Background: The upsurge of TB cases in the US in the 1980s is declining. The proportion of cases in recent immigrants is still high. The reasons may be socioeconomic including beliefs and attitudes of immigrants about TB. We surveyed the beliefs and attitudes of West African immigrants in the US to assess factors likely to influence TB control efforts. Method: We administered questionnaire to those above the age of 13 years living in New York City. Results: 56 people were interviewed (33 M, 23 F, mean 35.2 yrs, range 15-50 yrs). 71.4% were employed (mean annual income of $22,500.) None has had active TB. 85.7% had BCG. 60.7% believed that BCG is protective for life. 46/56 had PPD skin test and 17 were positive. 6 with positive PPD were offered INH, 3 refused. 44/56 did not agree or were undecided about the value of INH prophylaxis. Beliefs held that were contrary to Western culture included: (a) Evil spiritual forces were responsible for drug resistant TB and (b) TB is spread by witchcraft. 60% were not aware of the role of the health department in TB Control and 50% believed that the "US Government" was prejudiced in its TB policy on immigrants. Conclusion: Limited and distorted information about TB issues is common amongst recent US immigrants. Some beliefs such as the "prejudice" of regulatory agencies, doubts about ineffectiveness of BCG and the benefits of INH prophylaxis, hamper control measures. Clinical Implications: Control of TB in immigrants must include efforts at increased education, research on confusing data on BCG effectiveness and the utilization of healthcare workers with similar backgrounds.

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