"When you walk in the rain, you get wet": a qualitative study of Ghanaian immigrants' perspective on the epidemiological paradox.

This study sought to understand the perceptions of Ghanaian immigrants of the health status and health trajectory of their community. We conducted focus groups and interviews with 63 primarily Ghanaian immigrants living in New York City. Nearly all participants observed that Ghanaians are generally healthy when they arrive in the US, but that their health declines over time. Participants identified four causes of this perceived deterioration: changes in health behaviors, increased stress, environmental exposures, and barriers to health care. Participants see themselves as being at risk for many health problems resulting from changes in lifestyle that follow immigration. Although some vulnerabilities are unique to their experience as immigrants, many of the risk factors they described are the same as those that affect other residents in the communities in which they live.