Changes in smoking due to COVID-19 pandemic among persons of migrant origin compared with the general population: a population-based study

AIMS

Prior studies have implied that smokers may have changed their smoking behaviour during the COVID-19 pandemic. However, little is known about changes in smoking behaviour and correlates of change due to the pandemic among persons of migrant origin compared with the general population.

METHODS

Population-based cross-sectional studies with comparable study protocols and measures, one focusing on persons of migrant origin living in Finland (n = 3587, response rate 60%) and the other on the general Finnish population (n = 3444, response rate 56%), were utilised. The outcome measure was self-reported change in smoking behaviour due to COVID-19 among current smokers. Explanatory factors included sociodemographic-, health-, and COVID-19-related factors. Multinomial logistic regression was used in the analyses.

RESULTS

Most of the current smokers reported no change in their smoking behaviour. In the adjusted model, younger age was positively associated with increased smoking, while region of origin (Russia, Africa, Asia, and Latin America) and worrying about getting infected with COVID-19 were associated with decreased smoking among persons of migrant origin. In the general population, younger age, female sex, being other than employed/student, increased loneliness, and decreased contact with close ones were associated with increased smoking, while reduced working capacity and worries that someone close to the respondent will be infected with COVID-19 were associated with decreased smoking.

CONCLUSIONS

The findings of this study contribute to better identification of at-risk populations in future crises situations. This will allow for more efficient targeting and tailoring of health promotion services, including smoking cessation.

Potentially traumatic experiences pre-migration and adverse pregnancy and childbirth outcomes among women of Somali- and Kurdish-origin in Finland

BACKGROUND

Women in precarious conditions in their countries of origin, especially those who have left the country as refugees, may have been victims of serious mental and physical violence. These potentially traumatic experiences may threaten women's reproductive health. This study examines the prevalence of potentially traumatic experiences pre-migration and female genital mutilation/cutting (FGM/C) and their associations with adverse reproductive outcomes among migrant women of Somali- and Kurdish-origin who have been pregnant in Finland.

METHODS

Survey and register data of the participants of the Finnish Migrant Health and Wellbeing Study (Maamu), conducted in 2010-2012, were used. Women of 18 to 64 years of age, 185 Somali- and 230 Kurdish-origin, who had at least one pregnancy or birth in Finland were included in the analysis. The survey data were linked to the Finnish Medical Birth Register, the Register of Induced Abortions, and the Care Register for Health Care until 2018. For each outcome, logistic regression was used and adjusted for age, body mass index, time lived in Finland, and the number of births.

RESULTS

A total of 67% of Somali-origin and 71% of Kurdish-origin women had experienced potentially traumatic experiences pre-migration and 64% of Somali- and 32% of Kurdish-origin women had also undergone FGM/C. In Kurdish-origin women, complications during pregnancy (e.g. bleeding in the first trimester, known or suspected fetal abnormality, signs of fetal hypoxia, death of the fetus and other problems) were significantly more common among women without potentially traumatic experiences (70%) than among women with potentially traumatic experiences (48%) (p-value 0.005). No associations between potentially traumatic experiences or FGM/C and other adverse reproductive outcomes were observed among Somali- or Kurdish-origin women.

CONCLUSION

Past trauma is common among Somali- and Kurdish-origin women and this needs to be evaluated in maternity care. However, we found no association between potentially traumatic experiences pre-migration and adverse reproductive outcomes.

Association of sociodemographic characteristics with self-perceived access to COVID-19 information and adherence to preventive measures among migrant origin and general populations in Finland: a cross-sectional study

OBJECTIVES

This study examines how access to COVID-19 information and adherence to preventive measures varies by sociodemographic characteristics, and whether the associations differ among the migrant origin and the general Finnish population. Additionally, the association of perceived access to information with adherence to preventive measures is examined.

DESIGN

Cross-sectional, population-based random sample.

BACKGROUND

Equity in access to information is crucial for securing individual well-being and successful management of a crisis at population level.

SETTING

Persons who have a residence permit in Finland.

PARTICIPANTS

Migrant origin population constituted of persons aged 21-66 years born abroad, who took part in the Impact of the Coronavirus on the Wellbeing of the Foreign Born Population (MigCOVID) Survey conducted from October 2020 to February 2021 (n=3611). Participants in the FinHealth 2017 Follow-up Survey conducted within the same time frame, representing the general Finnish population, constituted the reference group (n=3490).

OUTCOME MEASURES

Self-perceived access to COVID-19 information, adherence to preventive measures.

RESULTS

Self-perceived access to information and adherence to preventive measures was overall high both among the migrant origin and the general population. Perceived adequate access to information was associated with living in Finland for 12 years or longer (OR 1.94, 95% CI 1.05-3.57) and excellent Finnish/Swedish language skills (OR 2.71, 95% CI 1.62-4.53) among the migrant origin population and with higher education (OR 3.56, 95% CI 1.49-8.55 for tertiary and OR 2.87, 95% CI 1.25-6.59 for secondary) among the general population. The association between examined sociodemographic characteristics with adherence to preventive measures varied by study group.

CONCLUSIONS

Findings on the association of perceived access to information with language proficiency in official languages highlight the need for rapid multilingual and simple language crisis communications. Findings also suggest that crisis communications and measures designed to influence health behaviours at population level may not be directly transferable if the aim is to influence health behaviours also among ethnically and culturally diverse populations.

Prevalence and risk factors of psychological distress among foreign-born population in Finland: A population-based survey comparing nine regions of origin

AIMS

Previous research indicates that foreign-born populations experience more psychological distress than general populations. However, it remains unclear how prevalence varies between regions of origin. The role of socio-demographic and migration-related factors also needs to be further investigated. We aimed to (a) compare the prevalence of psychological distress in foreign-born and general Finnish populations, (b) investigate differences in prevalence between nine regions of origin and (c) examine which socio-demographic and migration-related factors are associated with distress among foreign-born populations.

METHODS

The study used data from the Survey on Well-Being among Foreign Born Population (FinMonik), a population-based survey (n=6312) of foreign-born populations living in Finland collected between 2018 and 2019 by the Finnish Institute for Health and Welfare. Psychological distress was measured using the Mental Health Inventory-5 (MHI-5), with a cut-off point of 52. Logistic regression was used to adjust analyses by age and sex to determine the prevalence of psychological distress and the associated socio-demographic factors.

RESULTS

Psychological distress was more prevalent among those who were foreign born (17.4%) than among the general population (12.9%). Migrants from the Middle East and North Africa had the highest prevalence (29.7%) compared to other regions of origin. Unemployment or economic inactivity, international protection as a reason for migration and beginner-level language proficiency were the main factors increasing the odds for distress among foreign-born populations.

CONCLUSIONS

Foreign-born populations experience more psychological distress than the general population, but prevalence varies between regions of origin. Future efforts should aim at a better understanding of the mental health risk factors and the development of targeted interventions for these subpopulations.

Incidence of SARS-CoV-2 Infection and Factors Associated With Complete COVID-19 Vaccine Uptake Among Migrant Origin Persons in Finland

Objective: We examined incidence of SARS-CoV-2 infection, COVID-19 vaccine uptake and factors associated with complete COVID-19 vaccine uptake among persons of migrant origin in Finland. Methods: Data on laboratory-confirmed SARS-CoV-2 infection and COVID-19 vaccine doses between March 2020 and November 2021 were linked to FinMonik register sample (n = 13,223) and MigCOVID (n = 3,668) survey data using unique personal identifier. Logistic regression was the main method of analyses. Results: Among FinMonik sample, complete COVID-19 vaccine uptake was lower among persons of Russia/former Soviet Union, Estonia, and rest of Africa and higher among persons of Southeast Asia, rest of Asia, and the Middle East/North Africa than among persons originating from Europe/North America/Oceania. Male sex, younger age, migration age (<18 years) and shorter length of residence were associated with lower vaccine uptake among FinMonik sample, whereas younger age, being economically inactive, poorer language skills, experiences of discrimination and psychological distress were associated with lower vaccine uptake among MigCOVID sub-sample. Conclusion: Our Findings point to a further need of tailored and targeted communication and community outreach strategies to increase vaccine uptake among persons of migrant origin.

A multisource approach to health care use: concordance between register and self-reported physician visits in the foreign-born population in Finland

BACKGROUND

Reliable information on the use of health services is important for health care planning, monitoring and policy. It is critical to assess the validity of the sources used for this purpose, including register and survey-based data. Studies on foreign-born populations' health care use have usually implemented either survey or register data. The concordance of such data among groups of different cultural background remains largely unknown. In this study, we presented an approach to examine routinely how survey and register-related characteristics may explain disagreement found between the two information sources.

METHODS

We linked register- and survey-based data pertaining to the Finnish Register of Primary Health Care general physician visits and the Survey on Well-Being among Foreign Born Population (FinMonik, 2018-2019), a nationally representative survey. The sample comprised n = 5,800 informants for whom registered general physician visits were tracked in the 12-month period preceding their participation in the survey. Cohen's kappa was used as measure of multisource concordance, hierarchical loglinear models for the association between single predictors and multisource discrepancy, and a logistic regression model for examining source-related predictors of source discrepancy. Survey weights were used in all sample analyses.

RESULTS

Source concordance was poor. When dichotomizing general physician visits (zero vs one or more), 35% of informants had reported one or more visits while none were found from register. Both register- and informant-related predictors were associated to this discrepancy (i.e. catchment area, private health care use, inability to work, region of origin and reason for migration).

CONCLUSIONS

We found high discrepancy between the reported and the registered physician visits among the foreign-born population in Finland, with a particularly high number of reported physician visits when none were found in the register. There was a strong association between the specific catchment area and mismatch, indicating that both register under-coverage and survey over-report are plausible and may coexist behind the discrepancy. However, associations of informant's characteristics and mismatch were less pronounced. Implications on the validity of medical information sources are discussed.

National belonging and psychological strain among Finnish migrant populations

Background

National identities are socially constructed and imaginary groups with real-life consequences. Migrants are in a heightened risk to be treated as ‘others’ who do not belong to society. It remains unclear, to what extent national belonging is experienced among Finnish migrants and what consequences on health this has. We study migrants’ sense of belonging to Finns, how it’s manifested in sociodemographic groups and whether it’s associated with psychological strain.

Methods

We used nationally representative data from the cross-sectional Survey on Well-Being among Foreign-Born Population (FinMonik, n = 6836). National belonging was assessed by the item “Finns” in question “which of the following areas or groups you feel you belong to?”. Response options fully and quite a lot were coded to indicate sense of belonging. Logistic regression was used to test the association between belonging, sociodemographic factors and psychological strain (MHI-5). Weights were used to correct the sample.

Results

51% reported sense of belonging to Finns. 46% of those aged 30-44 reported sense of belonging to Finns, whereas the youngest and oldest age groups yielded highest prevalences (18-29=53% and 45-64=58%, p&lt;.001). Married persons reported sense of belonging to Finns more than those who weren't (55% vs. 48%, p&lt;.01). Country group accounted for the variation in Finnish identification with a p-value of less than 0.001. Only 27 percent of those born in East Asia reported sense of belonging to Finns, whereas almost 60% of those born in Middle East and North Africa sensed belonging to Finns. Those with sense of belonging to Finns were twice as likely to report lack of psychological strain than those with no sense of belonging to Finns (p&lt;.001).

Conclusions

Achieving national belonging to the receiving society seems to be more difficult or non-appealing for some migrant populations than others. Lack of national belonging poses risk of deterioration of mental health.

Key messages

• The socially constructed boundaries of national belonging can be exclusionary and have negative consequences for the health of migrant populations.

• Experiencing a sense of national belonging to the country of residence has positive associations with mental wellbeing.

The association of depressive and anxiety symptoms with the metabolic syndrome and its components among Russian, Somali, and Kurdish origin adults in Finland: A population-based study

OBJECTIVE

Positive association of depressive and anxiety symptoms with the metabolic syndrome (MetS) have been reported, however there is little information on these among migrant origin populations. The aim of this study was to examine these associations among diverse migrant origin populations in Finland.

METHODS

Data of 318 Russian, 212 Somali, and 321 Kurdish origin participants in the cross-sectional Finnish Migrant Health and Wellbeing Study (Maamu) aged 30-64 years was used. The general population reference group constituted of 786 Health 2011 Survey participants. Depressive and anxiety symptoms were measured with HSCL-25 subscales. Harmonized definition of MetS was used.

RESULTS

Depressive symptoms were associated with elevated blood pressure in Kurdish origin (30.1%, 95% CI 22.7-38.8 vs. 19.9%, 95%CI 15.4-25.4 for those with and without symptoms respectively); and elevated waist circumference (72.1%, 95%CI 56.9-83.5 vs. 55.0%, 95%CI 50.6-59.4) and triglycerides (30.8%, 95%CI 16.0-51.0 vs. 11.9%, 95%CI 9.3-15.0) in general population. Anxiety symptoms were associated with MetS (47.0%, 95%CI 37.6-56.7 vs. 31.9%, 95%CI 26.7-37.6) and elevated blood pressure (37.2%, 95%CI 28.3-46.9 vs. 18.8%, 95%CI 14.7-23.6), and with elevated triglycerides in Somali origin (33.0%, 95%CI 14.5-59.0 vs. 5.7%, 95%CI 3.3-9.6) and general population (30.2%, 95%CI 16.4-48.8, 12.8%, 95%CI 9.9-16.2). No associations between low HDL-cholesterol and depressive or anxiety symptoms were observed.

CONCLUSION

Cardiometabolic health should be taken into account in mental health services. Future studies should explore the underlying pathways to the observed differences in strengths of associations of depressive and anxiety symptoms with MetS and its components across diverse migrant origin populations.

Employment gaps of foreign-born women in Finland: an intercategorical intersectionality approach

Background

Previous studies have shown that foreign-born women have multiple disadvantages in the Finnish labor market leading to an employment gap between foreign-born women, foreign born men and the general population. The employment gap negatively affects the lives of many women and their children (e.g. poverty), contributing to disparities in health and wellbeing, as well as underutilization and waste of human capital in the society.

Methods

Using data from the cross-sectional survey on well-being among foreign born population (FinMonik), conducted in Finland 2018, we compared employment outcomes and the prevalence of different barriers to working life across studied population groups, aged 25-64, representing different ethnic backgrounds, genders and education levels. We employed an intercategorical intersectionality approach that uses categories to make visible which differences carry significance and how multiple simultaneous disadvantages intersect to produce inequities in full- and part-time employment outcomes. Analysis weights were applied in the analyses.

Results

Labor market outcomes showed wide variation across genders, ethnic backgrounds and education levels both within and between studied groups. Highly educated Estonian women had the highest rate of full-time employment 73% (95% CI [59.3, 83.1]), while highly educated women from African countries (excl. North Africa) and North Africa and Middle East lagged behind all migrant groups, with full-time employment around 42% and 34 % (95% CI [23.3, 63] and [20.6, 50.2], respectively). Low educated Estonians had the highest full-time employment rate, 69% (95% CI [61.5, 75.8]), exceeding that of general population, 55% (95% CI [53.2, 56.5]).

Conclusions

The results suggest that intersectionality of ethnicity, gender and education level have impacts on labor market participation. The most marginalized groups are disproportionately affected by inequities and exclusionary practices in the Finnish labor market.

Key messages

Distinct employment gaps between population groups demonstrate how multiply disadvantaged groups face multiple barriers in working life. To improve health equity, solutions are needed to remove structural barriers to employment that unfairly disadvantage certain groups of people.

Access to services among migrant origin persons during COVID-19 pandemic: Finnish MigCOVID Survey

Background

Compared with the general population, migrant origin persons had more difficulties in access to services already prior to the COVID-19 pandemic. This study examines the impact of the pandemic on the need and access to healthcare and social services among persons of migrant origin.

Methods

Data from the population-based Impact of the Coronavirus on the Wellbeing of the Foreign Born Population (MigCOVID) Survey was used. The survey was conducted in Finland among persons aged 20 to 66 years (n = 3 668 participated in the survey, participation rate 60%) between October 2020 and February 2021 with electronic and postal questionnaires and telephone interviews. Logistic regression was applied to examine age and sex-adjusted prevalence and 95 % confidence intervals (CI) for self-reported need and sufficiency of services (physician, nurse, dentist, mental health services and family services).

Results

Healthcare and family services were needed by 69.2% (95% CI 66.3-72.0). Services provided by the physician, dentist and nurse were needed most frequently. Women (74.5%, 95% CI 70.6-78.1) were more likely to report the need for health and family services than men (64.4%, 95% CI 60.0-68.5). Out of those who needed services, 34.9% (95% CI 36.1-38.3) reported that the received services were insufficient. Highest barriers were observed for mental health (45.5%, 95% CI 36.4-55.0) and dentist (33.9, 95% CI 29.6-38.6) services. Although difficulties were highly prevalent in a number of regional groups, persons originating from East, South and Central Asia had persistently high barriers in access to services.

Conclusions

Findings suggest that barriers in access to services have at least somewhat increased among persons of migrant origin during the COVID-19 pandemic. This may have both short and long-term consequences on the health and wellbeing of the migrant origin population. Of particular concern were high perceived barriers in access to mental health services.

Key messages

Barriers in access were reported by a third of persons of migrant origin who needed services. Particular difficulties were experienced in access to mental health services. The gap in access to needs to be acutely addressed to reduce both the short and long-term consequences of COVID-19 on the health and wellbeing of the population.

Mental health, integration, and voting in municipal elections among foreign-born population

Background

Social inclusion measures are essentially related with health among foreign-born population (FBP). Municipal elections provide a way to participate in societal decision making even for those without Finnish citizenship. However, the voter turnout in municipal elections among FBP has remained low. The aim of this study is to explore mental health, migration and integration related factors' associations with voting in municipal elections among FBP.

Methods

Associations between self-reported municipal voter turnout and language skills, main reason for migration, psychological strain and sense of belonging (SB) to locals, country of origin and other groups were studied by using nationally representative data from the cross-sectional Survey on Well-Being among Foreign-Born Population (FinMonik, n = 6836). Weights were used to correct the sample. Age and sex were used as control variables.

Results

Voter turnout was higher among those with: at least intermediate local language skills (39% vs. 25%, p &lt; 0.001); those who moved because of family (42%), studies (39%) or refugee status (39%) versus those who moved because of work (23%, p &lt; 0.001); no psychological strain (38% vs. 27%, p &lt; 0.001); SB to locals and country of origin (45%) and SB to locals but no country of origin (43%) versus those with SB to country of origin but no SB to locals, or those with no SB to any of the groups presented (both 25% p &lt; 0.001).

Conclusions

Lack of language skills can be a barrier to participate in municipal elections. Migrating for family reasons might reflect commitment to stay in current country and therefore increase motivation to influence by voting. Moreover, lack of sense of belonging to locals and psychological strain might demotivate participation.

Key messages

Factors hindering political participation can be manifold and need more studies to enhance participation across all groups. Attention should be paid to provide clear and sufficient information regarding municipal elections and candidates in several languages.

Information access and preventive measures during COVID-19 among migrants and general population

Background

Access to information and adherence to preventive measures are crucial for containing the COVID-19 outbreak. This study examines access to information and adherence to preventive measures during the COVID-19 pandemic among migrant origin persons and the general population.

Methods

Data from the Finnish MigCOVID Survey conducted 10/2020 to 2/2021 among persons aged 20 to 66 years was used (n = 3 668). Participants in Health 2017 follow-up survey were the reference group (n = 3 490). We examined age and sex-adjusted access to information by language skills and adherence to preventive measures (staying home if fluish; keeping a safety distance; wearing a face mask; good hand and coughing hygiene; avoiding traveling abroad; avoiding shaking hands with others; downloading the Koronavilkku contact tracing app).

Results

Persons with excellent Finnish/Swedish language skills (96.8%; 95% CI 95.0-97.9) reported receiving sufficient information more often those with intermediate (92.3; 95% CI 88.8-94.8) or basic (91.0%; 95% CI 88.0-93.3) language skills. Overall high adherence to preventive measures was observed both among the migrant origin and the general population. However, significant differences in the migrant origin population by region of origin were observed. More pronounced differences between migrant origin persons and general population persons were observed for avoiding traveling abroad (83.7%; 95% CI 81.1-86.0 vs. 96.6%; 95% CI 95.6-97.3) and downloading the Koronavilkku app (42.8%; 95% CI 39.8-45.9 vs. 64.3%; 95% CI 61.7-66.8).

Conclusions

Poorer perceived access to information by language skills points to the continuous need for use of simple language and multilingual communication materials. Self-reported adherence to key preventive measures campaigned by health authorities was generally high both among persons of migrant origin and the general population, although concerns were noted in adherence to these recommendation in some regional groups.

Key messages

Multilingual and multichannel communication is central in crisis situations to ensure adequate access to information among different population groups.

Higher incidence of COVID-19 among migrant origin persons is likely related not only to information access and adherence to preventive measures, but also to various social and structural factors.

Iranian and Iraqi torture survivors in Finland and Sweden: findings from two population-based studies

Background

Most refugees and other forced migrants have experienced potentially traumatic events (PTEs). Torture and other traumatic experiences, as well as various daily stressors, impact the mental health and psychosocial well-being of war-affected populations.

Methods

The study includes two population-based samples of Iranian and Iraqi men living in Finland and Sweden. The Finnish Migrant Health and Well-being Study (Maamu) was conducted in 2010–2012. The Linköping study was conducted in Sweden in 2005. In both samples, health and well-being measures, social and economic outcomes as well as health service utilization were reported.

Results

The final sample for analysis consisted of two groups of males of Iranian or Iraqi origin: 278 residents in Finland and 267 residents in Sweden. Both groups were subdivided according to the reported PTEs: Torture survivors; Other PTEs; No PTEs. Migrants that reported PTEs, torture survivors in particular, had significantly poorer social and health outcomes. Torture survivors also reported lower trust and confidence in authorities and public service providers, as well as more loneliness, social isolation and experiences of discrimination.

Conclusions

Torture and other PTEs prevalent in refugee and migrant populations create a wide-ranging and long-term impact in terms of increased risk of various types of adverse social and health conditions. Early identification through systematic and effective screening should be the first step in guiding migrants and refugees suffering from experiences of torture and other PTEs to flexible, multidisciplinary services.

Response Activity in Mixed-Method Survey Data Collection-The Methods Used in a Survey among the Foreign-Born Population in Finland (FinMonik)

In terms of the number of respondents, Survey on Well-Being among Foreign Born Population (FinMonik) is so far the most extensive survey carried out among the population with foreign background in Finland. It comprises a wide range of self-reported data, including information on the respondent’s health, well-being and access to care, which can be widely utilized in planning and assessing integration, health and welfare policies. A mixed-method approach (an electronic questionnaire, a paper questionnaire and phone interviews) was used in collecting the data which consists of responses by 6836 respondents aged 18–64 years. All response types included, the response rate was 53.1% (n = 6836). This study describes in detail the methods used in the FinMonik survey. In addition, we describe the demographics of the respondents partaking in each response format. The aim of the study is to promote the development of mixed-method survey as a way of collecting reliable data that can be used to enhance foreign-born people’s health, well-being and access to health care. The survey responses will be used as a baseline in observing the respondents’ well-being through the register-based data available in several national registers on health, medicine use and access to care as well as the data collected in the study Impact of Coronavirus Epidemic on Well-Being among Foreign Born Population Study (MigCOVID). Furthermore, the FinMonik study protocol will be repeated every four years.

Use of Health Services and Unmet Need among Adults of Russian, Somali, and Kurdish Origin in Finland

Equal access to health care is one of the key policy priorities in many European societies. Previous findings suggest that there may be wide differences in the use of health services between people of migrant origin and the general population. We analyzed cross-sectional data from a random sample of persons of Russian (n = 692), Somali (n = 489), and Kurdish (n = 614) origin and the Health 2011 survey data (n = 1406) representing the general population in Finland. Having at least one outpatient visit to any medical doctor during the previous 12 months was at the same level for groups of Russian and Kurdish origin, but lower for people of Somali origin, compared with the general population. Clear differences were found when examining where health care services were sought: people of migrant origin predominantly visited a doctor at municipal health centers whereas the general population also used private and occupational health care. Self-reported need for doctor's treatment was especially high among Russian women and Kurdish men and women. Compared to the general population, all migrant origin groups reported much higher levels of unmet medical need and were less satisfied with the treatment they had received. Improving basic-level health services would serve besides the population at large, the wellbeing of the population of migrant origin.

Cervical Cancer Screening Participation among Women of Russian, Somali, and Kurdish Origin Compared with the General Finnish Population: A Register-Based Study

Migrant-origin women are less prone to cervical screening uptake compared with host populations. This study examined cervical cancer screening participation and factors associated with it in the Finnish mass screening program during 2008–2012 in women of Russian, Somali and Kurdish origin compared with the general Finnish population (Finns) in Finland. The study population consists of samples from the Finnish Migrant Health and Well-being Study 2010–2012 and Health 2011 Survey; aged 30–64 (n = 2579). Data from the Finnish screening register linked with other population-based registry data were utilized. For statistical analysis we employed logistic regression. Age-adjusted screening participation rates were Russians 63% (95% CI: 59.9–66.6), Somalis 19% (16.4–21.6), Kurds 69% (66.6–71.1), and Finns 67% (63.3–69.8). In the multiple-adjusted model with Finns as the reference; odds ratios for screening were among Russians 0.92 (0.74–1.16), Somalis 0.16 (0.11–0.22), and Kurds 1.37 (1.02–1.83). Among all women, the substantial factor for increased screening likelihood was hospital care related to pregnancy/birth 1.73 (1.27–2.35), gynecological 2.47 (1.65–3.68), or other reasons 1.53 (1.12–2.08). Screening participation was lower among students and retirees. In conclusion, screening among the migrant-origin women varies, being significantly lowest among Somalis compared with Finns. Efforts using culturally tailored/population-specific approaches may be beneficial in increasing screening participation among women of migrant-origin.

Vahvan tunnistautumisen käyttömahdollisuus digitaalisiin palveluihin ei ole itsestäänselvyys kaikissa väestöryhmissä Suomessa

Vahva tunnistautuminen mahdollistaa henkilöllisyyden todentamisen digipalveluissa. Digipalvelut ovat arjen palveluita esimerkiksi laskunmaksu verkkopankissa tai terveystietojen tarkastelu Omakannassa. Selvitämme tutkimuksessa onko eri väestöryhmissä eroja internetin ja vahvan tunnistautumisen käyttömahdollisuudessa. Aineisto muodostettiin väestökyselyistä: 1) Ulkomailla syntyneiden hyvinvointitutkimus (FinMonik, 2018−2019), joka toteutettiin 18 eri kielellä ja vastausprosentiksi muodostui 53 (N=12 877). 2) Koko väestön Kansallinen terveys-, hyvinvointi- ja palvelututkimus (FinSote, 2017−2018), jonka vastausprosentiksi muodostui 45 (N=26 422). Rajasimme vastukset työikäisiin (20−64 vuotiaisiin) ja analyyseissä käytettiin 6 083 vastausta FinMonikista ja 11 029 FinSotesta. Tulosmuuttujille laskettiin ikävakioidut osuudet ja luottamusvälit. Itseilmoitetulle vahvan tunnistautumisen käyttömahdollisuudelle laskettiin vetosuhteet (odds ratio) logistisella regressiomallinnuksella. Estimaattien eroja maaryhmien ja koko väestön välillä tarkasteltiin F-testiin perustuvilla p-arvoilla. Työikäisessä väestössä lähes kaikki (98 %) raportoivat, että heillä oli mahdollisuus käyttää internetiä, mutta ulkomaalaistaustaisen väestössä osuus oli matalampi (92 %, p < 0,001). Itseilmoitetun vahvan tunnistautumisen käyttömahdollisuus oli yleisempää koko väestössä (98 %) kuin ulkomaalaistaustaisessa väestössä (88 %, p < 0,001). Ulkomaalaistaustaisessa väestössä Lähi-itä ja Pohjois-Afrikka -taustaiset raportoivat muita ryhmiä harvemmin, että heillä oli mahdollisuus vahvaan tunnistautumiseen. Molemmissa kyselyissä nuorilla itseilmoitettu vahvan tunnistautumisen käyttömahdollisuus oli yleisempää verrattuna vanhempiin henkilöihin ja opiskelijat ilmoittivat työssä olevia harvemmin vahvan tunnistautumisen käyttömahdollisuudesta. Itseilmoitetussa vahvassa tunnistautumisessa oli väestöryhmittäisiä eroja. Pohdittavaksi jää eritoten palkkatyön merkitys digiosallisuuden kasvattajana. Palkkatyö mahdollistaa varat laitteiden hankintaan, käyttömaksuihin sekä usein kerryttää digiosaamista. Digitaalisia palveluita tarjottaessa huomiota tulisi kiinnittää väestöryhmiin, joissa vahvan tunnistautumisen käyttömahdollisuus on muuta väestöä heikompaa. Digitaalisten palveluiden kehittäminen vaatii rinnalleen ohjausta, jossa huomioidaan neuvonnantarpeet myös vahvan sähköisen tunnistautumisen osalta.

Disparities in treatment of diabetes and hypertension among groups of foreign origin and the general Finnish population

BACKGROUND

Migrants from low-income countries are more predisposed to diabetes and cardiovascular risks than host European natives, but how treatment targets are met in migrant patients is unclear. We examined health service use and treatment of diabetes and hypertension among selected migrant groups and the general Finnish population and compared prevalence of cardiovascular risk factors between patients and non-patients.

METHODS

Cross-sectional data from randomly sampled 30- to 64-year-old participants (387 Russian, 198 Somali and 343 Kurdish origin migrants) of the Migrant Health and Wellbeing Survey (2010-2012) were used. Health 2011 survey data (n = 1086) were used as a comparison group.

RESULTS

Compared with the general population, diabetes-related doctor/nurse visits were more frequent among Russian and Somali, but not the Kurdish group. Use of prescribed antidiabetic and antihypertensive drugs were significantly lower among Russians (78%/56%) and Kurdish (68%/58%), but not in Somalis (85%/62%) compared with the general population (96%/78%). Obesity, elevated blood pressure and elevated glucose levels were more prevalent in patients than non-patients, and over 60% of patients and over 70% of non-patients had elevated plasma low density lipoprotein cholesterol. Differences in cardiovascular disease (CVD) risk profiles between patients and non-patients were not associated with socio-economic factors.

CONCLUSIONS

This study indicates disparities in prevalence and management of diabetes and hypertension and their associated risk factors among ethnic groups. Diabetes, CVD risks and treatment outcomes in patients were sub-optimal, especially among foreign origin groups. Comprehensive health promotion strategies are needed to improve cardiometabolic health in vulnerable populations.

Births, miscarriages and induced abortions among foreign born women in Finland

Background

The increasing number of foreign-born women living in Finland has raised a need for more information about their sexual and reproductive health and need for services. This study explores the prevalence of births, induced abortions and miscarriages as well as the associated socioeconomic factors of foreign-born women.

Methods

This study used data collected in the Survey on Well-Being Among Foreign Born Population (FinMonik), conducted in 2018-2019. The random sample (n = 6 695) consisted of women aged 18 to 64 years and living in Finland. The participation rate among women was 56% (n = 3 746). The results were stratified according to country groups based on geographic region of origin: Middle East and Africa; Russia, former Soviet Union and Estonia; Asia; EU, North America, Latin America and others. The analyses were conducted with logistic regression adjusting for age. In the analyses, weights were used to reduce non-response bias.

Results

The proportion of women who had at least one birth in their lifetime varied from 67 to 80%. Those from the Middle East or Africa had the highest proportion of three or more births (41%). The proportion of women who had experienced induced abortion was highest among women from Russia, former Soviet Union and Estonia: 34% of these women had experienced at least one abortion while 20% had experienced at least two abortions. No difference in reported miscarriages was observed between the groups (20-27%). In all groups, married women (82%) and those with only basic education (82%) had more often at least one birth than unmarried women (61%) and those with higher education (70%). Compared to the other groups, lower educated Russian, former Soviet Union and Estonian women had more often experienced at least one induced abortion (44 %).

Conclusions

There are major differences in the prevalence of births and abortions among women from different regions and educational level.

Key messages

Challenges in sexual and reproductive health vary by region of origin. Low-threshold health services and health education are needed to guarantee better sexual and reproductive health for all women.

Sense of belonging and years lived in Finland: associations among foreign-born population

Background

Belonging to different groups is associated with migrants' health. In this study, we examined the associations between sense of belonging (SoB) and years lived in Finland.

Methods

The data from the cross-sectional Survey on Well-Being among Foreign-Born Population (FinMonik, n = 6 836), conducted in Finland in 2018-19, was used. SoB was assessed by the question “Which of the following areas or groups you feel you belong to?” with options: local municipality; Finns; Europeans, country of origin; world citizens; religious or spiritual community; professional group or colleagues; political or ideological group. The data of years lived in Finland were linked from the National Population register and classified into three categories: less than five years; five to 10 years; over 10 years. Those who had lived less than one year in Finland were not included in the survey. Logistic regression was used to test the association between SoB and years lived in Finland, with age, sex and country of origin as confounding variables. In the analyses, weights were used to reduce non-response bias.

Results

Those who had lived in Finland over 10 years had higher odds for SoB towards Finns (OR = 1.74, p = &lt;0.001), local municipality (OR = 2.41, p = &lt;0.001) and Europeans (OR = 1.54, p = 0.001) and lower odds for SoB towards country of origin (OR = 0.68, p = 0.003) and religious or spiritual community (0.73, p = 0.043) when compared to those who had lived in Finland less than five years. No significant differences in SoB were found between less than five years in Finland and five to ten years in Finland.

Conclusions

SoB varied considerably when comparing those who had lived less than five years in Finland and those who had lived more than 10 years in Finland. Belonging to local people is more likely when one has lived in Finland more than ten years. Belonging to country of origin and religious or spiritual community is less likely when lived more than ten years in Finland.

Key messages

Sense of belonging seems to change over the course of stay in the new home country, but first after 10 years of stay. Identifying with local people and even with Europeans becomes more prominent after 10 or more years in Finland.

Better mental health through identifying with locals and country of origin among foreign-born people

Background

Sense of belonging (SoB) is an important determinant of health among foreign-born population and it has previously been found to be associated with perceived health. In this study we examined: 1) which types of SoB are associated with psychological strain (PS), and 2) whether this varies between different country groups.

Methods

The data were gathered from the cross-sectional Survey on Well-Being among Foreign-Born Population (FinMonik, n = 6 836), conducted in Finland in 2018-19. SoB was assessed by the question “Which of the following areas or groups you feel you belong to?”, classified into 1) both Finns/local municipality and citizens of country of origin CCO (acculturation identity), 2) only Finns/local municipality (local identity), 3) only CCO (origin identity), 4) only Europeans, world citizens, religious, work-related or political group (other identity), and 5) none of the previous. PS was measured by using the MHI-5 (psychological strain: yes; no). Logistic regression was used to test the association between SoB and PS, with age, sex and country of origin as confounding variables. In the analyses, weights were used to reduce non-response bias.

Results

Compared to the acculturation identity group, PS was more common among those with local identity (OR = 1.60, p &lt; 0.01), origin identity (OR = 1.99, p &lt; 0.001) or other identity (OR = 3.33, p &lt; 0.001) and those with no belonging to any of the groups presented (OR = 5.40, p &lt; 0.001). The last group was more likely to experience PS than the acculturation identity group in all five country groups included in the analysis. Acculturation identity was associated with less PS especially for those born in EU-, EFTA- and North American countries.

Conclusions

Acculturation identity was strongly associated with less psychological strain, especially when compared with the group reporting no belonging to any of the groups presented.

Key messages

Sense of belonging is associated with mental health and should be studied more extensively among different foreign-born population groups. Identification with both the local people and one’s own country of origin should be supported.

Comparability of questionnaire and interview responses on health among people with foreign origin

Background

In health surveys, self-administered questionnaires are a good way to collect data most cost-effectively. For some population groups, a mixture of methods might be necessary in order to reach the desired response rate. If the collection methods vary, the comparability of data might become an issue when evaluating differences between two population groups or changes over time. This study examines the comparability between questionnaire and phone interview responses in a survey on migrants in Finland.

Methods

This study uses the data collected in Survey on Well-Being Among Foreign Born Population (FinMonik), conducted in 2018-19. There were 6 836 respondents, out of which 6 505 filled the questionnaire and 331 were interviewed by phone. The survey included questions 'Do you ever feel lonely?' and 'Do you find that your current state of health is:'. Both were answered using a five-point Likert scale ranging from 'never'/'good' to 'all the time'/'bad'. Logistic regression was used to assess statistical differences.

Results

Among those interviewed by phone, the distributions were more skewed than among those who had filled the questionnaire. In the phone interviews, the emphasis was on the socially more desirable options: regarding loneliness, 'never' was selected 1.7 times more often in the phone interview compared to the questionnaire while 'good' was used to describe the state of health 1.3 times more often. On the common binary indicator 'fairly often or all the time', those who had filled the questionnaire appeared lonelier than those interviewed by phone (14.5% vs 10.4%, p = 0.032), and the difference remained significant when adjusted with a range of sociodemographic variables. However, there was no significant difference on the binary indicator of perceived health ('good or fairly good').

Conclusions

The distributions differed considerably between questionnaire and interview responses, but the level of impact varied between indicators.

Key messages

The data collection methods should be examined carefully when comparing results from different surveys. Instruments designed for questionnaires may yield different results when asked by an interviewer.

For which population groups will strong identification and thus eHealth services use not be possible?

Background

Digital services are expected to improve the availability of public social and health care services in many European countries as well as in Finland. eHealth and eWelfare services often require strong electronic identification which may form barriers in the availability of care. This study focuses on recognising population groups who are vulnerable to exclusion either by not having access to web or by lacking a strong electronic identification.

Methods

The data were gathered from the cross-sectional survey on well-being among people aged 20-64 with foreign background (PFB) (FinMonik), conducted in Finland 2018-19 (N = 12 877; response rate 53%). The data from the National survey of health, well-being and service use (FinSote 2017-18) were used as reference data for the overall population, (N = 26 422, response rate 45%). Surveys asked respondents “Do you have at your disposal internet access at home, your workplace, library or some other place?” and 'Do you have at your disposal online banking codes or a mobile certificate for electronic identification online?”. PFB were defined by background country into seven country-groups. The age-standardized proportions with confidence intervals were examined by socio-demographic background variables.

Results

Almost all (98%) of the overall population reported access to internet, but the proportion was lower (92%) among PFB (p &lt; 0.001). Proportion of having a strong electronic identification was higher among general population (98%) than among PFB (88%) (p &lt; 0.001). In both populations, younger age increased the likelihood of having a strong electronic identification. PFB students reported lower level of strong electronic identification compared to the employed.

Conclusions

Although most had access to internet and a strong identification, there were statistically significant differences between country-groups and by employment status.

Key messages

Designing and developing of eHealth and eWelfare services must ensure that everyone has the opportunity to have a strong electronic identification. Development of digital services requires user guidance, which takes into account the varying needs and operating environments.

Migrants Are Underrepresented in Mental Health and Rehabilitation Services-Survey and Register-Based Findings of Russian, Somali, and Kurdish Origin Adults in Finland

Mounting evidence suggests that migration background increases the risk of mental ill health, but that problems exist in accessing healthcare services in people of migrant origin. The present study uses a combination of register- and survey-based data to examine mental health-related health service use in three migrant origin populations as well as the correspondence between the need and use of services. The data are from the Finnish Migrant Health and Wellbeing Study (Maamu), a comprehensive cross-sectional interview and a health examination survey. A random sample consisted of 5909 working-aged adults of Russian, Somali, and Kurdish origin of which 3000 were invited to participate in the survey and the rest were drawn for a register-based approach. Some of the mental health services, based on registers, were more prevalent in the Kurdish origin group in comparison with the general population and less prevalent in the Russian and Somali origin groups. All the migrant origin groups were underrepresented in rehabilitation services. When affective symptoms were taken into account, all the migrant origin groups were underrepresented in all of the services. This calls for actions to promote mental health, diminish the barriers to access services, and improve the service paths for migrants.

Pre-migration traumatic experiences, post-migration perceived discrimination and substance use among Russian and Kurdish migrants-a population-based study

BACKGROUND AND AIMS

The associations between traumatic events, substance use and perceived discrimination have been rarely studied among migrants in host countries. We examined whether pre-migration potentially traumatic experiences (PTEs) or perceived discrimination (PD) are associated with substance use among migrants with voluntary (Russians) and forced (Kurds) migration backgrounds.

DESIGN

Cross-sectional interview and health examination data from the Finnish Migrant Health and Wellbeing Study were used. The target sample (n = 1000 for each group) was drawn from the national population register using stratified random sampling by participants' country of birth and native language.

SETTING

Population-based data were collected from six cities in Finland during 2010-12.

PARTICIPANTS

The participation rates were 68% (Russians) and 59% (Kurds). The analytical sample size varied (Russians n = 442-687, Kurds n = 459-613), as some participants completed only interview, health examination or short interview. The majority of Kurds had a refugee background (75%) while Russians had mainly migrated for other reasons (99%).

MEASUREMENTS

The three main outcomes were self-reported binge drinking, daily smoking and life-time cannabis use. PTEs and PD were self-reported in the interview. Socio-demographic background, migration-related factors and current affective symptoms were adjusted for.

FINDINGS

Among Kurds, PTEs were associated with binge drinking [adjusted odds ratio (aOR) = 2.65, 95% confidence interval (CI) = 1.30-5.42] and PD was associated with life-time cannabis use (aOR = 3.89, 95% CI = 1.38-10.97) after adjusting for contextual factors. Among Russians, PTEs were associated with life-time cannabis use adjusting for contextual factors (aOR = 2.17, 95% CI = 1.12-4.18).

CONCLUSIONS

In Finland, pre-migration traumatic experiences appear to be associated with life-time cannabis use among the Russian migrant population (voluntary migration) and binge drinking among the Kurdish migrant population (forced migration). Perceived discrimination in Finland appears to be associated with life-time cannabis use among Kurdish migrants.

The health of asylum seekers in Finland: a total population health examination survey (TERTTU)

Background

There is scarcity of representative population-based data on the health and wellbeing of asylum seekers in Europe. The Asylum Seekers Health and Wellbeing Survey (TERTTU) was launched to provide the evidence-base for developing services for asylum seekers as well as for planning and allocation of healthcare resources at a national level.

Methods

A sample of all first-time asylum applicants between 19.2-30.11.2018 was drawn from the Finnish Immigration Services electronic asylum database. Altogether 784 adults aged 18 years and older took part in the standardised health examination and face-to-face interview with participation rate of 79%. Interviewed health measures included the Minimum European Health Module, conditions previously diagnosed by a physician, permanent injury due to violence or accident and somatization.

Results

Self-rated health was good among 66% (95% CI 62,5-69,1) and 42% (95% CI 38,5-45,4) reported having some self-reported long-term illness or health problem. The most common previously diagnosed conditions were diseases of the circulatory system (19%, 95% CI 16,5-22,0), musculoskeletal system (18%, 95% CI 15,6-21,1), mental and behavioural disorders (13%, 95% CI 10,9-15,6) and diseases of the respiratory system (10%, 95% CI 8,0-12,2 ). Nearly half (47%, 95% CI 43,7-50,8) reported having a permanent injury due to violence or accident. Somatisation was common: 23% (95% CI 20,3-26,2) reported having headache, 23% (95% CI 19,9-25,8) back ache and 13% (95% CI 10,8-15,6) other pains at least several times a week.

Conclusions

The overall health of newly-arrived asylum seekers was poorer compared with the general Finnish population and migrant origin populations from similar countries of origin permanently living in Finland. Significant differences in asylum seekers health were found by sex and region of origin. Survey data will be used for developing the national initial health assessment protocol for asylum seekers during 2019.

Key messages

The TERTTU Survey is the largest population-based health examination survey among newly-arrived asylum seekers in Europe to date. The extensive data gathered over the course of the survey will be used for developing services for asylum seekers at a national level and is of high relevance also to other European countries.

The factors affecting response rate in survey on well-being among people with foreign origin

Background

Previous population surveys among people with foreign background (PFB) in Finland have had successful response rates (62%-66%) when using mainly face-to-face interviews. A cross-sectional population survey (FinMONIK) explored more cost-efficient ways to collect the data on PFB.

Methods

The data collection was conducted in Finland between May 2018 and January 2019. The random sample consisted of 12 877 (after removing over-coverage) 18-64-year-olds stratified by region. First, a letter containing a link to the online survey with 18 different language options was sent to the participants. After two reminders, the questionnaire was sent twice on paper to the non-respondents. Finally, supplementary phone interviews were carried out by multi-lingual interviewers. All the participants were able to enter in a draw to win gift cards.

Results

The response rate (RR) for the online survey was 34%. RR was highest for those who had lived in Finland 5 years or less (43%) and lowest among the divorced (23%) and Estonians (27%). The paper questionnaire was mostly preferred by older age groups, increasing the RR of 40-64 year-olds from 31% to 48%. Telephone interviews increased the RR by five percent points, thus making the final RR for the survey 53%. Persons born in the EU and North-America responded the most frequently (58%) whereas RR was lowest amongst the Sub-Saharan African origin migrants (47%). RR was particularly low (42%) for those who had moved to Finland at ages 0-6.

Conclusions

In surveys conducted amongst PFB, relatively good response rates can be obtained by using alternate methods for gathering data instead of costly and time-consuming face-to-face interview. Age and marital status seemed to affect the preference of survey format. The overall RR varied by country of origin.

Key messages

A good response rate can be obtained without face-to-face interviews in migrant population surveys. Migrant population surveys can be conducted more efficiently by combining a variety of methods.

Health of asylum seeker children in Finland: a total population health examination survey (TERTTU)

Background

There is scarcity of representative population-based data on the health and wellbeing of asylum seekers in Europe, especially children and adolescents. The Asylum Seekers Health and Wellbeing Survey (TERTTU) was launched to inform evidence-based policy-making and development of services.

Methods

A sample of all first-time asylum applicants was drawn from the Finnish Immigration Services electronic asylum database. Data on 303 children aged 0-17 years was gathered with a standardised health examination (including a dental assessment for 7-17 year-olds) and face-to-face-interview including the Minimum European Health Module and somatic and behavioural symptoms over the past 30 days. Guardians of 0-12 year-olds were interviewed, 13-17 year-olds responded themselves. Participation rate was 72%.

Results

62% (95% CI 49,4-73,0) of 13-17 year-olds have had their growth and development monitored compared with 91% (95% CI 83,6-95,6) of 7-12 year-old and 86% (95% CI 79,4-91,0) of 0-6 year-olds. Long-standing health problems were more common among 13-17 year-olds (28%, 95% CI 18,2-39,7) and 7-12 year-olds (25%, 95% CI 16,8-34,2) compared 0-6 year-olds (13%, 95% CI 8,2-19,5). Sleep disturbances were more common among 13-17 year-olds (35%, 95% CI 24,2-47,4) and 7-12 year-olds (28%, 95% CI 19,6-37,5) than 2-6 year-olds (18%, 95% CI 11,3-26,7). Approximately fifth of children aged 7-17 years and slightly more than tenth of younger children had fears and anxieties. Signs of dental caries were found in 46% (95% CI 35,4-55,9) of 7-12 year-olds and in 23% (95% CI 14,1-35,1) of 13-17 year-olds.

Conclusions

Timely and accurate assessment of healthcare needs is crucial to support and improve the health and wellbeing of children and adolescents. Survey data will be used for developing the national initial health assessment protocol for asylum seeking children and adolescents.

Key messages

The TERTTU Survey is the largest population-based health examination survey among newly-arrived asylum seeking adults, adolescents and children in Europe, allowing for examining family units. Health information on asylum seeking children and adolescents in Finland, is relevant for service development, also for other European countries.

Access to health care among people with foreign background and the general population in Finland

Background

Prior studies suggest that people with foreign background (PFB) often face problems in access to health care, although access to care may vary between the different PFB groups. This study explores 1) the potential differences in perceived access to care between different PFB groups and the general population, and 2) if marital status, education, employment, self-perceived health, long-term illness, length of stay, age moved to Finland or language skills are associated with access to care among PFB.

Methods

The data were gathered from the cross-sectional survey on well-being among the PFB (FinMONIK), conducted in Finland 2018. Its random sample consisted of 12 877 persons, aged 18-64 years and the response rate was 53%. Three items were used to assess perceived access to care: I was able to contact the place of care smoothly, I was able to make an appointment without undue delay and I was examined without undue delay (e.g. laboratory tests, X-ray, ultrasound). Logistic regression was used to test which factors were associated with accesses to care, adjusted for age, sex and region.

Results

After controlling for age, sex and region, the results showed significant differences in access to care among different migrant groups and the general population (p &lt; 0.001). Of those of Estonian background 37% felt that access to care was smooth while only 17% of those coming from Middle-East, and 26% of the general population. Employed persons, persons who had good self-perceived health, and people with no long-term illness, and those who had lived in Finland less than five years, had better access to health care. Marital status, education, language skills and age moved to Finland, were not associated with access to care.

Conclusions

Large inequities in access to care were identified among people with foreign background. Access to services seems to be better for employed persons and those who have good self-perceived health.

Key messages

Special attention should be given to improve access to care among non-employed migrants. Migrants should not be considered as a uniform group when planning services.

Asylum seekers’ mental health in the Finnish Asylum Seekers Health and Wellbeing Survey (TERTTU)

Background

Asylum seekers have major health and well-being burdens, including mental health. However, there is a lack of population-based survey data on the health status and service needs of asylum seekers in Europe. The TERTTU-project was launched to fill these information gaps and to develop the current health examination protocol for assessing the health, well-being and need for health care services, including mental health, of newly arrived asylum seekers.

Methods

As part of the TERTTU-project, systematic, nationally representative data was collected in 2018 by conducting a health examination and a face-to-face interview survey in reception centers in Finland (n = 1087). The sample was drawn from the Finnish Immigration Services electronic asylum database. Mental health was assessed with the HSCL and PROTECT questionnaires (SDQ among the children), along with questions of potentially traumatic experiences.

Results

39% (95% CI 35,6-42,6) of the adults had current severe depressive and anxiety symptoms, 50% (95% CI 46,9-53,9) had an increased risk for PTSD, and 83% (95% CI 80,0-85,3) had experienced at least one potentially traumatic event before arriving to Finland. The most common psychosocial symptoms among 2-6 year-olds were behavioral symptoms (49%) and difficulties in peer relationships (37%). Difficulties in peer relationships were also common among 7-17 year-olds (49%), followed by challenges in the emotional domain (42%).

Conclusions

Potentially traumatic experiences and mental health problems are common among asylum seekers in Finland. Based on the survey-data, a national health examination protocol will be developed in 2019 to improve assessment and identification and to enable systematic health monitoring and evidence-based development of services for asylum seekers. A common health examination protocol will also unify practices across reception centers all over the country.

Key messages

Potentially traumatic experiences and mental health problems are common among asylum seekers in Finland. A national health examination protocol allows for the early identification of vulnerable groups and individuals.

Sense of belonging and its association with health among people of foreign background in Finland

Background

Sense of belonging is recognized as an important determinant of health. There is little research on the association between sense of belonging and health of people of foreign background (PFB) in Finland. In this study we examined: 1) to which extent PFB feel they belong to the Finnish society and citizens of their country of origin (CCO) and 2) if sense of belonging is associated with self-perceived health.

Methods

Data from a cross-sectional survey FinMONIK conducted in Finland 2018 was used. The random sample consisted of PFB (N = 12 877, response rate 53%). Identity was assessed by using the question “Which of the following areas or groups you feel you belong to?” with response options “My local municipality”, “Finns”, “the citizens of my country of birth or origin”. Based on this, we constructed a variable to group respondents belonging 1) only to the Finnish society, 2) only to CCO and 3) to both Finnish society and CCO (bicultural identity). Self-perceived health was measured by using a 5-point-scale and merging good and fairly good as a good perceived health factor. Logistic regression was used to test the association between perceived health and sense of belonging, adjusted for age, sex and country of origin.

Results

Majority of the respondents (39%) reported a bicultural identity, whereas 21% felt they belonged only to the Finnish society and 23% only to CCO. Self-perceived health was significantly associated with sense of belonging (p &lt; 0.001). Good perceived health was more common among those with bicultural identity (73%) than among those who felt belonging only to the Finnish society (66%) and CCO (63%).

Conclusions

Bicultural identity was most common and also associated with better perceived health.

Key messages

Sense of belonging to both host country citizens and CCO is likely to benefit individual’s health. Identifying with host country citizens and maintaining sense of self as a member of CCO should be supported.

The association between discrimination and health: findings on Russian, Somali and Kurdish origin populations in Finland

Background

The Second European Union Minorities and Discrimination Survey recently demonstrated widespread discrimination across EU countries, with high discrimination rates observed in countries like Finland. Discrimination is known to negatively impact health, but fewer studies have examined how different types of perceived discrimination are related to health.

Methods

This study examines (i) the prevalence of different types of perceived discrimination among Russian, Somali and Kurdish origin populations in Finland, and (ii) the association between different types of perceived discrimination (no experiences; subtle discrimination only; overt or subtle and overt discrimination) and health (self-rated health; limiting long-term illness (LLTI) or disability; mental health symptoms). Data are from the Finnish Migrant Health and Wellbeing Study (n = 1795). Subtle discrimination implies reporting being treated with less courtesy and/or treated with less respect than others, and overt discrimination being called names or insulted and/or threatened or harassed. The prevalence of discrimination and the associations between discrimination and health were calculated with predicted margins and logistic regression.

Results

Experiences of subtle discrimination were more common than overt discrimination in all the studied groups. Subtle discrimination was reported by 29% of Somali origin persons and 35% Russian and Kurdish origin persons. The prevalence of overt discrimination ranged between 22% and 24%. Experiences of discrimination increased the odds for poor self-reported health, LLTI and mental health symptoms, particularly among those reporting subtle discrimination only.

Conclusions

To promote the health of diverse populations, actions against racism and discrimination are highly needed, including initiatives that promote shared belonging.

Advance directives in European long-term care facilities: a cross-sectional survey

BACKGROUND

End-of-life care practices in long-term care facilities (LTCFs) are the focus of growing attention in Europe, due to rapidly increasing number of older persons living in LTCFs. The knowledge about end-of-life discussions or existence of written advance directives in the European LTCFs is scarce. This study's aim is to investigate the prevalence of written advance directives and their sociodemographic associates, among recently deceased LTCF residents, in six European countries.

METHODS

Data from the European Union-funded PACE database were collected from 322 LTCFs in six European countries in 2014. The assessments were performed by using two questionnaires designed for LTCF administrative staff and for staff member.LTCFs were selected within each country by using proportional stratified random sampling procedure. Facilities with certain types and sizes were included from each country.Multilevel multivariate analyses were performed to evaluate associations between written advance directives and selected predictors.

RESULTS

In total, 32.5 % of the 1384 deceased LTCF residents had a written advance directive with a range from 0% to 77 % between countries. The proportion of the most common advance directive, 'Do not resuscitate in case of cardiac or respiratory arrest (DNR)', varied correspondingly from 0% to 75%.LTCF type (OR 2.86 95% CI 1.59 to 5.23) and capability of expressing at the time of admission (OR 3.26 95% CI 2.26 to 4.71) were the independent predictors for advance directive. Residents living in LTCFs where physician was available were less likely to have advance directive compared with residents from LTCFs where physician was not available.

CONCLUSION

Extensive differences for prevalence of written advance directive exist between countries among older LTCF residents in Europe. Timely and appropriate response to LTCF resident's health needs and preferences efforts advance care planning.

The association between anthropometric measures and glycated haemoglobin (HbA1c) is different in Russian, Somali and Kurdish origin migrants compared with the general population in Finland: a cross-sectional population-based study

BACKGROUND

Persons of African and Middle-Eastern origin living in European countries have a high prevalence of type 2 diabetes, accompanied by high prevalence of obesity among women but not always among men. The aim of this study was to examine whether there are differences in the association between anthropometric measures and glucose levels measured with glycated haemoglobin and fasting blood glucose among persons of migrant origin in Finland.

METHODS

Cross-sectional population-based data of the 30-64 year-old participants in the health examination of the Migrant Health and Wellbeing Study was used, selecting persons without diabetes (Russian origin n = 293, Somali origin n = 184, Kurdish origin n = 275). The reference group were non-diabetic participants in the Health 2011 Survey (n = 653), representative of the general Finnish population. Anthropometric measures included body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR) and waist-to-hip ratio (WHR, available for Maamu Study participants only).

RESULTS

Depending on whether continuous or categorical anthropometric measures were used, age, sex and anthropometrics explained 13-18% of variation in HbA1c among persons of Russian origin, 5-10% among persons of Somali origin, 1-3% among persons of Kurdish origin and 11-13% among the general population. Also depending on whether continuous or categorical anthropometric measures were used, age, sex and anthropometrics explained 13-19% of variation in fasting blood glucose among persons of Russian origin, 15-20% among persons of Somali origin, 13-17% among persons of Kurdish origin and 16-17% among the general population. With exception for BMI, strength of the association between continuous anthropometric measures and HbA1c was significantly lower among persons of Kurdish origin compared with the general Finnish population (p = 0.044 for WC and p = 0.040 for WHtR).

CONCLUSIONS

A low degree of association between anthropometric measures and HbA1c was observed among persons of Kurdish origin. Findings of this study suggest caution is warranted when using HbA1c as a screening tool for glucose impairment among persons without diabetes in populations of diverse origin.

Asylum seekers health and wellbeing (TERTTU) survey: study protocol for a prospective total population health examination survey on the health and service needs of newly arrived asylum seekers in Finland

INTRODUCTION

Health, well-being and health service needs of asylum seekers have emerged as urgent topics following the arrival of 2.5 million asylum seekers to the European Union (EU) between 2015 and 2016. However, representative information on the health, well-being and service needs of asylum seekers is scarce. The Asylum Seekers Health and Wellbeing (TERTTU) Survey aims to: (1) gather population-based representative information; (2) identify key indicators for systematic monitoring; (3) produce the evidence base for development of systematic screening of asylum seekers' health, well-being and health service needs.

METHODS AND ANALYSIS

TERTTU Survey is a population-based prospective study with a total population sample of newly arrived asylum seekers to Finland, including adults and children. Baseline data collection is carried out in reception centres in 2018 and consists of a face-to-face interview, self-administered questionnaire and a health examination following a standardised protocol. Altogether 1000 asylum seekers will be included into the study. Baseline data will be followed up with national electronic health record data encompassing the entire asylum process and later with national register data among persons who receive residency permits.

ETHICS AND DISSEMINATION

Ethical approval has been granted by the Coordinating Ethics Committee of the Helsinki and Uusimaa Hospital District. Participation is voluntary and based on written informed consent. Results will be widely disseminated on a national and international level to inform health and welfare policy as well as development of services for asylum seekers. Results of the study will constitute the evidence base for development and implementation of the initial health assessment for asylum seekers on a national level.

Births and induced abortions among women of Russian, Somali and Kurdish origin, and the general population in Finland -comparison of self-reported and register data

Background

Since reproductive health is often considered a highly sensitive topic, underreporting in surveys and under coverage of register data occurs frequently. This may lead to inaccurate information about the reproductive health. This study compares the proportion of women having births and induced abortions among migrant women of Russian, Somali and Kurdish origin in Finland to women in the general Finnish population and examines the agreement between survey- and register-based data.

Methods

The survey data from the Migrant Health and Wellbeing Study conducted in 2010–2012 and data from the Health 2011 Survey with corresponding information on women in the general population were used in this study. The respondents were women aged 18–64: 341 Russian, 176 Somali and 228 Kurdish origin women and 630 women in the general population. The survey data were linked to the Finnish Medical Birth Register and the Register of Induced Abortions.

Results

In the combined (survey and register) data, migrant groups aged 30–64 had a higher proportion (89–96%) compared to the general population (69%) of women with at least one birth. Under-coverage of registered births was observed in all study groups. Among women aged 18–64, 36% of the Russian group and 24% of the Kurdish group reported more births in the survey than in the register data. In the combined data, the proportions of Russian origin (69%) and Kurdish origin (38%) women who have had at least one induced abortion in their lifetime are higher than in the general population (21%). Under-reporting of induced abortions in survey was observed among Somali origin women aged 18–29 (1% vs. 18%). The level of agreement between survey and register data was the lowest for induced abortions among the Somali and Russian groups (− 0.01 and 0.27).

Conclusion

Both survey- and register-based information are needed in studies on reproductive health, especially when comparing women with foreign origin with women in the general population. Culturally sensitive survey protocols need to be developed to reduce reporting bias.

Which anthropometric measures best indicate type 2 diabetes among Russian, Somali and Kurdish origin migrants in Finland? A cross-sectional study

OBJECTIVES

To compare the performance of body mass index (BMI), waist-to-height ratio (WHtR), waist circumference (WC) and waist-to-hip ratio (WHR) in detecting type 2 diabetes among Russian, Somali and Kurdish (born in Iraq/Iran) origin migrants and Finns.

DESIGN AND PARTICIPANTS

Cross-sectional study comparing health examination survey data of Russian, Somali and Kurdish origin migrants (n=917) aged 30-64 years who took part in the Migrant Health and Wellbeing Survey with the general Finnish population in the Health 2011 Survey (n=887). Participants were randomly selected from the National Population Register.

SETTING

Six cities in Finland, where a substantial majority of migrants live.

OUTCOME MEASURES

Anthropometric measures included objectively measured BMI, WHtR, WC and WHR. Type 2 diabetes was defined based on self-report, laboratory measures of glycated haemoglobin and register data. Test performance was assessed using receiver operating characteristics curves, using area under the curve (AUC) as a measure of accuracy.

RESULTS

Among Finns, test performance was highest for WC (AUC=0.81, 95% CI 0.74 to 0.87) and WHtR (AUC=0.81, 95% CI 0.75 to 0.87). Test performance was similar for BMI (AUC=0.80, 95% CI 0.67 to 0.92), WC (AUC=0.79, 95% CI 0.67 to 0.91) and WHtR (AUC=0.70, 95% CI 0.66 to 0.93) among Russians. WC and WHtR had highest test performance also among Somali (AUC=0.74, 95% CI 0.64 to 0.84 for WC and AUC=0.75, 95% CI 0.65 to 0.85 for WHtR) and Kurds (AUC=0.71, 95% CI 0.61 to 0.81 for WC and AUC=0.70, 95% CI 0.59 to 0.80 for WHtR).Among migrants, WHR had the poorest test performance.

CONCLUSION

WC and WHtR performed overall the best across all study groups, however, accuracy of detection was lower particularly among Somali and Kurds. Currently used diabetes risk assessment tools assume a strong association between anthropometrics and diabetes. These tools need to be validated among non-Western populations.

Epidemiology of HIV in Estonia

The aim of this study was to report on the epidemiology of HIV infection in Estonia and to molecularly characterize Estonian HIV-1 variants. Epidemiological data were obtained from the Estonian National HIV/AIDS Database. In 1995-1996 blood samples were collected from 54 of the 65 HIV-infected individuals that had been diagnosed at that time. The V3 domain of the env gene was directly sequenced from peripheral blood mononuclear cells of 49 of these 54 individuals and the sequences used for phylogenetic analyses. At the end of 1999 Estonia reported 96 diagnosed HIV cases; 46 (48%) were homosexual or bisexual men and 31 (32%) were presumed to have been infected heterosexually. Importantly, only four individuals were likely to have become infected through intravenous drug use. Forty-three individuals (45%) were presumed to have been infected outside of Estonia, whereas 38 (40%) were likely to have become infected in Estonia. As expected, a majority of the investigated individuals (80%) were found to carry subtype B virus. Infections with subtypes A, C, D, G, and CRF02_AG were also documented. The dominance of subtype B was restricted to homosexual and bisexual men. Thus, subtype B infections were documented in 33 of 34 (97%) homosexual and bisexual men, but only 6 of 15 (40%) individuals with other probable routes of infection. Thirty of the 39 subtype B sequences were joined in a tight sequence cluster that also included sequences from neighboring Russia and Lithuania. This pattern suggests a local spread of HIV-1 among homosexual and bisexual men within the region. The results from the phylogenetic analyses agreed well with other epidemiological information. In conclusion, Estonia remains a country with a low prevalence of HIV infection. A majority of the identified cases are homosexual or bisexual men, whereas HIV infection among intravenous drug users is rare. A large proportion of the homosexual and bisexual men carried closely related subtype B variants. The sequences have been deposited in GenBank under accession numbers AF286538-AF286586.

An HIV type 1 subtype A outbreak among injecting drug users in Latvia

Local, explosive outbreaks of HIV-1 infections among intravenous drug users (IDUs) caused by closely related variants have been reported in the Ukraine and Russia since 1996. Latvia experienced the start of a similar outbreak at the end of 1997 and already at the end of 1998 IDUs constituted approximately 50% of all known HIV cases (122 of 251). To investigate the molecular epidemiology of HIV-1 variants circulating among Latvian IDUs the V3 domain of the env gene was directly sequenced from samples of seven recently infected IDUs. Phylogenetic tree analysis showed that the seven Latvian HIV-1 variants had closely related subtype A genotypes that shared recent ancestry with each other as well as with variants involved in outbreaks in the Ukraine and southern Russia. There exists a clear risk for continued spread of HIV-1 in Latvia because the number of IDUs is increasing and needle sharing is common.

Assay of plasma samples representing different HIV-1 genetic subtypes: an evaluation of new versions of the amplicor HIV-1 monitor assay

Quantification of plasma HIV-1 RNA levels has rapidly become the main tool for monitoring disease progression and treatment. However, some first-generation assays do not accurately quantify all HIV-1 subtypes. This study compares the first-generation and two newer prototype Amplicor HIV-1 Monitor assays (Roche Diagnostic Systems) in terms of their performance in quantifying HIV-1 RNA in stored plasma samples from 101 individuals infected with various genetic subtypes of HIV-1 (28 subtype A, 18 B, 26 C, 20 D, 2 E, 3 G, 2 H, and 2 J). The HIV-1 subtype had previously been determined by direct sequencing of the V3 domain of the env gene. The results from the three assays agreed for subtypes B and C, as well as for most subtype D samples. In contrast, the first-generation assay reported significantly lower plasma HIV-1 RNA levels than did the two newer versions of the assay for most subtype A, E, G, and H samples. There were no differences in mean plasma HIV-1 RNA levels between individuals infected with subtypes A, B, C, and D if the results from the two newer test versions were used, and if an adjustment was made between subtypes for differences in CD4 count. Thus, this study confirms that the first-generation assay does not accurately quantify HIV-1 RNA levels in many individuals infected with subtype A, E, G, and H. These problems appeared to have been greatly reduced in the two new prototype versions.

Reevaluation of the relaxed calcaneal stance position. Reliability and normal values in children and adults

Reliability and normal values for the relaxed calcaneal stance position were determined in a nonclinic population of healthy adults and children (88 adults and 124 children) ranging in age from 5 to 36 years. The mean relaxed calcaneal stance position for adults was 6.07 degrees valgus (SD 2.71 degrees) (range, 1 degree varus to 14 degrees valgus). The mean relaxed calcaneal stance position for children was 5.6 degrees valgus (SD 2.9 degrees) (range, 6 degrees varus to 12 degrees valgus). There was no significant difference between the relaxed calcaneal stance positions of adults and children. In children the relaxed calcaneal stance position did not correlate with age, height, or weight and did not decrease with age to the theoretical normal value of 0 degree +/- 2 degrees as postulated by Root et al. The relaxed calcaneal stance position was found to be a reliable measurement; however, the theoretical normal value of 0 degree +/- 2 degrees was not found. The values reported in the present study correspond with the results of other empirical studies; thus the theoretical normal value for the relaxed calcaneal stance position of 0 degree +/- 2 degrees may be invalid.

Infectious causes of heel pain

Heel pain is often attributed to a biomechanical etiology or sports-related injury. However, failure to recognize an infectious cause can lead to a delay in proper treatment and result in severe patient disability. This article reviews some of the more common infectious etiologies of heel pain.