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J Immigr Minor Health. 2018 Jun 15. doi: 10.1007/s10903-018-0765-y. [Epub ahead of print]

Relationships Between English Language Proficiency, Health Literacy, and Health Outcomes in Somali Refugees.

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Division of General Internal Medicine, Warren Alpert Medical School of Brown University, Mailing Address: 245 Chapman Street, Suite 300, Providence, RI, 02905, USA.
Division of Global Populations and Infectious Disease Prevention, Massachusetts Department of Public Health, Boston, MA, USA.
Health Economics Unit, School of Public Health and Family Medicine at the University of Cape Town, Cape Town, South Africa.
Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.
Division of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA.
Division of Global Populations and Refugee and Immigrant Health, Massachusetts Department of Public Health, Boston, MA, USA.


Little is known about the impacts of health literacy and English proficiency on the health status of Somali refugees. Data came from interviews in 2009-2011 of 411 adult Somali refugees recently resettled in Massachusetts. English proficiency, health literacy, and physical and mental health were measured using the Basic English Skills Test Plus, the Short Test of Health Literacy in Adults, and the Physical and Mental Component Summaries of the Short Form-12. Associations were analyzed using multiple linear regression. In adjusted analyses, higher English proficiency was associated with worse mental health in males. English proficiency was not associated with physical health. Health literacy was associated with neither physical nor mental health. Language proficiency may adversely affect the mental health of male Somali refugees, contrary to findings in other immigrant groups. Research on underlying mechanisms and opportunities to understand this relationship are needed.


English proficiency; Health literacy; Mental health; Physical health; Refugees


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