EFFECTIVENESS OF PROVIDING A WRITTEN REFERRAL TO NEWLY ARRIVING IMMIGRANTS AT FIRST PORT OF ENTRY ON THE COMPLETION OF U.S. TB EVALUATIONS Pubblico
Spieldenner, Susan Lynn (2011)
Published
Abstract
Abstract
Tuberculosis (TB) remains one of the most serious infectious
diseases worldwide and continues to pose a significant public
health concern in the U.S. Of the 11,545 cases of TB disease
reported in the U.S. in 2009, 60% were among foreign-born
residents. Over the past 15 years, the percentage of TB cases in
the U.S. among foreign-born individuals has doubled. A two-step
process is used in the U.S. to reduce the likelihood that
immigrants seeking permanent residence arrive with TB, an overseas
pre-immigration examination, and a U.S.-based post-immigration TB
evaluation for individuals at risk for TB disease. In 2005, 53% of
immigrants with a TB classification completed their U.S.
examination. Incomplete U.S. examinations represent missed
opportunities for early detection and treatment of TB disease and
latent TB infection. This retrospective cohort study of 398
Filipino immigrants arriving at Detroit Metropolitan Airport (DTW)
with a TB classification between December 2006 and August 2007
examines whether or not the written referral used at DTW given upon
U.S. entry increase the likelihood of U.S. TB evaluation
completion. Of the 398 cohort immigrants, 212 (53%) completed a
U.S. examination. This proportion is the same as seen in other
studies. Almost no difference was found in the proportion of
immigrants completing a U.S. TB evaluation between those
individuals that received a written referral and those that did not
( p = .97). Results did not support use of the referral used
at DTW as an effective method for increasing U.S. examination
completion rates. Lack of effectiveness of the referral in this
study does not however, support not providing a referral upon U.S
entry. Recommendations made from this study include completing an
analysis of referral methods currently used by other CDC Quarantine
Stations to facilitate completion of U.S.-based TB evaluations
(particularly Chicago and Honolulu), improving the current referral
form used at DTW, a review of information provided to immigrants
prior to departure for the U.S, and exploring the use of incentives
for both public health agencies and arriving immigrants.
Table of Contents
Table of Contents
Tables...iii
Figures...iv
Chapter I: Introduction...1
Introduction and Rationale...1
Problem Statement...2
Theoretical Framework...10
Purpose Statement...12
Research Question...12
Significance Statement...12
Definition of Terms...14
Chapter II: Review of the Literature...17
Introduction...17
Public Health and Tuberculosis...19
Current Epidemiology of TB among U.S. Foreign-born Persons and U.S.
TB Control Strategies...21
Impact and Effectiveness of Immigrant Health Screenings...23
Acceptability of TB Screening to Immigrants...26
Methods used to Increase Completion of Immigrant Health
Screenings...28
Summary...29
Chapter III: Methods...31
Introduction...31
Population and Sample...31
Research Design...33
Procedures...33
Instrument...35
Data analysis...35
Limitations and delimitations...38
Chapter IV: Results...42
Introduction...42
Findings...42
Other Findings...49
Summary...51
Chapter V: Conclusions, Implications and Recommendations...53
Introduction...53
Summary of Study...53
Conclusion...55
Implications...56
Recommendations...57
References...61
Appendix 1: Referral Form Used at Detroit Metropolitan
Airport...65
Appendix 2: Overseas Medical Examination Form DS2053...66
Appendix 3: Overseas Medical Examination Form DS3024...68
Appendix 4: Overseas Medical Screening Form DS3026...70
Appendix 5: CDC Form 75.17...72
Tables
Table 1. Algorithm for Determining if a U.S. TB Evaluation was
Completed Using Answers from Returned CDC Form 75.17...36
Table 2. Demographics and Social Characteristics of Study Cohort by
Referral Group...44
Table 3. Study Cohort Completion of U.S. TB Evaluation by Referral
Status...47
Table 4. Demographics and Social Characteristics of Study Cohort by
U.S. TB Evaluations Completed...47
Table 5. Characteristics and Demographics of Arriving Immigrants
Diagnosed with Active TB Disease during Completion of U.S. TB
Evaluation...50
Table 6. Comparison of the Time Interval to Completion of U.S. TB
Evaluation within One Year U.S. Entry by Referral Status...51
Figures
Figure 1. Conceptual Model for Study...11
Figure 2. Annual Legal Permanent Admissions and Status Adjustments,
* 1900 - 2008...18
Figure 3. Immigrants Arriving at Detroit Metropolitan Airport,
Detroit, Michigan (DTW) with a B1 or B2 TB Classification between
December, 2006 and August, 2007...43
Figure 4. U.S. Residence for Study Cohort (n = 398)...45
Figure 5. Completed U.S. TB Evaluations among Cohort...46
Figure 6. U.S. TB Evaluations Completed for the Seven States
Receiving 20 or More Immigrant Arrivers with a TB
Classification...49
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