteristics; D005260:Female; D015438:Health Behavior / Q000208:ethnology*; D006786:Hospitals, Urban / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009519:New York City / Q000453:epidemiology; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D012959:Socioeconomic Factors