The devolution of welfare services in the United States has increased the importance of the nonprofit sector. Geiger and Wolch argue that decentralization has left nonprofit organizations (NPOs) under the purview of the state. They refer to this as the “shadow state.” Trudeau argues for a more nuanced view of the shadow state in which governmental agencies and NPOs are highly interdependent. This research expands on the findings of Trudeau by extending the shadow state construct to the individual. I examine the role of refugees in the shadow state construct and their ability to affect government policy through participation in NPOs and find that refugees do indeed play a role in the shadow state. Through feedback, experience and, most importantly, by becoming part of the organization, refugees can have an impact on refugee services through participation in NPOs.

Background: Historically, most refugees have originated from countries with high rates of infectious diseases. However, non-communicable diseases are becoming increasingly more common in refugee populations resettling in the United States. Purpose: Examine the prevalence of selected chronic conditions among newly arriving adult Cuban refugees and compare the results to the prevalence of the same chronic conditions among the other top five incoming refugee populations: Burmese, Bhutanese, Iranians, Iraqis, and Somalis Methods: Data used in this study were derived from the Department of State’s Medical History and Physical Examination Worksheet and included all adult (≥20 years) Cuban, Burmese, Bhutanese, Iranian, Iraqi, and Somali refugees identified through the Center’s for Disease Control and Prevention Electronic Disease Notification Center, and who entered the United States during October 2008-September 2011. Data were analyzed using SPSS version 19.0. Descriptive statistics, chi-square analysis, and logistic regressions were performed to assess the prevalence of chronic conditions, check for associations between country of origin and outcome of interest, and to estimate the relative risk for Cubans compared to the remaining top five incoming refugee populations. Results: A total of 99,920 adults were included in the study. The largest population was Iraqi (27.6%), followed by Bhutanese (26.2%), Burmese (24.4%), Iranian (8.6%), Cuban (7.9%), and Somali (5.3%). All outcomes of interest were significantly associated with country of origin. Cubans were at a greater risk for asthma but were not the greatest at-risk population for the remaining outcomes of interest. Conclusion: The prevalence of non-communicable diseases was higher among the incoming refuges than has been traditionally assumed. These findings point to the need for a better understanding of the health status of refugee populations and the development of culturally appropriate health programs that include education on prevention and treatment of chronic conditions.

This thesis examines the lives of Cuban refugees who entered Atlanta, Georgia between 1950 and 1980. It explores early trans-national ties between the two areas. and how Cuban refugees relied on this relationship when they left the island. It shows the process they went through from finding aid and shelter to becoming a strong active community. It explains the role religious institutions had in settling refugees and shows how the state had to work to become equipped to provide resources to a large influx of Spanish-speakers. Through this thesis one will learn of the beginnings of an important Latino community in Atlanta and how its formation prepared the city for larger immigrant groups that would arrive later.