A Vulnerable Population:

Refugees
Lauren King, Melina Miller, Kimberly Murphy, Alexa
Stallworth
 Definition: Refugees

Definition: The population of

individuals who are fleeing conflict or
persecution and moving to a place of
refuge.
(The UN Refugee Agency, 2017)
Demographics of Refugees: Those Living
as Refugees in the US
The number of refugees admitted to the US as of December 31, 2015 is
estimated to be 69,933.

(U.S. Department of State, 2015)

Demographics of Refugees:
Country of Origin
Top three countries in which refugees are entering the US
from:
Democratic Republic of Congo (DRC)
Syria
Burma

Collectively, these countries encompass 49% of all relocated

refugees.

(Igielnik & Krogstad, 2017)

Demographics of Refugees: Sex and Age
In Fiscal Year 2017, children under the age 14 and women made up:

67% of refugees from Iraq and Burma

71% of refugees from the DRC, Somalia, and Syria

The U.S. refugee resettlement program focuses on the most vulnerable populations and those with the
best prospects for long-term integration. Individuals with critical medical conditions or disabilities and
families with young children are typically prioritized for resettlement.

(Zong & Batalova, 2017)

 Health Disparities and Health Care
Disparities Among Refugees
- Smoking Prevalence
- Active and Latent Tuberculosis Infection
(LTBI)
- Delayed Medical Care
Health Disparity: Smoking Prevalence

Iraqi men and women, 18 years of age and older, who arrived in the United States are 26%
more likely to smoke.

The estimated percentage of Americans who are smokers is 19%.

The historically high prevalence of the number of Iraqis who smoke, increases the risk of
smoking-associated diseases among this population.

(Taylor et al., 2014)

Health Disparity: Tuberculosis (TB)

Recent studies have shown that smoking is an independent risk factor associated with LTBI
and active TB disease.

A recent study found that the TB case rate among Africans in the United States was 3 times
higher than that among other foreign-born people and 27 times higher than that among US-
born people, a finding attributed to the large burden of LTBI in this population.

(Bennett, Brodine, Waalen, Moser, & Rodwell, 2014)

Health Care Disparity:
Delayed Medical Care
A health disparity refers to a higher burden of illness, injury, disability, or mortality experienced by
one population group relative to another. A health care disparity typically refers to differences
between groups in health insurance coverage, access to and use of care, and quality of care.

(Ubri & Artiga, 2016)

Iraqi men and women 18 years of age and older who arrived in the United States are 33%
more likely to have a delay in health care due to costs.

Only 11% of American adults reported having a delay in medical care due to costs.

The most common reasons for the delayed care in Iraqi men and women was the lack of
funds to pay for treatment, lack of interpretation, and lack of insurance.
(Taylor et al., 2014)
Nursing Intervention for Culturally
Competent Care of Refugees
Implementation- Health Teaching and Health Promotion (SOP #5B)
Sehatack is a culturally and linguistically tailored smoking cessation
program for Arab American (ARA) men
It utilizes:
Motivational interviewing (MI)
Telephone counseling in Arabic
Arabic workbooks
Nicotine replacement therapy (NRT).
Sehatack has demonstrated successful outcomes in reducing smoking
behaviors in ARA men as part of evidence-based practice and research.

(Haddad, Al-Bashaireh , Ferrell, & Ghadban, 2017).

Nursing Intervention Rationales
Resettled refugees with LTBI have a high prevalence of clinical risk factors for active TB
Especially diabetes and current smoking
Smoking is a preventable risk factor for TB and therefore efforts to decrease smoking among
newly arrived refugees is important
Initiating LTBI treatment of refugees who smoke should be a high priority for medical
providers in order to generalized wellbeing

(Bennett, Brodine, Waalen, Moser, & Rodwell, 2014).

The combination of NRT with Motivational Interviewing (MI) may be a promising way to treat
tobacco dependence in smokers
Participants reported high degrees of satisfaction with the program as a whole (mean 93%).
Culturally tailored and linguistically appropriate intervention approaches may be more
effective than standard interventions

(Haddad, Al-Bashaireh , Ferrell, & Ghadban, 2017).

References
Bennett, R.J., Brodine, S., Waalen, J., Moser, K., & Rodwell, T.C. (2014). Prevalence and treatment of latent tuberculosis infection among
newly arrived refugees in san diego county, january 2010october 2012, American Journal of Public Health, 4, 95-102.
doi:10.2105/AJPH.2013.301637)

Haddad, L.G., Al-Bashaireh, A.M., Ferrell, A.V., & Ghadban, R. (2017). Effectiveness of a culturally-tailored smoking cessation intervention for arab-american
men, International Journal of Environmental Research and Public Health, 14, 1-16. doi:10.3390/ijerph14040411

Horne, D.J., Campo, M., Ortiz, J.R., Oren, E., Arentz, M., Crothers, K., & Narita, M.(2012). Association between smoking and latent tuberculosis
in the U.S. population: An analysis of the national health and nutrition examination survey. PLOS One, 7, 1-6.
doi:10.1371/journal.pone.0049050.t002

Igielnik, R., & Krogstad, J.N. (2017). Where refugees to the U.S. come from. Retrieved from
http://www.pewresearch.org/fact-tank/2017/02/03/where-refugees-to-the-u-s-come-from/

Taylor, E. M., Yanni, E. A., Pezzi, C., Guterbock, M., Rothney, E., Harton, E., & Burke, H. (2014) Physical and mental health status of iraqi
refugees resettled in the united states. Journal Immigrant Minority Health, 16, 1130-1137. Doi: 10.1007/s10903-013-9893-6
References
Ubri, P., & Artiga, S. (2016). Disparities in health and health care: Five key questions and answers. Retrieved from
https://www.kff.org/disparities-policy/issue-brief/disparities-in-health-and-health-care-five-key-questions-and-answers/

The UN Refugee Agency [UNHCR]. (2017). Refugees. Retrieved from http://www.unhcr.org/en-us/refugees.html

U.S. Department of State. (2015). FY15 Refugee Admissions Statistics [Data file]. Retrieved from
https://2009-2017.state.gov/j/prm/releases/statistics/251285.htm

Zong, J., & Batalova, J. (2017). Refugees and Asylees in the United States. Retrieved from
https://www.migrationpolicy.org/article/refugees-and-asylees-united-states#Arrivals