NYU's Shedlin publishes study on the health of Colombian refugees in Ecuador

(Press-News.org) New York University College of Nursing's Professor Michele Shedlin, PhD, recently published a paper, "Sending-Country Violence and Receiving-Country Discrimination: Effects on the Health of Colombian Refugees in Ecuador," on-line in the Journal of Immigrant and Minority Health, February 2, 2013.

Studies of immigrant health have historically focused on individual-level risk factors more than environmental/structural factors as salient mediating variables. Shedlin's research addresses the need to reach a more complete understanding of the migration process and vulnerabilities experienced by refugees as they cross international borders, particularly in South America.

"The main objective of the study was to gather descriptive data on the characteristics of recent refugees moving from Colombia into Ecuador as a result of drug-related violence and how the conflict, displacement and a new environment affected their health vulnerabilities and risk behaviors," said Shedlin.

Findings highlight the urgent need for identifying specific health risks experienced by mobile and displaced populations, underscoring the voluntary and involuntary risk behaviors shaped by the nature and reach of life and environmental changes.

Originally submitted as "Substance Abuse and Health Vulnerability: Colombian Refugees in Ecuador," the study title and focus were modified in-country to address the concerns of advocacy agencies regarding the association of substance abuse with the refugees. The sample participants were recruited only in urban Quito, and participants were recruited through peers and trusted NGO sources.

The urgency of forced displacement to escape violence shapes the migration and adaptation of Colombian refugees in Ecuador.

"What emerged as most salient, were data on how the sequelae of violence, coupled with the stigma and discrimination experienced as refugees, affect all aspects of health, well-being, and survival of this population," Shedlin continued.

The refugees deal with the daily stresses resulting from on-going confrontations with Ecuadorian society. Even given government mechanisms for refugee status and efforts to create a more positive climate for Colombian refugees, the reactions of the receiving community reflect fears, territoriality, and erroneous assumptions about Colombians.

Forced migration itself produces changes and tensions in social networks and, specifically, in the family. Reports of anxiety, frustration and "depression" permeated the interviews even before accounts of discrimination and the effects of isolation and rejection. Lack of basic survival needs and inadequate health services result in the poor health they describe, and the escape provided by drugs and alcohol for some.

Data analyses were focused on understanding health risks and vulnerabilities in a new receiving environment. Individual accounts of daily challenges clearly reflect the context of structural violence in which they now live as well as the potential or real physical violence that prompted their migration in the first place. This structural violence is manifested in the poverty, social and gender inequality, and racism and discrimination they describe.

"Additional research is needed to identify the geopolitical, historical and cultural factors that influence health and well-being," said Shedlin. "Understanding the impact of structural violence on these displaced and vulnerable populations as well is crucial to developing effective structural level interventions, e.g. policy responses, efforts toward community education and organization, and advocacy," she said.

### Other researchers who contributed to the paper are: Carlos U. Decena, Rutgers State University of New Jersey, New Brunswick, NJ, USA; Hugo Noboa and Óscar Betancourt, Fundación Salud Ambiente y Desarrollo (FUNSAD), Quito, Ecuador

The research reported in this article was supported by Award Number 5R21DA024706-02 by the National Institute on Drug Abuse (NIDA).

About Michele G. Shedlin, PhD, Professor, NYU College of Nursing: Shedlin formerly held the Charles H. and Shirley T. Leavell Endowed Chair in Nursing & Health Sciences at the University of Texas at El Paso where she was also Professor, Department of Sociology & Anthropology and Co-Director, of the NIH Hispanic Health Disparities Research Center. A medical anthropologist with extensive experience in reproductive health, substance abuse and HIV/AIDS research internationally and in the U..S., she has designed and implemented behavioral studies and qualitative research training at the community, university and national levels, to inform and evaluate prevention and care.

Shedlin has recently finished another NIH-funded study on , ARV adherence among US-Mexico border populations, and continues to develop research on acculturation and the health vulnerabilities of new immigrant groups. She maintains adjunct faculty appointments at Columbia University, the University of Texas at El Paso and the University of Connecticut. She serves on a number of NIH study sections, and is a reviewer for various public health journals. Her recent papers and publications report results of research on the cultural factors influencing reproductive health, health disparities and immigrant health.

About NYU College of Nursing: NYUCN is a global leader in nursing education, research, and practice. It offers a Bachelor of Science in Nursing; Master of Arts and Post-Master's Certificate Programs; a Doctor of Philosophy in Research Theory and Development, and a Doctor of Nursing Practice degree. For more information, visit www.nyu.edu/nursing.