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The purpose of this paper is to determine the morbidity of Giardia in Monroe County, New York attributed to refugees, foreign adoptees and immigrants, and to examine factors related to asymptomatic Giardia infection.

A retrospective epidemiological analysis was conducted of Giardia case investigations submitted to the New York State Department of Health on the Communicable Disease Electronic Surveillance System, between January 1, 2003 and December 31, 2013 from Monroe County Department of Public Health. Univariate and multivariate logistic regression models were used to assess odds for asymptomatic Giardia.

Of the 1,221 Giardia cases reported in Monroe County during that time, 38 percent (n=467) were refugees, 6 percent (n=77) were foreign adoptees and 1.4 percent (n=17) were immigrants. In total, 95 percent of the refugees and 89 percent of the adoptees/immigrants were asymptomatic, compared to 15 percent of the non-refugee/adoptee/immigrant cases. Unadjusted odds for asymptomatic infection were 113.4 (95 percent CI: 70.6-183.7) for refugees, and 45.6 (95 percent CI: 22.9-91) for adoptees/immigrants.

This study demonstrates the importance of routine screening for Giardia during refugees’ initial health assessment.

Using participatory action research, this paper explains how the Service Employees International Union and community groups collaborated to organize home care workers in Oregon. The tactics used include policy borrowing and tinkering, a ballot initiative, coalition building, lobbying, and legislative politics. This approach to organizing low-wage human service providers has important implications for other unions. Home care workers are similar to many other human service providers because the funding stream for their jobs is public. In essence, they are quasi-public sector employees. The tactics employed by the SEIU may serve as a “handle” for organizing other human service workers, who are employed by nongovernmental organizations, but are paid through federal, state, and local government funds.