CMPH Journal

Introduction

Health care services utilization, particularly preventive health care measures are generally underutilized among immigrant and minority populations in the United States [1-5]. These vulnerable populations usually present in advanced stages of disease secondary to poor screening measures particularly for common preventable diseases such as colon, breast and cervical cancers as well as chronic illnesses such as diabetes, hypertension and hypercholesterolemia. While data available regarding healthcare utilization among several ethnic minorities, little is known regarding health behavior among Albania American communities 

Objectives 

To assess the rate of preventive screening measures among Albanian Americans for common preventable disorders and to identify barriers to health care utilization among this population. 

Methods

Cross sectional analysis of data obtained through anonymous surveys offered to Albanian-American adults over eighteen years of age. The surveys were available in both English and Albanian languages. These surveys were conducted in large community centers, places of worship, as well as community events. The survey included demographic, socioeconomic, as well as data on health care utilization, and behavior. Communities surveyed where generally located in cities such as Detroit, Boston, Philadelphia and New York metropolitan areas. Data were analyzed using the SPSS^® version 21. We used measures of central tendencies and dispersion for continuous variables and frequency distribution for categorical variable. Using logistic regression model we assessed the predictors of health behavior. 

Results

Of the 175 participants surveyed 85% were foreign born, 52% were females, age range of 18-80 years. Men had significantly higher Body Mass Index (BMI) compared to women, BMI (Kg/m²) were 29.0 ± 0.62 (± SEM) versus 26.3±0.73 for men and women respectively, P < 0.01. 

57.7% of the cohort reported having a college degree or higher, 67.5 % of the study cohort was married while 24% were single with 4.1 % divorced and another 4.1% widowed. 12.6% of those surveyed reported current tobacco smoking and 12.5% reported feeling depressed. Of those above the age of 50 years, 62% had screening colonoscopy and 49 % had hepatitis C screening test. Of eligible female participants 68% had a pap smear and 71% had a mammogram. 

Colonoscopy rate was higher among married, compared to non-married (68% Vs 32 %) for married and unmarried respectively, P < 0.01. Rate of colonoscopy was also significantly higher among those born in the USA, compared to foreign born Albanians (55% Vs 45%) for USA born and foreign-born Albanians respectively, P = 0.036. 

In a logistic regression model, the odds ratio OR of having a colonoscopy was higher among married individuals and remained highly significant after adjusting for various potential confounders including Sex, Obesity, birth place, smoking, depression and level of education and alcohol use OR = 4.8 (1.87-12.66) (95% CI), P = 0.004. 

Conclusion

Among Albanian immigrants in the USA preventive health measures were somewhat comparable to USA population; Colonoscopy rate for Albanians was 62% (USA rate 54.1-75.2%). Mammography rate among Albanians was 71% (USA rate 64.1-73.2%). Pap smear rate among Albanian women was 68% (USA rate 68-77.9%), Our study also confirms previously published reports indicating that married adults are more likely to participate in colorectal cancer screening than the non-married individuals [6,7]. However, our study indicates higher rate of marriage among Albanian 67.5%, compared to that reported in the USA (50.0% reported in 2013) [8]. 

Our study suggests a higher BMI (Kg/m²) among Albanian men, compared to men in the USA (29.0 vs 27.6) for Albanian and USA men respectively. However, Albanian women tended to be skinnier with a lower BMI, compared to USA women (26.3 Vs 27.19) for Albanian and USA women respectively [8]. 

Acknowledgments 

1.       Gross R, Brammli-Greenberg S, Remennick L (2001) Self-rated health status and health care utilization among immigrant and non-immigrant Israeli Jewish women. Women Health 34: 53-69.

2.       Ivanov LL, Buck K (2002) Health care utilization patterns of Russian-speaking immigrant women across age groups. J Immigr Health 4: 17-27.

3.       Khan S, Velazquez V, O'Connor C, Simon RE, De Groot AS (2011) Health care access, utilization, and needs in a predominantly Latino immigrant community in Providence, Rhode Island. Med Health R I 94: 284-7.

4.       Koh HK, Graham G, Glied SA (2011) Reducing racial and ethnic disparities: the action plan from the department of health and human services. Health Aff (Millwood) 30: 1822-9.

5.       Lucas JW, Barr-Anderson DJ, Kington RS (2003) Health status, health insurance, and health care utilization patterns of immigrant Black men. Am J Public Health 93:1740-1747.

6.       Osias GL, Osias KB, Srinivasan R (2001) Colorectal cancer in women: an equal opportunity disease. J Am Osteopath Assoc 101: S7-12.

7.       van Jaarsveld CH, Miles A, Edwards R, Wardle J (2006) Marriage and cancer prevention: does marital status and inviting both spouses together influence colorectal cancer screening participation? J Med Screen 13: 172-6.

8.       National Health Interview Survey. 2015.