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Juárez SP, Honkaniemi H, Gustafsson NK, Rostila M, Berg L. Health Risk Behaviours by Immigrants’ Duration of Residence: A Systematic Review and Meta-Analysis. Int J Public Health 2022; 67:1604437. [PMID: 35990194 PMCID: PMC9388735 DOI: 10.3389/ijph.2022.1604437] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 06/28/2022] [Indexed: 12/02/2022] Open
Abstract
Objectives: The aim was to systematically review and synthesise international evidence on changes in health risk behaviours by immigrants’ duration of residence. Methods: We searched literature databases for peer-reviewed quantitative studies published from 2000 to 2019, examining alcohol, drug and tobacco use; physical inactivity; and dietary habits by duration of residence. Results: Narrative synthesis indicated that immigrants tend to adopt health risk behaviours with longer residence in North America, with larger variation in effect sizes and directionality in other contexts. Random-effects meta-analyses examining the pooled effect across all receiving countries and immigrant groups showed lower odds of smoking (OR 0.54, 0.46–0.63, I2 = 68.7%) and alcohol use (OR 0.61, 0.47–0.75, I2 = 93.5%) and higher odds of physical inactivity (OR 1.71, 1.40–2.02, I2 = 99.1%) among immigrants than natives, but did not provide support for a universal trend by duration of residence. Conclusion: Findings suggest that duration of residence could serve as an effective instrument to monitor immigrants’ health changes. However, differences in receiving country contexts and immigrant populations’ composition seem to be important to predict the level and direction of behavioural change. Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, PROSPERO CRD42018108881.
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Affiliation(s)
- Sol P. Juárez
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
- Department of Public Health Sciences, Faculty of Social Sciences, Stockholm University, Stockholm, Sweden
- *Correspondence: Sol P. Juárez,
| | - Helena Honkaniemi
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
- Department of Public Health Sciences, Faculty of Social Sciences, Stockholm University, Stockholm, Sweden
| | - Nina-Katri Gustafsson
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
- Department of Public Health Sciences, Faculty of Social Sciences, Stockholm University, Stockholm, Sweden
| | - Mikael Rostila
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
- Department of Public Health Sciences, Faculty of Social Sciences, Stockholm University, Stockholm, Sweden
| | - Lisa Berg
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
- Department of Public Health Sciences, Faculty of Social Sciences, Stockholm University, Stockholm, Sweden
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2
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Kelleher D, Kharroubi S, Doherty E, Baio G, O’Neill C. Examining the Association between Polish Migrant Status and Health Preferences Using a Novel Application of a Smaller Design EQ-5D-5L Valuation Study. PHARMACOECONOMICS - OPEN 2022; 6:425-435. [PMID: 35080756 PMCID: PMC9043148 DOI: 10.1007/s41669-021-00314-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/21/2021] [Indexed: 05/13/2023]
Abstract
INTRODUCTION Migrants have different utilisation of healthcare services and health-related behaviours than host populations. A potential factor that may contribute to the notable differences in healthcare use and health-related behaviours between migrants and host populations is how these groups value health. Those who place a high value on health have greater healthcare-seeking practices than those who do not. OBJECTIVE The aim of this study was to examine how Polish migrants and native Irish differ in health state utility valuations using a novel application of a smaller design EQ-5D-5L valuation study. METHODS This study uses health preferences as a predictor of how one values health. We examined the EQ-5D-5L health preferences of 119 Polish migrants and 123 native Irish, both residing full-time in Ireland. To do so, we used a novel application of a smaller design EQ-5D-5L valuation study that consisted of 30 health states and a targeted sampling strategy coupled with a Bayesian statistical nonparametric model. We collected data from June 2018 to September 2019. RESULTS Our results highlight that Polish migrants and native Irish differ in their health preferences for and valuation of severe health states. Polish migrants place meaningfully higher utility valuations of 0.1 or more on the three most severe health states compared with the native Irish. CONCLUSION This study can provide an understanding of a potential new factor underpinning some of the disparities in healthcare utilisation and health-related behaviours among migrants and host populations in Europe. This study also provides proof of principle for using a smaller design EQ-5D-5L valuation study to explore differences in health preferences among other minority subgroups, which can otherwise be hard to uncover when using the secondary analysis of national EQ-5D-5L valuation studies.
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Affiliation(s)
- Dan Kelleher
- The Institute for Lifecourse and Society, NUI Galway, Room 2007, Upper Newcastle, Galway, H91C7DK Ireland
| | - Samer Kharroubi
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Riad El Solh, PO Box 11-0236, Beirut, Lebanon
| | - Edel Doherty
- Health Economics and Policy Analysis Centre, The Institute for Lifecourse and Society, Upper Newcastle, NUI Galway, National University of Ireland, Galway, H91C7DK Ireland
| | - Gianluca Baio
- Department of Statistical Science, University College London, Gower Street, London, WC1E 6BT UK
| | - Ciaran O’Neill
- Institute of Clinical Sciences, Centre for Public Health, Queen’s University Belfast, Royal Victoria Hospital, Block B, Belfast, BT12 6BA Northern Ireland, UK
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3
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Amiri S. Worldwide prevalence of smoking in immigration: A global systematic review and meta-analysis. J Addict Dis 2020; 38:567-579. [PMID: 32780650 DOI: 10.1080/10550887.2020.1800888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Sohrab Amiri
- Behavioral Sciences Research Center, Lifestyle Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
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4
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Byrne G, Murphy F, Eustace-Cook J, Mooney M, O'Brien F, O'Donnell S, Corry M, Lynch AM, Neenan K, McKee G. Prevalence of tobacco smoking among European migrants residing in EU 15 countries: a quantitative systematic review protocol. JBI Evid Synth 2020; 18:2647-2657. [PMID: 32740029 DOI: 10.11124/jbisrir-d-19-00396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES The objective of this systematic review is to summarize the prevalence of tobacco smoking in European migrants residing in EU 15 countries. INTRODUCTION Most of the migration within the World Health Organization European Region is intracontinental. The prevalence of smoking varies greatly across the European Region. Migrants may choose to adopt the smoking behaviors of their host countries or retain the smoking behaviors of their countries of origin. Several studies have identified the high prevalence of smoking of some migrant groups in comparison to their host countries, but no systematic reviews have been completed on intracontinental migrants within the European Region. INCLUSION CRITERIA Epidemiological studies, which include data on the prevalence of tobacco smoking in European migrants aged ≥ 15 years of age living in the following EU 15 countries host countries for ≥ 1 year: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, Netherlands, Portugal, Spain, Sweden, and the United Kingdom. METHODS MEDLINE, Embase, CINAHL, PsycINFO, ASSIA, and Web of Science will be searched to identify published studies. General gray literature (eg, Open Grey) as well as gray literature for migrants (Migrant Health Research Portal) and tobacco will be searched. The JBI methodology for systematic reviews of prevalence will be used in this review. Data synthesis will use meta-analysis where appropriate and narrative synthesis.
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Affiliation(s)
- Gobnait Byrne
- Trinity Centre for Practice and Healthcare Innovation, Trinity College Dublin: A JBI Affiliated Group, Dublin, Ireland.,School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Fiona Murphy
- Trinity Centre for Practice and Healthcare Innovation, Trinity College Dublin: A JBI Affiliated Group, Dublin, Ireland.,School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | | | - Mary Mooney
- Trinity Centre for Practice and Healthcare Innovation, Trinity College Dublin: A JBI Affiliated Group, Dublin, Ireland.,School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Frances O'Brien
- Trinity Centre for Practice and Healthcare Innovation, Trinity College Dublin: A JBI Affiliated Group, Dublin, Ireland.,School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Sharon O'Donnell
- Trinity Centre for Practice and Healthcare Innovation, Trinity College Dublin: A JBI Affiliated Group, Dublin, Ireland.,School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Margarita Corry
- Trinity Centre for Practice and Healthcare Innovation, Trinity College Dublin: A JBI Affiliated Group, Dublin, Ireland.,School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Aileen M Lynch
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Kathleen Neenan
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Gabrielle McKee
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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5
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Cramm JM, Nieboer AP. Acculturation is associated with older Turkish immigrants' self-management abilities. BMC Public Health 2019; 19:1228. [PMID: 31488086 PMCID: PMC6727562 DOI: 10.1186/s12889-019-7471-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 08/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The few previous studies investigating acculturation and self-management have suggested that increased participation in (or adaptation to) the host culture is associated with better health and disease management. However, research on the relationship between acculturation strategies (attachment to the Dutch and Turkish cultures) and broader self-management abilities among older Turkish immigrants in the Netherlands is lacking. This study aimed to investigate this relationship in this population. METHODS Turkish immigrants aged > 65 years and residing in Rotterdam, the Netherlands (n = 2350), were identified using the municipal register. In total, 680 respondents completed the questionnaire (32% response rate). RESULTS The average age of the respondents was 72.90 (standard deviation, 5.02; range, 66-95) years and 47.6% of respondents were women. The majority (80.3%) of respondents reported having low educational levels. Women, single individuals, less-educated respondents, and those with multimorbidity experienced lower levels of attachment to the Dutch culture and reported poorer self-management abilities. Slightly stronger relationships were found between self-management and attachment to the Dutch culture than attachment to the Turkish culture. Multimorbidity negatively affected the self-management abilities of older Turkish people living in the Netherlands. CONCLUSIONS The study findings indicate that especially attachment to the Dutch culture matters for the self-management abilities of older Turkish immigrants in the Netherlands. Given the high prevalence of multimorbidity in this population, investment in their self-management abilities is expected to be beneficial. Special attention is needed for women, single individuals, less-educated people, and those with multimorbidity. Interventions aiming to better integrate these groups into Dutch society are also expected to be beneficial for their self-management abilities.
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Affiliation(s)
- Jane M Cramm
- Department of Social Medical Sciences, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, Rotterdam, DR, The Netherlands.
| | - Anna P Nieboer
- Department of Social Medical Sciences, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, Rotterdam, DR, The Netherlands
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6
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Lung cancer mortality in historical context. How stable are spatial patterns of smoking over time? DEMOGRAPHIC RESEARCH 2019. [DOI: 10.4054/demres.2019.40.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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7
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Houghton F, Doherty DO, McInerney D, Duncan B. Response to Tobacco Free Ireland 2025: SimSmoke prediction for the end-game. Tob Prev Cessat 2019; 5:1. [PMID: 32411867 PMCID: PMC7205162 DOI: 10.18332/tpc/102277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/22/2018] [Accepted: 12/21/2018] [Indexed: 11/24/2022]
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8
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Health-Related Lifestyle Behavior and Religiosity among First-Generation Immigrants of Polish Origin in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112545. [PMID: 30428597 PMCID: PMC6266255 DOI: 10.3390/ijerph15112545] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/06/2018] [Accepted: 11/09/2018] [Indexed: 01/02/2023]
Abstract
Background: Health-related lifestyle behaviors such as smoking, alcohol consumption, physical inactivity and obesity are major cardiovascular risk factors. Previous studies have mostly demonstrated a favorable association between religiosity and these cardiovascular risk factors; however, no studies have investigated this relationship in Polish immigrants. The aim of this cross-sectional study was to examine the association between health-related lifestyle behaviors and religiosity in Polish immigrants in Germany. Methods: The smoking patterns, frequency of alcohol consumption, physical activity, and presence of overweight/obesity were assessed in 257 first-generation immigrants of Polish origin living in Germany. Religiosity was measured with the Centrality of Religiosity Scale (CRS, Huber, 2003) consisting of 15 items that categorized the respondents into intrinsically, extrinsically, and not/marginally religious. Results: After adjusting for various sociodemographic, migration, and health-related characteristics, intrinsic religiosity was significantly associated with a lower risk of being a smoker (odds ratios (OR) = 0.34, confidence intervals (CI) = 0.15–0.76) and was also associated with a lower risk of alcohol consumption (OR = 0.33, CI = 0.15–0.71), but a higher risk of being overweight/obese (OR = 2.53, CI = 1.15–5.56) in comparison with extrinsic/marginal religiosity. No significant relationship was found between religiosity and physical activity. Conclusions: In Polish immigrants, intrinsic religiosity acts as a protective factor against some cardiovascular risk factors (smoking and alcohol consumption).
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Li S, Levy D, Clancy L. Tobacco Free Ireland 2025: SimSmoke prediction for the end game. Tob Prev Cessat 2018; 4:23. [PMID: 32411849 PMCID: PMC7205082 DOI: 10.18332/tpc/91427] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/04/2018] [Accepted: 05/22/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION This study estimates the impact of tobacco control policies implemented between 1998 and 2016 on smoking prevalence reduction in Ireland by 2016. It then assesses the potential of further strong policies, relative to a scenario of inaction, to see if Tobacco Free Ireland 2025 is feasible. METHODS SimSmoke, the dynamic simulation model of tobacco control policy, was adapted to examine the impact of Irish tobacco control policies on smoking prevalence, through initiation and cessation, and smoking-attributable deaths and to make predictions for the future. RESULTS Between 1998 and 2016, the model prediction of smoking prevalence is reasonably close to those from several surveys. As a result of policies implemented in this period, the smoking rate was reduced by 42% from 32.2% in 1998 to 18.7% in 2016. If tobacco control policies remain unchanged from their 2016 levels, smoking prevalence is projected to be 15.8% in 2025. With the introduction of stricter MPOWER-compliant policies in 2017, the smoking prevalence could be reduced to 12.4% in 2025. CONCLUSIONS Predictions from the SimSmoke Ireland model confirm that the policies implemented between 1998 and 2016 have had a considerable effect. In addition, implementing policies fully compliant with MPOWER could further reduce the smoking prevalence afterwards. However, even under the stricter MPOWER-compliant policies, there is still a gap between the predicted rate in 2025 and the Tobacco Free Ireland target of 5%. Therefore, new policies going beyond MPOWER are needed.
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Affiliation(s)
- Shasha Li
- TobaccoFree Research Institute, Ireland
| | - David Levy
- Georgetown University, Washington, D.C., USA
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10
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Czapka EA, Sagbakken M. "Where to find those doctors?" A qualitative study on barriers and facilitators in access to and utilization of health care services by Polish migrants in Norway. BMC Health Serv Res 2016; 16:460. [PMID: 27586150 PMCID: PMC5007991 DOI: 10.1186/s12913-016-1715-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 08/25/2016] [Indexed: 11/25/2022] Open
Abstract
Background Poles constitute the largest group of migrants in Norway. Research confirms a steady inflow and a minimal outflow of Polish migrants. One of the key aspects of migrants’ structural integration is access to health care services. This study explored barriers to and facilitators of Polish migrants’ access to Norwegian health care services. Methods A qualitative interview-based study was carried out between November 2013 and July 2014. The study is part of a larger, ongoing mixed-method study of Polish migrants’ access to health care services in Norway. Semi-structured interviews were conducted with 19 Polish migrants in Oslo. The interviews were transcribed, coded, and analyzed. Thematic analysis was performed to identify barriers and facilitators related to the use of Norwegian health care services. Results Migrants experienced several barriers to and facilitators of access to health care services in Norway. The barriers most often mentioned were problems resulting from insufficient command of the language, related communication problems, and lack of knowledge about navigating the Norwegian health care system. Other barriers related to the organization of the health care system, perceptions of doctors’ skills and practices, and attitudes among health personnel. Factors such as having a Polish social network, meeting friendly health personnel, and perceptions of equal treatment of all patients, facilitated access to and use of health care services. Conclusions The study shows that there are both system- and patient-related barriers to and facilitators of migrants’ access to health services in Norway. These findings suggest that successful inclusion of migrants into the Norwegian health system requires regular evaluation of access and utilization of health care services. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1715-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elżbieta Anna Czapka
- Sykehuset Innlandet, Norwegian National Advisory Unit on Concurrent, Substance Abuse and Mental Health Disorders, Postboks 104, 2381, Brumunddal, Norway. .,Norwegian Center for Minority Health Research, Oslo University Hospital HF, Ullevaal, P.O. Box. 4956, Nydalen, 0424, Oslo, Norway.
| | - Mette Sagbakken
- Norwegian Center for Minority Health Research, Oslo University Hospital HF, Ullevaal, P.O. Box. 4956, Nydalen, 0424, Oslo, Norway.,Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo and Akershus University College, Pilestredet 32, 0130, Oslo, Norway
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11
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Sordo L, Indave B, Vallejo F, Belza M, Sanz-Barbero B, Rosales-Statkus M, Fernández-Balbuena S, Barrio G. Effect of country-of-origin contextual factors and length of stay on immigrants’ substance use in Spain. Eur J Public Health 2015; 25:930-6. [DOI: 10.1093/eurpub/ckv144] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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12
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Factors associated with smoking in immigrants from non-western to western countries - what role does acculturation play? A systematic review. Tob Induc Dis 2015; 13:11. [PMID: 25908932 PMCID: PMC4407357 DOI: 10.1186/s12971-015-0036-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 03/28/2015] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION We aimed to identify factors associated with smoking among immigrants. In particular, we investigated the relationship between acculturation and smoking, taking into consideration the stage of the 'smoking epidemic' in the countries of origin and host countries of the immigrants. METHODS We searched PubMed for peer-reviewed quantitative studies. Studies were included if they focused on smoking among adult immigrants (foreign-born) from non-western countries now residing in the USA, Canada, Ireland, Germany, the Netherlands, Norway, the UK, and Australia. Studies were excluded if, among others, a distinction between immigrants and their (native-born) offspring was not made. RESULTS We retrieved 27 studies published between 1998 and 2013. 21 of the 27 studies focused on acculturation (using bidimensional multi-item scales particularly designed for the immigrant group under study and/or proxy measures such as language proficiency or length of stay in host country) and 16 of those found clear differences between men and women: whereas more acculturated women were more likely to smoke than less acculturated women, the contrary was observed among men. CONCLUSION Immigrants' countries of origin and host countries have reached different stages of the 'smoking epidemic' where, in addition, smoking among women lags behind that in men. Immigrants might 'move' between the stages as (I) the (non-western) countries of origin tend to be in the early phase, (II) the (western) host countries more in the advanced phase of the epidemic and (III) the arrival in the host countries initiates the acculturation process. This could explain the 'imported' high (men)/low (women) prevalence among less acculturated immigrants. The low (men)/high (women) prevalence among more acculturated immigrants indicates an adaptation towards the social norms of the host countries with ongoing acculturation.
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Reiss K, Sauzet O, Breckenkamp J, Spallek J, Razum O. How immigrants adapt their smoking behaviour: comparative analysis among Turkish immigrants in Germany and the Netherlands. BMC Public Health 2014; 14:844. [PMID: 25124365 PMCID: PMC4150979 DOI: 10.1186/1471-2458-14-844] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 08/07/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Smoking behaviour among immigrants is assumed to converge to that of the host country's majority population with increasing duration of stay. We compared smoking prevalence among Turkish immigrants residing in two different countries (Germany (DE)/the Netherlands (NL)) between and within countries by time spent in Turkey and DE/NL. METHODS The German 2009 micro-census and the Dutch POLS database (national survey, 1997-2004) were analysed. An interaction variable with dichotomised length of stay (LOS) in Turkey (age: 0-17; 18+) and categorised LOS in the host country (immigration year: 1979 and earlier, 1980-1999, 2000-2009; the latter only for Germany) was generated. Age standardised smoking prevalences and sex-specific logistic regression models were calculated. RESULTS 6,517 Turkish participants were identified in Germany, 2,106 in the Netherlands. Age-standardised smoking prevalences were higher among Turkish immigrants in the Netherlands compared to those in Germany: 62.3% vs. 53.1% (men/lower education); 30.6% vs. 23.0% (women/lower education). A similar trend was observed for the majority population of both countries. The chance of being a smoker was lower among Turkish men with short LOS in Turkey and middle LOS in Germany/the Netherlands compared to those with short LOS in Turkey and long LOS in Germany/the Netherlands (NL: OR = 0.57[95% CI = 0.36-0.89]; DE: OR = 0.73[95% CI = 0.56-0.95]). Contrary to that, the chance of being a smoker was higher among Turkish men with long LOS in Turkey and middle LOS in Germany/the Netherlands compared to those with long LOS in Turkey and long LOS in Germany/the Netherlands (NL: OR = 1.35[95% CI = 0.79-2.33]; DE: OR = 1.44[95% CI = 1.03-2.02]). The effects for Turkish women were similar, but smaller and often non-significant. CONCLUSION Turkish immigrants adapt their smoking behaviour towards that of the Dutch/German majority population with increasing duration of stay. This was particularly obvious among those who left Turkey before the age of 18 years - a group that needs tailored interventions to prevent further increases in smoking. Those who left Turkey as adults and spent a short time in the host countries show 'imported' smoking patterns. A limitation of this study is the use of cross-sectional data: a cohort effect cannot be ruled out. Our findings have to be confirmed with longitudinal data.
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Affiliation(s)
- Katharina Reiss
- Department of Epidemiology & International Public Health, Bielefeld School of Public Health (BiSPH), Bielefeld University, P.O. Box 10 01 31, 33501 Bielefeld, Germany
| | - Odile Sauzet
- Department of Epidemiology & International Public Health, Bielefeld School of Public Health (BiSPH), Bielefeld University, P.O. Box 10 01 31, 33501 Bielefeld, Germany
| | - Jürgen Breckenkamp
- Department of Epidemiology & International Public Health, Bielefeld School of Public Health (BiSPH), Bielefeld University, P.O. Box 10 01 31, 33501 Bielefeld, Germany
| | - Jacob Spallek
- Department of Epidemiology & International Public Health, Bielefeld School of Public Health (BiSPH), Bielefeld University, P.O. Box 10 01 31, 33501 Bielefeld, Germany
| | - Oliver Razum
- Department of Epidemiology & International Public Health, Bielefeld School of Public Health (BiSPH), Bielefeld University, P.O. Box 10 01 31, 33501 Bielefeld, Germany
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14
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Stallings-Smith S, Goodman P, Kabir Z, Clancy L, Zeka A. Socioeconomic differentials in the immediate mortality effects of the national Irish smoking ban. PLoS One 2014; 9:e98617. [PMID: 24887027 PMCID: PMC4041857 DOI: 10.1371/journal.pone.0098617] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 05/06/2014] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Consistent evidence has demonstrated that smoking ban policies save lives, but impacts on health inequalities are uncertain as few studies have assessed post-ban effects by socioeconomic status (SES) and findings have been inconsistent. The aim of this study was to assess the effects of the national Irish smoking ban on ischemic heart disease (IHD), stroke, and chronic obstructive pulmonary disease (COPD) mortality by discrete and composite SES indicators to determine impacts on inequalities. METHODS Census data were used to assign frequencies of structural and material SES indicators to 34 local authorities across Ireland with a 2000-2010 study period. Discrete indicators were jointly analysed through principal component analysis to generate a composite index, with sensitivity analyses conducted by varying the included indicators. Poisson regression with interrupted time-series analysis was conducted to examine monthly age and gender-standardised mortality rates in the Irish population, ages ≥35 years, stratified by tertiles of SES indicators. All models were adjusted for time trend, season, influenza, and smoking prevalence. RESULTS Post-ban mortality reductions by structural SES indicators were concentrated in the most deprived tertile for all causes of death, while reductions by material SES indicators were more equitable across SES tertiles. The composite indices mirrored the results of the discrete indicators, demonstrating that post-ban mortality decreases were either greater or similar in the most deprived when compared to the least deprived for all causes of death. CONCLUSIONS Overall findings indicated that the national Irish smoking ban reduced inequalities in smoking-related mortality. Due to the higher rates of smoking-related mortality in the most deprived group, even equitable reductions across SES tertiles resulted in decreases in inequalities. The choice of SES indicator was influential in the measurement of effects, underscoring that a differentiated analytical approach aided in understanding the complexities in which structural and material factors influence mortality.
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Affiliation(s)
| | - Pat Goodman
- Environmental Health Sciences Institute, Dublin Institute of Technology, Dublin, Ireland
- TobaccoFree Research Institute Ireland, Dublin, Ireland
| | - Zubair Kabir
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Luke Clancy
- TobaccoFree Research Institute Ireland, Dublin, Ireland
| | - Ariana Zeka
- Institute for the Environment, Brunel University, London, United Kingdom
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15
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Aspinall PJ, Mitton L. Smoking prevalence and the changing risk profiles in the UK ethnic and migrant minority populations: implications for stop smoking services. Public Health 2014; 128:297-306. [PMID: 24612958 DOI: 10.1016/j.puhe.2013.12.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 12/17/2013] [Accepted: 12/19/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Smoking is the leading risk factor for disability-adjusted life-years, yet evidence with which to establish the smoking rates of people with different ethnic backgrounds and how they are changing in relation to recent migration is lacking. The objective is to provide current information on the changing risk profiles of the UK population. STUDY DESIGN Observational study using cross-sectional surveys. METHODS Data from the Integrated Household Survey (pooled for the years 2009/10-2011/12), obtained under Special Licence, and the GP Patient Survey (2012) have been used to establish smoking prevalence in a wider range of ethnic groups in England and Wales, including the 'mixed' groups and amongst East European migrants, and how such prevalence differs across socio-economic classes. RESULTS Smoking prevalence is substantially higher amongst migrants from East European countries (that for males exceeding 50% from three such countries and for females over 33% from four countries) and from Turkey and Greece, compared with most other non-UK born groups, and amongst ethnic groups is elevated in the 'mixed' groups. Rates are highest in the Gypsy or Irish Traveller group, 49% (of 162) and 46% (of 155) for males and females respectively. Across ethnic groups, rates are almost always higher in the UK born than non-UK born population with the notable exception of the 'White Other' group, with Prevalence Ratios (PRs) indicating a larger migrant-non-migrant differential amongst females (e.g. Indians 2.95 (2.33-3.73); Black Caribbeans 3.28 (2.73-3.94). Age-adjusted rates show the persistence of these differentials in females across age groups, though young males (18-29) in seven minority ethnic groups show lower rates in the UK-born groups. The 'White' and 'Chinese' groups show a strong socio-economic gradient in smoking which is absent in the South Asian groups and diminished in the 'mixed' and black groups. CONCLUSIONS Given the evidence that smoking behaviour is significantly different in some of the new groups, notably East European migrants, stop smoking services are failing to optimize the acceptability and, consequently, favourable outcomes for these programmes. These services need to be adapted to the particular patterns of smoking behaviour and language skills within different communities of descent.
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Affiliation(s)
| | - L Mitton
- University of Kent, Canterbury, Kent, UK
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Giuliani KKW, Mire O, Leinberger-Jabari A, Ehrlich LC, Stigler MH, Pryce DJ, DuBois DK. Cigarettes and the Somali diaspora: tobacco use among Somali adults in Minnesota. Am J Prev Med 2012; 43:S205-13. [PMID: 23079218 DOI: 10.1016/j.amepre.2012.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 07/31/2012] [Accepted: 08/01/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Since the onset of the Somali civil war in 1991, more than 1 million Somalis have been displaced from Somalia. Minnesota has the largest Somali population in the U.S. Informal tobacco prevalence estimates among Somali populations in the U.S. and the United Kingdom range from 13% to 37%, respectively. Little research has been conducted to determine the extent of Somali tobacco use. PURPOSE This paper reports the results from a knowledge, attitudes, and practices (KAP) survey conducted and analyzed in 2009 that explores tobacco use and estimates prevalence among Somali adults aged ≥ 18 years in Minnesota. METHODS Modeled after validated state and national tobacco use surveys, the survey was adapted for Somalis and administered to ethnically Somali adults (N=392) from 25 neighborhood clusters in Minnesota. Participants were chosen through probability proportional to size and multistage random sampling methods. RESULTS Estimated prevalence for cigarette use among Somalis was 24% (44% among men, 4% among women). Ever users were significantly more likely to be men, have attended college, and have friends who used cigarettes (p<0.0001). Belief in Islamic prohibition of tobacco was protective and affected current use and future intention to use tobacco (p<0.0001). The majority of Somali smokers were unwilling to use current cessation programs. CONCLUSIONS Estimated cigarette use prevalence was lower than perceived prevalence (37%). Contrary to typical results, greater smoking prevalence was found among Somalis with higher education levels. Positive peer pressure and religion are protective factors from tobacco use and should be integrated into prevention and cessation programs.
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Levy DT, Currie L, Clancy L. Tobacco control policy in the UK: blueprint for the rest of Europe? Eur J Public Health 2012; 23:201-6. [PMID: 22826505 DOI: 10.1093/eurpub/cks090] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION With male smoking prevalence at ~30% in 1998, the UK implemented stricter tobacco control policies, including a comprehensive cessation treatment programme. We evaluate their effect. METHODS Data for the UK (excluding Northern Ireland) are applied to 'SimSmoke', a simulation model used to examine the effect of tobacco control policies over time on smoking initiation and cessation. Upon validating the model against smoking prevalence, the model is used to distinguish the effect of policies implemented between 1998 and 2009 on smoking prevalence. Using standard attribution methods, the model estimates lives saved as a result of policies. RESULTS The model predicts smoking prevalence accurately between 1998 and 2009. A relative reduction of 23% in smoking rates over that period is attributed to tobacco control policies, mainly tax increases, smoke-free air laws, advertising restrictions and cessation treatment programmes. The model estimates that 210 000 deaths will be averted by the year 2040, as a consequence of policies implemented between 1998 and 2010. CONCLUSIONS The results document the UK's success in reducing smoking prevalence and prolonging lives, thereby providing an example for other European nations. When Framework Convention for Tobacco Control- (FCTC) consistent policies are also implemented, the model projects that smoking prevalence will fall by another 28% with an additional 168,000 deaths averted by 2040.
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Affiliation(s)
- David T Levy
- Cancer Control, Lombardi Comprehensive Cancer Centre, Georgetown University, WA 20007, USA
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Currie LM, Blackman K, Clancy L, Levy DT. The effect of tobacco control policies on smoking prevalence and smoking-attributable deaths in Ireland using the IrelandSS simulation model. Tob Control 2012; 22:e25-32. [PMID: 22634570 DOI: 10.1136/tobaccocontrol-2011-050248] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study estimates the relative contribution of policies implemented between 1998 and 2010 to reductions in smoking prevalence by 2010. It then models the impact of implementing stronger policies, relative to a scenario of inaction, on smoking prevalence and smoking-attributable mortality in Ireland. METHODS IrelandSS is an adapted version of SimSmoke, a dynamic simulation model used to examine the effect of tobacco control policies on smoking prevalence, through initiation and cessation, and associated future premature mortality. RESULTS Model predictions for smoking prevalence are reasonably close to those from surveys. As a result of tobacco control policies implemented between 1998 and 2010, there was a 22% relative reduction in smoking prevalence and 1716 fewer smoking-attributable deaths (SADs) by 2010 increasing to a 29% relative reduction in prevalence and 50 215 fewer SADs by 2040. With the introduction of stricter FCTC-compliant policies in 2011, the smoking prevalence can be decreased by as much as 13% initially, increasing to 28% by 30 years. With these stronger policies, a total of 24 768 SADs will be averted by 2040. CONCLUSIONS Predictions from the IrelandSS model suggest that policies implemented between 1998 and 2010 have had considerable effect; however, appreciable reductions in smoking prevalence and SADs can still be achieved through increasing taxes, maintaining a high-intensity tobacco control media campaign, introducing graphic health warnings and improving smoking cessation services.
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Affiliation(s)
- Laura M Currie
- Division of Population Health Science, Royal College of Surgeons in Ireland, Dublin, Ireland.
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Lakha F, Gorman DR, Mateos P. Name analysis to classify populations by ethnicity in public health: validation of Onomap in Scotland. Public Health 2011; 125:688-96. [PMID: 21907365 DOI: 10.1016/j.puhe.2011.05.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 03/29/2011] [Accepted: 05/10/2011] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Health inequalities between ethnic minorities and the general population are persistent. Addressing them is hampered by the inability to classify individuals' ethnicity accurately. This is addressed by a new name-based ethnicity classification methodology called 'Onomap'. This paper evaluates the diagnostic accuracy of Onomap in identifying population groups by ethnicity, and discusses applications to public health practice. STUDY DESIGN Onomap was applied to three independent reference datasets (birth registration, pupil census and register of Polish health professionals) collected in Britain and Poland at individual level (n = 260,748). METHODS Results were compared with the reference database ethnicity 'gold standard'. Outcome measures included sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Ninety-five percent confidence intervals and Chi-squared tests were used. RESULTS Onomap identified the majority of those in the British participant group with high sensitivity and PPV (>95%), and low misclassification (<5%), although specificity and NPV were lowest in this group (56-87%). Outcome measures for all other non-British groupings were high for specificity and NPV (>98%), but variable for sensitivity and PPV (17-89%). Differences in misclassification by gender were statistically significant. Using maiden name rather than married name in women improved classification outcomes for those born in the British Isles (0.53%, 95% confidence interval 0.26-0.8%; P < 0.001) but not for South Asian or Polish groups. CONCLUSIONS Onomap offers an effective methodology for identifying population groups in both health-related and educational datasets, categorizing populations into a variety of ethnic groups. This evaluation suggests that it can successfully assist health researchers, planners and policy makers in identifying and addressing health inequalities.
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Affiliation(s)
- F Lakha
- NHS Lothian, Waverley Gate, 2-4 Waterloo Place, Edinburgh EH1 3EG, UK
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Catto A, Gorman D, Higgins M. The impact of recent Central and Eastern European migration on the Scottish health service: A study of newspaper coverage 2004–2008. Health Place 2010; 16:765-75. [DOI: 10.1016/j.healthplace.2009.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2009] [Revised: 11/24/2009] [Accepted: 12/03/2009] [Indexed: 10/20/2022]
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Fassaert T, Hesselink AE, Verhoeff AP. Acculturation and use of health care services by Turkish and Moroccan migrants: a cross-sectional population-based study. BMC Public Health 2009; 9:332. [PMID: 19744326 PMCID: PMC2749828 DOI: 10.1186/1471-2458-9-332] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2009] [Accepted: 09/10/2009] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND There is insufficient empirical evidence which shows if and how there is an interrelation between acculturation and health care utilisation. The present study seeks to establish this evidence within first generation Turkish and Moroccan migrants, two of the largest migrant groups in present-day Western Europe. METHODS Data were derived from the Amsterdam Health Monitor 2004, and were complete for 358 Turkish and 288 Moroccan foreign-born migrants. Use of health services (general practitioner, outpatient specialist and health care for mental health problems) was measured by means of self-report. Acculturation was measured by a structured questionnaire grading (i) ethnic self-identification, (ii) social interaction with ethnic Dutch, (iii) communication in Dutch within one's private social network, (iv) emancipation, and (v) cultural orientation towards the public domain. RESULTS Acculturation was hardly associated with the use of general practitioner care. However, in case of higher adaptation to the host culture there was less uptake of outpatient specialist care among Turkish respondents (odds ratio [OR] = 0.90, 95% confidence interval [CI] = 0.82-0.99) and Moroccan male respondents (OR = 0.81, 95% CI = 0.71-0.93). Conversely, there was a higher uptake of mental health care among Turkish men (OR = 0.81, 95% CI = 0.71-0.93) and women (OR = 0.81, 95% CI = 0.71-0.93). Uptake of mental health care among Moroccan respondents again appeared lower (OR = 0.74, 95% CI = 0.55-0.99). Language ability appeared to play a central role in the uptake of health care. CONCLUSION Some results were in accordance with the popular view that an increased participation in the host society is concomitant to an increased use of health services. However, there was heterogeneity across ethnic and gender groups, and across the domains of acculturation. Language ability appeared to play a central role. Further research needs to explore this heterogeneity into more detail. Also, other cultural and/or contextual aspects that influence the use of health services require further identification.
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Affiliation(s)
- Thijs Fassaert
- Department of Epidemiology, Documentation and Health Promotion, Amsterdam Municipal Health Service, Amsterdam, the Netherlands
- Department of Social Medicine, Academic Medical Center/University of Amsterdam, Amsterdam, the Netherlands
| | - Arlette E Hesselink
- Department of Epidemiology, Documentation and Health Promotion, Amsterdam Municipal Health Service, Amsterdam, the Netherlands
| | - Arnoud P Verhoeff
- Department of Epidemiology, Documentation and Health Promotion, Amsterdam Municipal Health Service, Amsterdam, the Netherlands
- Department of Sociology and Anthropology, University of Amsterdam, Amsterdam, the Netherlands
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