Local health workers are redoubling their efforts to educate immigrant communities in Oregon about the carcinogenic effects of hookah smoking.
The biggest obstacle to their quest: the staggering lack of documentation on the African immigrant population within local health agencies, school districts and service providers.
Evelyne Ello-Hart, coordinator of the African Women's Coalition, says not only are immigrant families under-served by area health providers, but by lumping them together in statistical studies as "Black" and "African American," the immigrants' actual population isn't really counted by local government agencies.
"I have one school where I did a training last Monday, pulled out the number of African immigrants in the school, and there were 70 African immigrants and that was only one school," Ello-Hart said. "And for a population of 500 that's more than 10 percent, but when you see the school district description it won't say 'African immigrant,' it will say 'Black' or 'African American.'"
This is a crucial distinction when it comes to educational resources. Ello-Hart says that group of children, who are all enrolled at Harvey Scott Elementary, are almost all Somali refugees, with different issues and cultural barriers than African American children.
"I'm not African American, I'm sorry, I'm African immigrant, and you need to identify me for who I am," she says. "Then we can have a healthy discussion. We are not there."
Ello-Hart described a meeting where a health educator from the Multnomah County Health Department spoke to the coalition about HIV/AIDS cases.
"Talking about HIV — how many of our members have HIV and AIDS in the community? And then the numbers were like – we were crying at that meeting when she said 100 percent of all the new cases were African immigrant.
"Do we talk about it in our community? Who do we go to? Nobody," Ello-Hart said.
Yugen Rashad of LifeWorks Northwest is has been working to extend awareness of the long-term health effects of smoking tobacco in many communities of color, but he says outreach to local immigrant communities is his toughest task yet.
"The issue is the widespread use of hookah among African and Middle Eastern populations and whether there's an awareness of — or not an awareness of — nicotine as still the harmful ingredient," he says.
He is working to make sure that these communities have the same benefits from educational resources and prevention and cessation programs as the larger population does.
"See and that goes to the heart of the matter when you start looking at whether the state of Oregon is compiling actively or in the past any information or health disparity data as it relates to new immigrants arriving to America, whether it's African the Middle East or Russian. 
"And there is no data on them — no health disparity data on them specifically as it relates to tobacco use."
Ello-Hart says the women's coalition brings immigrant and refugee women from Africa together and connects them with resources including health services and educational opportunities that can smooth their integration into the local community.
She says that local leaders in the immigrant and refugee community estimated it to number between 25,000 and 30,000 people.
Over the past six years, the coalition has engaged more than 600 women from 32 African countries.
"It's quite diverse but the organization is very small," she said. "The steps that we take toward organizing our community are baby steps because when we started the organization the women were all organizing in their home — so they were doing meetings in northeast and southeast and southwest."
Finally they were able to come officially together on Jan. 11, 2003.
"That's when we started recording the minutes and talking about the issues, and when you go back to that first document you see some of the concerns are not only health, but education, language barriers parenting skills," Ello-Hart said.
"I want to give you an example," Ello-Hart says. "A couple of meetings ago one of the things we talked about was women's health and things that are of concern to us.
"We were talking, and one of them didn't realize that tobacco use was damaging to her own health, and who was using tobacco in her house? It was her husband," Ello-Hart said. "It was quite interesting in that conversation to see that many of my sisters don't know that even if I don't smoke, my husband smoke my son smoke, it can impact my health."
Ello-Hart said many immigrant and refugee families don't know how to obtain health insurance, and are stymied by the nonprofit services that are aimed at "African Americans," and not Africans.
"Even Sen. Avel Gordly she's a wonderful woman that I admire so much, when they do the center for her and people say this is a center that will serve African American men and women, but then when I talk to my community members, my ladies from Somalia, Eritrea, or Kenya or Togo, struggling with depression, they say. 'I can't go there, they are African American. It's not for me, they say African American.'"
Ello-Hart says even if there are counselors willing to work with refugee and immigrant families, these communities have their own set of cultural competency issues that are different from those of African Americans.
"Even if they do a good job do they have counselors that come from my country, that look like me, that can come to my home, because in terms of mental health I don't see the same way," she said. "So those are the sad realities."
For more information about stop smoking resources, call 1-800-QUIT-NOW (784-8669). To find out more about the African Women's Coalition, go to http://www.lcsnw.org/mcs/buildingbridges.html, or call 503-231-7480.
